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

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

Authors

Mayor MeshTerms

Health Personnel

Protective Devices

Keywords
Journal Title the cochrane database of systematic reviews
Publication Year Start




PMID- 29190036
OWN - NLM
STAT- MEDLINE
DCOM- 20180110
LR  - 20180110
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 11
DP  - 2017 Nov 14
TI  - Devices for preventing percutaneous exposure injuries caused by needles in
      healthcare personnel.
PG  - CD009740
LID - 10.1002/14651858.CD009740.pub3 [doi]
AB  - 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.
FAU - Reddy, Viraj K
AU  - Reddy VK
AD  - Cochrane Work Review Group, Finnish Institute of Occupational Health,
      Neulaniementie 4, Kuopio, Finland, 70101.
FAU - Lavoie, Marie-Claude
AU  - Lavoie MC
FAU - Verbeek, Jos H
AU  - Verbeek JH
FAU - Pahwa, Manisha
AU  - Pahwa M
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20171114
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
SB  - IM
UOF - Cochrane Database Syst Rev. 2014 Mar 09;(3):CD009740. PMID: 24610008
MH  - Blood Specimen Collection/*instrumentation/methods
MH  - Controlled Before-After Studies
MH  - *Health Personnel
MH  - Humans
MH  - Infusions, Intravenous/instrumentation
MH  - Injections/instrumentation
MH  - Needlestick Injuries/epidemiology/*prevention & control
MH  - Occupational Diseases/epidemiology/*prevention & control
MH  - Personal Protective Equipment
MH  - *Protective Devices
MH  - Randomized Controlled Trials as Topic
EDAT- 2017/12/01 06:00
MHDA- 2018/01/11 06:00
CRDT- 2017/12/01 06:00
PHST- 2017/12/01 06:00 [pubmed]
PHST- 2018/01/11 06:00 [medline]
PHST- 2017/12/01 06:00 [entrez]
AID - 10.1002/14651858.CD009740.pub3 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2017 Nov 14;11:CD009740. doi:
      10.1002/14651858.CD009740.pub3.