Safety engineered injection devices for intramuscular, subcutaneous and intradermal injections in healthcare delivery settings: a systematic review and meta-analysis

Direct Care Nurses' Needlestick Injury Experiences: A Qualitative Descriptive Study

BACKGROUND

Even when education and the use of safety equipment are emphasized, nurses frequently experience needlestick injuries. Understanding the risk situations and coping mechanisms for needlestick injuries experienced by nurses facilitates their prevention.

OBJECTIVES

We aimed to explore and describe the phenomenon of needlestick injuries through the research questions: (1) What causes nurses to suffer from needlestick injuries? (2) How to cope after a needlestick injury? and (3) What are the recommendations for needlestick injury prevention?

METHODS

This qualitative descriptive study involved focus group interviews with 31 direct care nurses in 6 groups who had experienced needlestick injuries while working in different acute care hospitals across 3 regions in South Korea. Data were collected from January 29 to March 29, 2022, and analyzed using thematic analysis.

RESULTS

The average age of the participating nurses was 29.7 years. The following 3 themes were identified: various needlestick injury experiences, post-needlestick injury coping, and expectations regarding needlestick injuries.

CONCLUSIONS

Risk situations and coping mechanisms of nurses who experienced needlestick injuries were diverse. Emergency situations and novice nurses were the causes of most of the needlestick injuries. Often, personal protective equipment was found cumbersome. Reporting needlestick injuries depended on the work environment.

A temperature-responsive intravenous needle that irreversibly softens on insertion

The high stiffness of intravenous needles can cause tissue injury and increase the risk of transmission of blood-borne pathogens through accidental needlesticks. Here we describe the development and performance of an intravenous needle whose stiffness and shape depend on body temperature. The needle is sufficiently stiff for insertion into soft tissue yet becomes irreversibly flexible after insertion, adapting to the shape of the blood vessel and reducing the risk of needlestick injury on removal, as we show in vein phantoms and ex vivo porcine tissue. In mice, the needles had similar fluid-delivery performance and caused substantially less inflammation than commercial devices for intravenous access of similar size. We also show that an intravenous needle integrated with a thin-film temperature sensor can monitor core body temperature in mice and detect fluid leakage in porcine tissue ex vivo. Temperature-responsive intravenous needles may improve patient care.

Prevalence and influence factors of occupational exposure to blood and body fluids in registered Chinese nurses: a national cross-sectional study

Background

Occupational exposure to blood and body fluids poses a threat to medical providers and to nurses especially. This harm is not only physical, but psychology as well and can ultimately impact patient safety. This study aims to understand the prevalence of occupational exposure to blood and body fluids among Chinese registered nurses and explores the factors that influence this exposure.

Methods

A cross-sectional online survey was conducted for 31 province-level divisions in China, using a self-created questionnaire entitled Status Survey on Occupational Exposure in Nurses. Descriptive statistics were used to describe both the demographic characteristics of the respondents and the characteristics of occupational exposure. Categorical variables were presented as frequencies and percentage, and the relationship between possible influential factors and the occurrence of occupational exposure was determined using binary logistic regression.

Results

Out of a total of 20,791 nurses analyzed, over half (52.1%) of them had experienced occupational exposure to blood or body fluids, but over 1/3 (34.6%) of them did not ever report their exposures to a supervisor/official. The top three causes of under-reporting were: the source patient failed to test positive for infectious pathogens (43.6%), perception of a burdensome reporting process (24.6%), and indifferent attitude towards being infected (16.9%). Nurses who worked over 8 hours per day had higher risks of exposure (OR 1.199, 95% CI 1.130 to 1.272, P < 0.001, respectively). The occupational exposure risk from providing 1–2 types of PPE is 1.947 times that of providing 9–10 types of PPE (OR 1.947, 95% CI 1.740 to 2.178, P < 0.001). Likewise, the occupational exposure risk of providing 1–2 types of safety-engineered injection devices is 1.275 times of that of providing 5–6 types (OR 1.275, 95% CI 1.179 to 1.379, P < 0.001).

