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

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.

Data extraction

The authors do not state how the data were extracted for the review, or how many of the reviewers performed the data extraction.

The following information was extracted from the studies: reference details, study design, populations, intervention, outcomes, results, and additional comments on the findings of the trials.

Methods of synthesis

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.

CRD commentary

This appeared to be a review of moderate quality. Some inclusion and exclusion criteria were reported. The literature search appeared to be fairly comprehensive, although the years searched and the specific search terms used were not reported. No attempt was made to locate unpublished studies and publication bias cannot, therefore, be ruled out.

Very little details were given on the methodology of the review process, such as how many of the reviewers were involved in selecting the studies or in extracting the data. Relevant details of the primary studies were presented in tabular format and as a narrative summary, although the total number of participants included in each study was not given. The overall quality of the included studies was summarised. However, an a priori list of the criteria used to assess the validity was not presented, and it was not stated how many reviewers were involved in this process.

The heterogeneity between the included studies was discussed, and a narrative summary of the results was appropriate. However, the findings of some of the included studies were reported to have been significant in the text, but were not statistically significant according to the confidence intervals presented in the tables.

The authors' conclusions appear to follow from the results.

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

AccessionNumber

12000001113

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.