Effectiveness of measures to prevent needlestick injuries among ...

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4 Intervention program evaluation 4.3 Summary We obtained 278 unique papers for individual, preliminary review to identify evaluation 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 needles, 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
4 Intervention program evaluation aspect of prevention. Combination programs are not designed to allow for inferences about effectiveness of individual program components, however, and so cannot be used to determine which element of a given program was (most) effective at reducing NSI. Table 12 (see page 98) summarizes the results reported in the best quality intervention evaluations. The relative improvements in NSI rates varied considerably by type of intervention, though differences in study units (denominators) preclude direct compare- sons across intervention types. In three trials, replacing hollow-bore needles with safety-engineered devices resulted in approximately a two-fold improvement in NSI rates [33 to 35; 47]. The introduction of needleless IV systems showed no statistical significant difference between intervention and control group in one trial [33], but was very effective in another [47]. In single studies, the use of blunt suture needles reduced surgical glove perforations from 50 % to 7 % [60] and the Suture Mate reduced glove perforations from 27 % to 8 % [72]. An intervention consisting of moving needle disposal boxes closer to the work area successfully decreased needle recapping from 30 % to 26 % in one evaluation [76], while training staff in universal precautions reduced the NSI rate at one facility from 13/100 FTE to 8/100 FTE [89]. Report „Needlestick injuries“ 57
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Effectiveness of measures to preven
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Authors: Sandra I. Sulsky, Thomas B
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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 53 and 54: 4 Intervention program evaluation b
Page 55 and 56: 4 Intervention program evaluation 4
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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
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Annex 2: QBCR review form Character
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Annex 2: QBCR review form DISCUSSIO
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Annex 3: Definitions/guidelines for
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Annex 3: Definitions/guidelines for
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Annex 4: Working group Needlestick
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