Conclusions

Occupational exposure to blood and body fluids in registered nurses is common, but the rate of under-reporting such exposure is high. Implementing engineered “sharp” injury prevention devices, following exposure prevention procedures, giving sufficient education and training to healthcare personnel on exposure prevention and control, and developing exposure reporting policies are all steps that can both reduce exposure and increase its reporting.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-01090-y.

Clinical Application of a Safe Blood Sampling Device with an Indwelling Needle

Background

The traditional indwelling needle catheter is hard and can only complete one puncture at a time. The safety and indwelling needle catheter is soft, with a large lumen, with high success rate of blood collection, and one puncture completes two operations, so it is of important value and significance to study the new safety and indwelling needle. To explore the clinical utility of a novel blood collection device with indwelling needle for blood collection among pediatric patients.

Methods

A total of 300 children who were admitted to the children's hospital from March to June 2020 were selected and randomly divided into the control group (148) and the observation group (152). The control group received venipuncture using regular needles for infusion and blood collection. For the observation group, a modified indwelling needle device was used for the procedures. Comparisons were made between the two devices in five aspects: blood sample quality, operation time, needlestick incidence, related complications, and patient satisfaction.

Results

There was no significant difference in coagulation rate between the two groups, but slightly lower overall hemolysis incidence in the observation group. The unqualified rate of blood specimens collected in the observation group was 10.0% lower than that in the control group (P < 0.05). Shorter operation time, lower incidence of needlestick injuries, and improved satisfaction were observed in the group using the novel blood collection device.

Conclusions

This modified blood collection device is superior to the regular venipuncture needle, in terms of safety, efficiency, and patient satisfaction; thus, it has potential for broad clinical applications for infusion and blood collection.

Causes of Needlestick and Sharps Injuries When Using Devices with and without Safety Features

Safety-engineered devices (SEDs) have been developed to protect healthcare personnel (HCP) from needlestick and sharps injuries (NSIs). The aim of this study was to analyze NSIs associated with SEDs and non-SEDs among HCP in hospitals, medical offices and care facilities. Records from online questionnaires on NSIs were used. Causes of NSIs were compared for SED use and healthcare setting. A sample of 835 files was included. Injuries with SEDs accounted for 35.0% of all NSIs, whereas the proportions were higher in medical offices and lower in care facilities. NSIs in nurses were more often associated with SEDs than NSIs in physicians. NSIs from intravenous needles were associated with SEDs in more than 60% of cases in hospitals and medical offices and in about 30.0% of cases in care facilities. In contrast, suturing was associated with every fourth NSI in hospitals, of which fewer than 10.0% were associated with SEDs. In care facilities, SEDs were involved in 36.1% of NSIs during subcutaneous injections. NSIs during disposal accounted for 29.2% of total NSIs, of which 36.1% were associated with SEDs. Frequent reasons for SED-associated NSIs were technical problems, unexpected patient movement and problems during disposal. Our analysis shows that many NSIs are associated with SEDs. Continuous training is necessary in the handling and disposal of SEDs.

DropSafe safety pen needle helps to prevent accidental needlesticks after injections: results of a simulated clinical study

Background

Most needlestick injuries (NSIs) result from unsafe needle devices. DropSafe safety pen needle (SPN) was designed to help prevent such injuries before, during and after use through a built-in sharps injury prevention feature (SIPF).

Methods

A two-phase study was undertaken. For the pilot study, five non-healthcare users (NHCUs) performed evaluations. For the validation study, 30 evaluators comprising 10 healthcare professionals (HCPs) and 20 NHCUs performed evaluations. The aim of the study was to validate the performance of the SIPF of the SPN and to collect feedback from the evaluators on several aspects of the safety device. Participants performed simulated injections into an orange.

Results

The results show that no device failures were observed, and all manipulations were performed without a needlestick or without contact with the needle after injection. The safety feature of the SPN was activated successfully. It was shown that: the label on the seal was legible; the SPNs were easy to attach to the pen injector; injections were easy to perform; it was clear when safety feature was activated; removing the SPN from the injection pen was easy; and the written instructions were easy to understand.

