Which nursing intervention is done to prevent accidental needle stick injuries?

Authors' objectives

To evaluate interventions that reduce or prevent needlestick injuries (NSIs) in health care occupations.

The systematic review was one of many undertaken as part of an occupational injury project coordinated by the Harborview Injury Prevention Research Centre in the US. It included participants from the Injury Control Research Centres, and the Division of Safety Research, Agricultural Safety and Health Centres. Some methodological details of the review were published elsewhere (see Other Publications of Related Interest).

Searching

MEDLINE, EMBASE, CINAHL and Dissertation Abstracts were searched using the Cochrane Collaboration strategy. Further information on the search was described previously (see Other Publications of Related Interest), although this did not include details of the search terms used or the years searched.

Study selection

Study designs of evaluations included in the review

Randomised trials with an appropriate comparison group were included.

Specific interventions included in the review

Any method of intervention that sought to reduce NSIs was eligible for inclusion. The type of interventions evaluated in the included studies were: the use of double gloves; the use of blunt or protected point suture needles for wound closure in selected surgery; the use of safety devices, such as needleless intravenous systems with or without a shield safety syringe and surgical assist device; and a 'no-touch' surgical technique, as opposed to a 'hand-in' surgical technique.

Participants included in the review

The studies had to evaluate a defined population of health care workers. Most of the included studies looked at NSIs among surgeons and their assistants. The other populations evaluated were obstetricians, family physicians, residents in obstetrics, medical students performing postpartum vaginal surgery, and nursing personnel in a 1000-bed hospital.

Outcomes assessed in the review

The primary outcome of interest was the occurrence of percutaneous NSIs. This was measured as the actual number of percutaneous injuries or glove punctures. For inclusion, studies had to evaluate outcomes that were objectively measured and included interpretable data. The type of outcomes reported by included studies were the number of glove perforations, the episodes of hand or inner glove contamination, the number of skin perforations, the number of percutaneous injuries, and the number of NSIs.

How were decisions on the relevance of primary studies made?

The studies were selected for inclusion as described previously (see Other Publications of Related Interest). The abstracts or titles were screened independently by two experts using standardised criteria to identify potentially eligible articles. If an abstract or title met the screening criteria, a full copy of the study was retrieved. A standardised checklist was then used by two independent raters to determine whether the retrieved articles should be included. The authors of the review then made the final decisions on inclusions after they had abstracted the study and judged its methodological quality.

Assessment of study quality

The studies appear to have been assessed for the following criteria: the use of a non-intervention control group; an adequate method of randomisation; the concealment of allocation; the blinding of participants; the use of objective outcome measures; and the method used to evaluate these outcomes. The authors do not state how the papers were assessed for validity, or how many of the reviewers performed the validity assessment.

Methods of synthesis

How were the studies combined?

The studies were combined in a narrative summary.

How were differences between studies investigated?

Differences between the studies were investigated in a narrative. No formal test of heterogeneity was undertaken.

Results of the review

Eleven randomised controlled trials were included (the total number of participants was not reported).

One study did not include a non-intervention control group. In the only 2 studies that evaluated interventions used by nurses or a variety of health care workers, compliance with the protocol could not be directly assessed. The incidence of percutaneous injuries was self-reported in both studies. Direct observations of outcomes were not made in one surgical trial. The participants were not blinded to the assigned treatment since interventions in all the studies involved the use of new devices or new techniques. In studies evaluating needleless devices, allocation was not concealed. In studies where the intervention was used during surgical procedures, allocation was concealed in 5 out of the 9 studies.

The included studies differed in a variety of ways, such as the location of the intervention, the time period of the study, the types of surgeries performed, and the reporting of the number of participants.

When double gloves, or combinations of gloves, were used by surgeons and their assistants (3 studies), there was a decrease in the number of glove or skin perforations found. One study found an increase in glove perforations with surgeons (odds ratio, OR 1.89; 95% confidence interval, CI: 0.81, 4.85), their assistants (OR 1.35, 95% CI: 0.34, 5.44) and scrub nurses (OR 5.66, 95% CI: 1.14, 28.1), but a decrease in hand contamination with surgeons (OR 0.23, 95% CI: 0.05, 1.13). The use of specialised needles during surgical wound closure (3 studies) also decreased the number of glove or skin perforations reported, as did the use of protective devices (3 studies): significant reductions in glove perforations were found when using the needleless intravenous system and the surgical assist device. One study evaluating a 'no-touch' technique, compared with the traditional 'hand-in' method of closure, found a statistically-significant reduction in the number of glove perforations favouring 'no touch' technique.

Authors' conclusions

There have been few randomised controlled trials evaluating the effectiveness of interventions to reduce NSIs in health care occupations. The majority of the studies evaluated interventions during surgical procedures, rather than during patient care on nursing units, probably because the latter is more difficult to observe.

Implications of the review for practice and research

Practice: The authors state that a myriad of approaches are necessary to protect the worker from needlestick exposures, including educational and barrier-type (gloves) interventions. However, it is clear that engineering control research will produce the most effective prevention strategies.

Research: The authors state that more randomised controlled trials are needed to evaluate interventions that can be used in nonsurgical settings, such as hospital units and physicians' offices and clinics. They go on to report that needleless intravenous systems, shield syringes, self-capping needles, and needle covers appear to provide protection against NSIs for phlebotomists, nurses and housekeeping staff, and that these types of interventions require further evaluation.

Bibliographic details

Rogers B, Goodno L. Evaluation of interventions to prevent needlestick injuries in health care occupations. American Journal of Preventive Medicine 2000; 18(4 Supplement): 90-98. [PubMed: 10793285]

Other publications of related interest

Beahler CC, Sundheim JJ, Trapp NI. Information retrieval in systematic reviews: challenges in the public health arena. Am J Prev Med 2000;18 Suppl 4:6-10.

Indexing Status

Subject indexing assigned by NLM

MeSH

Evaluation Studies as Topic; Female; Gloves, Protective; Hand Injuries /epidemiology /prevention & control; Health Personnel; Humans; Incidence; Intervention Studies; Male; Needles /classification; Needlestick Injuries /epidemiology /prevention & control; Occupational Diseases /epidemiology /prevention & control; Protective Devices; Randomized Controlled Trials as Topic; Risk Factors; United States /epidemiology

Database entry date

30/04/2002

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

How would you prevent needle stick injury?

Which of the following nursing actions will assist with preventing needlestick injuries?