Effectiveness of measures to prevent needlestick injuries among ...

4 Intervention program evaluation
4.3 Summary
We obtained 278 unique papers for individual, preliminary review to identify evalua-
tion studies. Several additional articles were added from the bibliographies of key
review papers, and from the updated PubMed search. Sixty-one papers were ultimately
included in this review.
The majority of intervention programs were implemented in the United States, a not
unexpected result bearing in mind the history of the NSI discussion and political devel-
opment.
Overall, the literature regarding interventions to reduce the incidence of NSI among
health care workers may be considered to be of intermediate quality. Each category
of replacement equipment discussed included a small number of reasonably well-
planned and executed evaluations that adequately controlled for potential biases.
The majority of papers reviewed, however, had one or more methodological flaws
that precluded any firm conclusion regarding intervention effectiveness.
Among the fourteen papers describing replacements for traditional hollow-bore nee-
dles, the data generally favored protection against NSI by the new safety-engineered
equipment. The twenty-five papers evaluating replacements for other sharp devices
were less well-done, and showed some inconsistent results. However, especially in the
case of needleless IV systems, where the majority of the studies have been rated of low
quality, these systems seem to be able to reduce NSI to a large extent. Introduction of
assistive devices, new types of or locations for needle disposal boxes and double
gloving protocols appeared to be generally protective against NSI, but the majority of
the programs evaluating these types of interventions were too methodologically flawed
to allow for firm conclusions to be drawn.
The programs that focused on safety training resulted, at least, in improved complete-
ness of NSI reporting. Reductions in NSI could not be definitively linked to training,
however, in part due to inability to control for biases due to study design and in part
due to concurrent introduction of other intervention programs. Some might suggest
that combination programs, especially those incorporating overall safety training with
use of safety equipment, are more effective than interventions that focus on only one
Report „Needlestick injuries“ 56