Conclusion

The performance of the safety feature of SPN was successfully evaluated in terms of the prevention of NSIs. User feedback demonstrate that the device's ease of use, handling and instructions for use ensure safety and effectiveness of the SPN when used as intended.

Economic burden of needlestick injuries among healthcare workers in China

Objective: To estimate the economic burden of needlestick injuries (NSIs) among healthcare workers (HCWs) in China.Design: A model was built to evaluate the economic burden of NSIs.Methods: The cost model was developed from a societal perspective, including both direct and indirect costs, with lifetime horizon. The direct costs were categorized into infection prevention and treatment of infections. The indirect cost included productivity loss of both HCWs and his/her family members due to the blood-borne infections. Sub-group analyses were conducted to estimate the cost per NSI when the source patient (SP) was confirmed with hepatitis B virus/hepatitis C virus/human immunodeficiency virus (HBV/HCV/HIV) infection. One-way and probabilistic sensitivity analyses were conducted for all parameters to examine the robustness of the result.Results: The model projected a total cost of ¥699 for each NSI (direct and indirect cost were ¥553 and ¥146, respectively). The cost per NSI when the SP was confirmed with HBV/HCV/HIV was ¥4,238, ¥18,404, and ¥6,152, respectively. The total economic burden of NSIs among HCWs in China was estimated to be ¥5.8 billion, and about half of the cost was associated with NSIs in nurses, at ¥2.8 billion.Limitations: This study did not incorporate the costs of litigation/psychological, and the prevalence of the infections was based on the general population, so the actual costs per NSI may be underestimated. More real-world studies of treatment cost about HBV/HCV are needed to further supporting this study.Conclusions: The economic burden of NSIs among HCWs in China is substantial. Comprehensive NSI prevention programs, including implementation of safety needles and devices, have high potential for healthcare institutions to achieve downstream cost savings and cost offsets.

Cost-Effectiveness of Therapeutic Use of Safety-Engineered Syringes in Healthcare Facilities in India

BACKGROUND

Globally, 16 billion injections are administered each year of which 95% are for curative care. India contributes 25-30% of the global injection load. Over 63% of these injections are reportedly unsafe or deemed unnecessary.

OBJECTIVES

To assess the incremental cost per quality-adjusted life-year (QALY) gained with the introduction of safety-engineered syringes (SES) as compared to disposable syringes for therapeutic care in India.

METHODS

A decision tree was used to compute the volume of needle-stick injuries (NSIs) and reuse episodes among healthcare professionals and the patient population. Subsequently, three separate Markov models were used to compute lifetime costs and QALYs for individuals infected with hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Three SES were evaluated-reuse prevention syringe (RUP), sharp injury prevention (SIP) syringe, and syringes with features of both RUP and SIP. A lifetime study horizon starting from a base year of 2017 was considered appropriate to cover all costs and consequences comprehensively. A systematic review was undertaken to assess the SES effects in terms of reduction in NSIs and reuse episodes. These were then modelled in terms of reduction in transmission of blood-borne infections, life-years and QALYs gained. Future costs and consequences were discounted at the rate of 3%. Incremental cost per QALY gained was computed to assess the cost-effectiveness. A probabilistic sensitivity analysis was undertaken to account for parameter uncertainties.

RESULTS

The introduction of RUP, SIP and RUP + SIP syringes in India is estimated to incur an incremental cost of Indian National Rupee (INR) 61,028 (US$939), INR 7,768,215 (US$119,511) and INR 196,135 (US$3017) per QALY gained, respectively. A total of 96,296 HBV, 44,082 HCV and 5632 HIV deaths are estimated to be averted due to RUP in 20 years. RUP has an 84% probability to be cost-effective at a threshold of per capita gross domestic product (GDP). The RUP syringe can become cost saving at a unit price of INR 1.9. Similarly, SIP and RUP + SIP syringes can be cost-effective at a unit price of less than INR 1.2 and INR 5.9, respectively.

CONCLUSION

RUP syringes are estimated to be cost-effective in the Indian context. SIP and RUP + SIP syringes are not cost-effective at the current unit prices. Efforts should be made to bring down the price of SES to improve its cost-effectiveness.

