Effectiveness of measures to prevent needlestick injuries among ...

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4 Intervention program evaluation mented educational program. It was not possible, therefore, to conclude that changes in reported injury rates were the result of box relocation, increased safety awareness or changes in knowledge resulting from the educational program, or uncontrolled con- founding. Edmond et al. placed observers to record needle recapping by nurses before and after relocation of needle disposal boxes [73]. The observed rates of recapping both before and after relocation of the boxes held steady at higher than 90 %, suggesting either that this was a uniquely non-compliant population or that the presence of the observers affected the nurses’ behavior more than placement of the disposal boxes. � Rigid disposal containers The pre-post intervention comparison was also used by all four of the studies within this subgroup assessing the effectiveness of transitioning from cardboard disposal boxes to impermeable plastic boxes [43; 77 to 79]. None of these evaluations adequately addressed the concern about concurrent changes in practice, policy or back- ground risks (e. g. due to changes in staffing levels). All relied on self-reported injuries, potentially introducing bias if reporting practices changed during the observation period independent of the change to rigid disposal containers. D’Arco et al. rated poor, implemented several interventions at the same time, including safety training and improvements to injury reporting systems, in addition to the transition to rigid disposal containers [43]. Though a decrease in the needle stick injury rate was observed, it was not possible to conclude that the decrease was attrib- utable to the new disposal boxes. Smith et al. judged to be of intermediate quality, reported no change in injury rates following introduction a plastic sharps disposal box [79]. However, they did note that the number of needle containing devices used increased 13.5 % over the observation period. Therefore, a constant incidence of needle stick injuries may actually be indica- tive of a decreased risk, since exposure had increased. The analyses presented by the authors were inadequate to reach a firm conclusion, however. Ribner et al. and Krasinski et al. both of intermediate quality, provided slightly more evidence of the potential protective effect of rigid containers as compared to card- Report „Needlestick injuries“ 50
4 Intervention program evaluation board containers [77; 78]. In both programs, concurrently initiated educational programs complicate the interpretation of results. Ribner et al. reported a reduction in disposal-related needle stick injuries from 0.9 per FTE to 0.3 per FTE over the observation period [78], and Krasinksi et al. reported reductions in disposal-related injuries from 1.3 to 0.3 per month [77]. The rates of other needle stick injuries (e. g. occurring during procedures, due to recapping, or carrying sharps) remained the same or increased. The decrease in disposal-related injuries in either of these studies could be due to changes in needle disposal practices, such as avoidance of overfilling disposal units, more frequent emptying of units, or greater caution while disposing of sharps, or to changes in reporting practices following from the educational programs. � Other design features Three interventions focused on changes in box design, including open top, letterbox style units, units with hinged lids and units with clear tops [80 to 82]. The letterbox style disposal unit has a counterbalanced lid that allows sharps to enter but is other- wise closed. All employed weak methods, and were considered to be of intermediate quality. Hatcher compared NSI rates with the use of a straight drop disposal box vs. use of a letter drop box [81]. During a 24-month baseline observation period with a straight drop container, 2.83 injuries/month were reported. During the 14-month period following introduction of the letterbox style unit, 1.17 NSI/month were reported. After adjusting for number of people at risk, the author noted a statistically significant change from 0.36 % of employees reporting injuries with old box to 0.13 % reporting injuries with the new box (p = 0.002). The main strengths of this evaluation were the inclusion of a pre-testing period to acquaint employees with the new equipment, and the adjustment for changes in the size of the population at risk. However, no other potential confounders or biases were considered, and the author failed to adequately describe or consider the impact of concurrent safety training. In addition, the outcome was poorly defined in this report. In another study, Sellick et al. described three separate time periods [82]. Data were collected over a nine-month interval prior to the implementation of any interventions to Report „Needlestick injuries“ 51
Page 1: Effectiveness of measures to preven
Page 4 and 5: Authors: Sandra I. Sulsky, Thomas B
Page 6 and 7: Wirksamkeit und Wirtschaftlichkeit
Page 8 and 9: Eficacia y rentabilidad de medidas
Page 10 and 11: 5 Cost effectiveness ..............
Page 13 and 14: Preface Preface It has long been re
Page 15 and 16: 1 Introduction 1 Introduction Altho
Page 17 and 18: 1 Introduction scientific laborator
Page 19: 1 Introduction To complete each of
Page 23 and 24: 3 Descriptive epidemiology of NSI 3
Page 25 and 26: 3 Descriptive epidemiology of NSI a
Page 27 and 28: 3 Descriptive epidemiology of NSI c
Page 29 and 30: 3 Descriptive epidemiology of NSI s
Page 31 and 32: 3 Descriptive epidemiology of NSI h
Page 33 and 34: 4 Intervention program evaluation 4
Page 35 and 36: 4 Intervention program evaluation u
Page 37 and 38: 4 Intervention program evaluation d
Page 39 and 40: 4 Intervention program evaluation (
Page 41 and 42: 4 Intervention program evaluation c
Page 43 and 44: 4 Intervention program evaluation t
Page 45 and 46: 4 Intervention program evaluation a
Page 47 and 48: 4 Intervention program evaluation d
Page 49 and 50: 4 Intervention program evaluation t
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Page 55 and 56: 4 Intervention program evaluation 4
Page 57 and 58: 4 Intervention program evaluation C
Page 59: 4 Intervention program evaluation a
Page 62 and 63: 5 Cost effectiveness Both costs and
Page 64 and 65: 5 Cost effectiveness 21 % by using
Page 66 and 67: 5 Cost effectiveness the high HBV v
Page 68 and 69: 5 Cost effectiveness After the impl
Page 70 and 71: 5 Cost effectiveness estimating cos
Page 73 and 74: 6 Discussion 6 Discussion This repo
Page 75: 7 Recommendations 7 Recommendations
Page 78 and 79: 8 Bibliography [12] Verordnung übe
Page 80 and 81: 8 Bibliography A retrospective stud
Page 82 and 83: 8 Bibliography [48] Gartner, K.: Im
Page 84 and 85: 8 Bibliography [66] O'Connor, R. E.
Page 86 and 87: 8 Bibliography [86] Thomas, S.; Aga
Page 89 and 90: Tables Table 1: Overview of prevent
Page 91 and 92: Tables Table 3: Distribution of cou
Page 93 and 94: Tables Table 5: Distribution of nee
Page 95 and 96: Tables Table 7: Activity during nee
Page 97 and 98: Tables Table 9: Screening Criteria
Page 99 and 100: Tables Table 11: Quality indicators
Page 101 and 102: Tables Table 13: Examples of estima
Page 103 and 104:
Annex 1: Glossary and abbreviations
Page 105 and 106:
Annex 1: Glossary and abbreviations
Page 107 and 108:
Annex 2: QBCR review form COMPARISO
Page 109 and 110:
Annex 2: QBCR review form Character
Page 111 and 112:
Annex 2: QBCR review form DISCUSSIO
Page 113 and 114:
Annex 3: Definitions/guidelines for
Page 115 and 116:
Annex 3: Definitions/guidelines for
Page 117 and 118:
Annex 4: Working group Needlestick
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