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RCT of preventive needlestick devices

 

Clinical bottom line

Though the study had a poor design, a variety of influences contrived to produce a 70% reduction in needlestick injuries, at a modest cost or possible saving.


Reference:

R Orenstein et al. Do protective devices prevent needlestick injuries among health care workers. American Journal of Infection Control 1995 23: 344-351.

Study

This was a before-after study over 12 months in three medical, two surgical and one intensive care unit. For the first six months all units used standard needles and devices. For the second six months five of the six units used one of three different protective devices (randomised to choose) and one acted as control.

During the period occupational needlestick exposure was ascertained by infection control nurses, from employee health records, and from requests for HIV and HBV tests.

Results

Between the first and second six month periods, needlestick injuries fell in all six units, including the control unit. There were 47 such events (46 with body fluid contamination) in the first six months, and 14 in the second six months. Nurses using hollow-bore needles accounted for most injuries (29 in the first period and 11 in the second). Overall the reduction in injury rate was statistically significant at the level of 0.05. The estimated cost per needlestick prevented was $789.

Comment

This was probably not the best designed study. It was clear that there would be insufficient events for statistical analysis of three devices against a control, and at a time of increased awareness about needlestick injuries, with a number of high profile initiatives over and above any study effects in the hospital. Still, whatever the cause, it did show that a 70% reduction in needlestick injuries was possible, even with incomplete take up of safer units.

Ascertainment of injuries was good, and this also may have contributed to a heightened local awareness of needle safety.

The estimate of costs was crude. Increased costs of safe units was offset by lower testing costs after injury. These testing costs were particularly low in this hospital, and no allowance was made for lost employee time, or legal fees, or disability. All of these, if included, could have turned this modest cost, to a modest saving. That it, it might be possible to have lower needlestick injury rates and reduce costs at the same time.