Injection practices in 2011-2015: a review using data from the demographic and health surveys (DHS)

Background

Reuse of injection devices to give healthcare injections decreased from 39.8 to 5.5% between 2000 and 2010, but trends since 2011 have not been described. We reviewed results of Demographic and Health Surveys (DHS) to describe injection practices worldwide from 2011 to 2015.

Methods

We searched the DHS Internet site for data published on injection practices conducted in countries from 2011 to 2015, extracted information on frequency (number of healthcare injections per person in the last 12 months) and safety (proportion of syringes and needles taken from a new, unopened package). We compared gender groups and WHO regions in terms of frequency and safety. For countries with data available, we compared injection practices 2004–2010 and 2011–2015.

Results

Since 2011, 40 of 92 countries (43%) that conducted DHS surveys reported on injection practices. On average, the frequency of injection was 1.64 per person per year (from 3.84 in WHO Eastern Mediterranean region to 1.18 in WHO African region). Among those, 96.1% of injections reportedly used new injection devices (from 90.2% in the WHO Eastern Mediterranean region to 98.8% in the WHO Western Pacific region). On average, women received more injections per year (1.85) than men (1.41). Among 16 (40%) countries with data in 2004–2010 and 2011–2015, 69% improved in terms of safety. The annual number of unsafe injections reduced in 81% of countries. In Pakistan, the number of unsafe injections was the highest and did not decrease between 2006 and 2012.

Conclusions

Injection practices have continued to improve in most countries worldwide, although the Eastern Mediterranean region in particular still faces unsafe practices that are not improving. Further efforts are needed to eliminate unsafe injection practices in health care settings, including through the use of reuse-prevention devices. Despite some limitations, DHS is an easily available method to measure progress over time.

Safety-Engineered Syringes: An Intervention to Decrease Hepatitis C Burden in Developing Countries-A Cost-Effectiveness Analysis From Egypt

INTRODUCTION

To assess the cost-effectiveness of introducing the safety-engineered syringe (SES) to decrease hepatitis C burden resultant from unsafe injection practices in healthcare settings.

METHODS

A Markov process model for a hypothetical study cohort was developed over a 30-year time horizon to compare the adoption of SES use with the current strategy, conventional syringes (CS), in the Egyptian healthcare settings. The national treatment program was applied in both groups. Health benefits and total direct medical costs were estimated in both strategies.

RESULTS

The SES use demonstrated a reduction in the burden of injection-associated HCV infection because of unsafe practices in the Egyptian healthcare settings. The probability of HCV infection was 1.4% in the SES group and 40% in the CS group. Adoption of the SES use averted 177 hepatitis C cases and 157 hepatitis C-related deaths per 10 000 individuals. Introducing SES as a preventive strategy resulted in better quality-adjusted life-years (QALYs) (difference; 0.95 QALYs) and lower costs (difference; $-1712).

CONCLUSIONS

Adoption of SES in the Egyptian healthcare settings is a more effective and cost-saving strategy. Our results are consistent with the WHO Injection Safety Program and Safe Injection Global Network initiatives, which call for adoption of smart syringes. The introduction of SES as one of the most urgently needed interventions is mostly encouraged to decrease hepatitis C burden in similar resource-limited settings. The use of SES as a prevention strategy may bring substantial population-level health gains and governmental cost savings in developing countries.

A cost-effectiveness analysis of the use of safety-engineered syringes in reducing HBV, HCV, and HIV burden in Egypt

INTRODUCTION

The objective of this study was to estimate the effects and costs of safety-engineered syringes (SS) as a prevention strategy from HBV, HCV, and HIV infections versus conventional syringes (CS).

METHODS

A decision-analytic model with five health states was constructed. The clinical parameters and utilities were derived using published data. Direct medical costs from the health care system perspective were sourced from national data. All costs and effects were discounted at 3.5% annually.

RESULTS

The estimate of total quality adjusted life years (QALYs) while using SS were 10.87 compared to 9.20 for the use of CS in the Egyptian population exposed to unsafe injection practices. The total costs for using SS and CS were EGP2,870 and EGP81,794 (I$1,130 and I$32,202), respectively, per 5.9 injections per person per year. Adopting SS resulted in better outcomes (difference; 1.66 QALYs) and total savings (EGP-78,924/I$-31,073) per person.

