Effectiveness of measures to prevent needlestick injuries among ...

4 Intervention program evaluation
to the quality assessment of the studies included appropriate definition of outcome,
reliability of outcome assessment, and appropriate time intervals.
The best of this subgroup was by Makofsky et al., judged to be of intermediate quality
[76]. Hospital employees within a medical/surgical ward and an intensive care unit
were part of the evaluation. Prior to the intervention, needle disposal boxes within the
medical surgical ward were located in common restrooms; the intensive care unit
already had bedside needle disposal boxes, and thus served as a comparison series.
On the medical-surgical ward, the intervention consisted of relocating needle disposal
boxes to patient bedsides and changing from round to letterbox style. Box type alone
was changed for the intensive care unit, so post-intervention changes could be attrib-
uted to the change in the box type and not relocation. Prior to the intervention, 20
boxes in the medical-surgical ward and seven from the intensive care unit were col-
lected and rates of needle recapping were determined. Six months later, boxes were
again collected and recapping rates determined. The authors observed no differences
in recapping rates in the intensive care unit (change of box type, only), but a statisti-
cally significant decrease from 30.2 % to 26.2 % recapped needles in the medical-sur-
gical ward following the intervention (p = 0.0019). Although the outcome measure
was not a direct measure of injury incidence, it was an objective, valid and reliable
metric, given the study design and objective. A major strength of this evaluation was
the authors’ consideration of the potential effect of changing disposal type in addition
to location.
Two other interventions (described in three papers) evaluated the effect of bedside
placement of disposal boxes and risk of injury; both were rated “poor” quality. The
two Haiduven et al. papers described a program in which needle disposal boxes were
relocated to the area of use [74; 75]. The number of reported needle stick injuries
decreased from 144 in 1986, the year preceding the intervention, to 104 in 1990
(p = 0.003). The number of reported injuries specifically resulting from recapping
decreased from 32 in 1986 to six in 1990 (p = 0.005). The authors’ selection of
reported annual injury incidence failed to account for changes in number of personnel
or number of procedures between intervention periods. No adjusted analyses were
presented in either report, although the second paper describes a concurrently imple-
Report „Needlestick injuries“ 49