CONCLUSION

Introducing SS in the Egyptian health care system might help in preventing transmission of blood-borne infections that are acquired through health care settings. The overall benefit of investing in this technology is far more than CS. These findings encourage the urgent adoption of SS by health care delivery institutions in similar resource-limited settings.

Seroconversion after needlestick injuries - analyses of statutory accident insurance claims in Germany

Objective: After a needlestick injury (NSI) with contaminated blood, there is a risk of seroconversion. Statutory accident insurance (SAI) claims data were used to determine the numbers of seroconversions for hepatitis B and C viruses (HBV, HCV) and for HIV.

Materials and methods: Cases of HBV, HCV or HIV infection recognised as occupational diseases between 2006 and 2015 were selected from the BGW (Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege) database. Cases where an NSI was reported to the accident insurer before the diagnosis of the infectious disease was made were included in the analysis. The causal link between the infection and the NSI identified was estimated based on diagnostic findings in medical case files.

Results: In total, 566 cases with an occupation-related HBV, HCV or HIV infection were identified, including 44 cases where an NSI had been reported before diagnosis. Data on file indicated a possible causal link in 34 cases. In 16 of the 34 cases, seroconversion after the NSI was proven by diagnostic findings; in 13 of the 34 cases, seroconversion was possible but not proven because of the lack of initial findings. The index case was known in 23 of the 34 cases. The injuries occurred most often during waste disposal and high-risk procedures such as taking blood samples. The injuries were most often caused by cannulas for intravenous puncture. Subcutaneous devices were involved in two NSIs but there was no information on the initial serology or known index case.

Conclusions: It is possible to identify seroconversion in SAI claims data. However, data on the injured person’s initial infection status is often incomplete and this makes it difficult to assess any causal link. The incidence of seroconversions resulting from injuries from subcutaneously applied devices is apparently low; this is consistent with the literature.

Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel

BACKGROUND

Percutaneous exposure injuries from devices used for blood collection or for injections expose healthcare workers to the risk of blood borne infections such as hepatitis B and C, and human immunodeficiency virus (HIV). Safety features such as shields or retractable needles can possibly contribute to the prevention of these injuries and it is important to evaluate their effectiveness.

OBJECTIVES

To determine the benefits and harms of safety medical devices aiming to prevent percutaneous exposure injuries caused by needles in healthcare personnel versus no intervention or alternative interventions.

SEARCH METHODS

We searched CENTRAL, MEDLINE, EMBASE, NHSEED, Science Citation Index Expanded, CINAHL, Nioshtic, CISdoc and PsycINFO (until 11 November 2016).

SELECTION CRITERIA

We included randomised controlled trials (RCT), controlled before and after studies (CBA) and interrupted time-series (ITS) designs of the effect of safety engineered medical devices on percutaneous exposure injuries in healthcare staff.

DATA COLLECTION AND ANALYSIS

Two of the authors independently assessed study eligibility and risk of bias and extracted data. We synthesized study results with a fixed-effect or random-effects model meta-analysis where appropriate.

MAIN RESULTS

We included six RCTs with 1838 participants, two cluster-RCTs with 795 participants and 73,454 patient days, five CBAs with approximately 22,000 participants and eleven ITS with an average of 13.8 data points. These studies evaluated safe modifications of blood collection systems, intravenous (IV) systems, injection systems, multiple devices, sharps containers and legislation on the implementation of safe devices. We estimated the needlestick injury (NSI) rate in the control groups to be about one to five NSIs per 1000 person-years. There were only two studies from low- or middle-income countries. The risk of bias was high in 20 of 24 studies. Safe blood collection systems:We found one RCT that found a safety engineered blood gas syringe having no considerable effect on NSIs (Relative Risk (RR) 0.2, 95% Confidence Interval (95% CI) 0.01 to 4.14, 550 patients, very low quality evidence). In one ITS study, safe blood collection systems decreased NSIs immediately after the introduction (effect size (ES) -6.9, 95% CI -9.5 to -4.2) but there was no further decrease over time (ES -1.2, 95% CI -2.5 to 0.1, very low quality evidence). Another ITS study evaluated an outdated recapping shield, which we did not consider further. Safe Intravenous systemsThere was very low quality evidence in two ITS studies that NSIs were reduced with the introduction of safe IV devices, whereas one RCT and one CBA study provided very low quality evidence of no effect. However, there was moderate quality evidence produced by four other RCT studies that these devices increased the number of blood splashes when the safety system had to be engaged actively (relative risk (RR) 1.6, 95% CI 1.08 to 2.36). In contrast there was low quality evidence produced by two RCTs of passive systems that showed no effect on blood splashes. Yet another RCT produced low quality evidence that a different safe active IV system also decreased the incidence of blood leakages. Safe injection devicesThere was very low quality evidence provided by one RCT and one CBA study showing that introduction of safe injection devices did not considerably change the NSI rate. One ITS study produced low quality evidence showing that the introduction of safe passive injection systems had no effect on NSI rate when compared to safe active injection systems. Multiple safe devicesThere was very low quality evidence from one CBA study and two ITS studies. According to the CBA study, the introduction of multiple safe devices resulted in a decrease in NSI,whereas the two ITS studies found no change. Safety containersOne CBA study produced very low quality evidence showing that the introduction of safety containers decreased NSI. However, two ITS studies evaluating the same intervention found inconsistent results. LegislationThere was low to moderate quality evidence in two ITS studies that introduction of legislation on the use of safety-engineered devices reduced the rate of NSIs among healthcare workers. There was also low quality evidence which showed a decrease in the trend over time for NSI rates.Twenty out of 24 studies had a high risk of bias and the lack of evidence of a beneficial effect could be due to both confounding and bias. This does not mean that these devices are not effective.

AUTHORS' CONCLUSIONS

For safe blood collection systems, we found very low quality evidence of inconsistent effects on NSIs. For safe passive intravenous systems, we found very low quality evidence of a decrease in NSI and a reduction in the incidence of blood leakage events but moderate quality evidence that active systems may increase exposure to blood. For safe injection needles, the introduction of multiple safety devices or the introduction of sharps containers the evidence was inconsistent or there was no clear evidence of a benefit. There was low to moderate quality evidence that introduction of legislation probably reduces NSI rates.More high-quality cluster-randomised controlled studies that include cost-effectiveness measures are needed, especially in countries where both NSIs and blood-borne infections are highly prevalent.

Clinical, economic, and humanistic burden of needlestick injuries in healthcare workers

Introduction

Needlestick injuries (NSIs) from a contaminated needle put healthcare workers (HCWs) at risk of becoming infected with a blood-borne virus and suffering serious short- and long-term medical consequences. Hypodermic injections using disposable syringes and needles are the most frequent cause of NSIs.

Objective

To perform a systematic literature review on NSI and active safety-engineered devices for hypodermic injection.

Methods

MEDLINE, EMBASE, and COCHRANE databases were searched for studies that evaluated the clinical, economic, or humanistic outcomes of NSI or active safety-engineered devices.

Results

NSIs have been reported by 14.9%–69.4% of HCWs with the wide range due to differences in countries, settings, and methodologies used to determine rates. Exposure to contaminated sharps is responsible for 37%–39% of the worldwide cases of hepatitis B and C infections in HCWs. HCWs may experience serious emotional effects and mental health disorders after a NSI, resulting in work loss and post-traumatic stress disorder. In 2015 International US$ (IntUS$), the average cost of a NSI was IntUS$747 (range IntUS$199–1,691). Hypodermic injections, the most frequent cause of NSI, are responsible for 32%–36% of NSIs. The use of safety devices that cover the needle-tip after hypodermic injection lowers the risk of NSI per HCW by 43.4%–100% compared to conventional devices. The economic value of converting to safety injective devices shows net savings, favorable budget impact, and overall cost-effectiveness.

Conclusion

The clinical, economic, and humanistic burden is substantial for HCWs who experience a NSI. Safety-engineered devices for hypodermic injection demonstrate value by reducing NSI risk, and the associated direct and indirect costs, psychological stress on HCWs, and occupational blood-borne viral infection risk.

Comparing non-safety with safety device sharps injury incidence data from two different occupational surveillance systems

The United States Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard as amended by the Needlestick Safety and Prevention Act requiring the use of safety-engineered medical devices to prevent needlesticks and sharps injuries has been in place since 2001. Injury changes over time include differences between those from non-safety compared with safety-engineered medical devices. This research compares two US occupational incident surveillance systems to determine whether these data can be generalized to other facilities and other countries either with legislation in place or considering developing national policies for the prevention of sharps injuries among healthcare personnel.

Causes of needlestick injuries in three healthcare settings: analysis of accident notifications registered six months after the implementation of EU Directive 2010/32/EU in Germany

BACKGROUND

Needlestick injuries (NSIs) are the most common cause of sharps injuries and pose a serious risk to healthcare workers (HCWs). In 2014, 'Technical rule for biological agents in healthcare and welfare facilities' (TRBA 250) was modified in Germany in order to promote the prevention of sharps injuries.

AIMS

To examine the epidemiology of NSIs among HCWs in hospitals, doctor's offices and in- and outpatient care; to collect information on the causes of the accidents when safety-engineered devices (SEDs) are used; and to compare the results with the main principles of TRBA 250.

METHODS

The survey was based on HCWs' compensation claims for NSIs, as notified within a four-week period in November 2014. Detailed information on the NSI was collected by telephone interview.

FINDINGS

In total, 533 HCWs participated. Subcutaneous needles were most often involved in NSIs, regardless of the healthcare setting (39% of all NSIs). Insulin pens were involved in 48% of NSIs in in- and outpatient care. Disposal of sharps devices accounted for 38% of the injuries. SEDs were used in 20% of NSIs. Lack of activation was the most important cause of failure when SEDs were used.

CONCLUSION

Despite the binding recommendations of TRBA 250, more efforts are needed to increase the experience of HCWs in terms of working with SEDs. All professional groups must be encouraged to be more aware of the risks associated with sharps disposal. Safe handling practices for disposal of insulin pens are needed in in- and outpatient care settings.

Use of safety-engineered devices by healthcare workers for intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-analysis

Background

The acquisition of needle-stick injuries (NSI) in a healthcare setting poses an occupational hazard of transmitting blood-borne pathogens from patients to healthcare workers (HCWs). The objective of this study was to systematically review the evidence about the efficacy and safety of using safety-engineered intravenous devices and safety-engineered phlebotomy devices by HCWs.

Methods

We included randomized and non-randomized studies comparing safety-engineered devices to conventional/standard devices that lack safety features for delivering intravenous injections and/or for blood-withdrawal procedures (phlebotomy). The outcomes of interest included NSI rates, and blood-borne infections rates among HCWs and patients. We conducted an extensive literature search strategy using the OVID interface in October 2013. We followed the standard methods for study selection and data abstraction. When possible, we conducted meta-analyses using a random-effects model. We used the GRADE methodology to assess the quality of evidence by outcome.

Results

We identified twenty-two eligible studies: Twelve assessed safety-engineered devices for intravenous procedures, five for phlebotomy procedures, and five for both. Twenty-one of those studies were observational while one was a randomized trial. All studies assessed the reduction in NSIs among HCWs. For safety-engineered intravenous devices, the pooled relative risk for NSI per HCW was 0.28 [0.13, 0.59] (moderate quality evidence). The pooled relative risk for NSI per device used or procedure performed was 0.34 [0.08,1.49] (low quality evidence). For safety-engineered phlebotomy devices, the pooled relative risk for NSI per HCW was 0.57 [0.38, 0.84] (moderate quality evidence). The pooled relative risk for NSI per device used or procedure performed was 0.53 [0.43,0.65] (moderate quality evidence). We identified no studies assessing the outcome of blood-borne infections among healthcare workers or patients.

Conclusion

There is moderate-quality evidence that the use of safety-engineered devices in intravenous injections and infusions, and phlebotomy (blood-drawing) procedures reduces NSI rates of HCWs.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1705-y) contains supplementary material, which is available to authorized users.