Needlesticks with safety devices and accident prevention: an integrative review

To identify in the literature the efficacy of needlesticks with safety devices to reduce the occurrence of occupational accidents with exposure to biological material among health workers.

Method:

Integrative literature review, structured in the stages: Guiding question, search, categorization of studies, evaluation, discussion and interpretation of results, and synthesis of knowledge. Search for original articles and systematic reviews on the main bases of the Health area, published from 2000 to 2016 in Portuguese, English and Spanish, with descriptors: needlesticks injuries, exposure to biological agents, needles, protective devices, occupational accidents, accident prevention and health personnel.

Results:

We selected eleven articles, most characterized the passive safety devices as more effective in reducing the occurrence of injuries by needlesticks.

Conclusion:

The use of needlesticks with safety devices reduces the occurrence of accidents, bringing greater solvency when combined with the training of workers.

Descriptors:
Needlestick Injuries; Needles; Protective Devices; Accident Prevention; Health Personnel

Title	Year/Country	Type of safety device analyzed	Methodologival outline	Main Results	Evidence Level
Study 1 Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses ⁽²⁶⁾26 Clarke SP, Rockett JL, Sloane DM, Aiken LH. Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near misses in hospital nurses. Am J Infect Control[Internet]. 2002[cited 2017 Apr 25];30(4):207-16. Available from: http://www.ajicjournal.org/article/S0196-6553(02)09916-9/pdf http://www.ajicjournal.org/article/S0196...	2002 USA	As security device active as passive protection	Quantitative, Exploratory	The use of 3 of the 4 types of protective devices examined was associated with a decrease in the probability of incident occurrences with needlesticks and near misses.	4
Study 2 Using an intravenous catheter system to prevent needlestick injury ⁽³¹⁾31 Sossai D, Puro V, Chiappatoli L, Dagnino G, Odone B, Polimeri A, et al. Using an intravenous catheter system to prevent needlestick injury. Nurs Stand[Internet]. 2010[cited 2017 Apr 25];24(29):42-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20426370 https://www.ncbi.nlm.nih.gov/pubmed/2042...	2010 Italy	Passive protection safety device	Quantitative, Descriptive	After the campaign and use of the safety catheters the reported incidents of injuries involving catheters were 19 to 2. And in these two cases no devices were used for prevention.	2
Study 3 Safety Syringes and Anti-Needlestick Devices in Orthopaedic Surgery ⁽²³⁾23 Sibbitt WL, Band PA, Kettwich LG, Sibbitt CR, Sibbitt LJ, Bankhurst AD. Safety Syringes and Anti-Needlestick Devices in Orthopaedic Surgery. J Bone Joint Surg Am[Internet]. 2011[cited 2017 Apr 25];93(17):1641-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21915580 https://www.ncbi.nlm.nih.gov/pubmed/2191...	2011 USA	As security device active as passive protection	Quantitative, Quasi - Experimental	Passive devices are most effective, followed by automatic retractable syringes, armored needlesticks, armored syringes and manually retractable syringes.	3
Study 4 Percutaneous injuries from hollow bore safety-engineered sharps devices ⁽²⁵⁾25 Black L. Percutaneous injuries from hollow bore safety-engineered sharps devices. Am J Infect Control[Internet]. 2013[cited 2017 Apr 25];41(5):427-32. Available from: http://www.ajicjournal.org/article/S0196-6553(12)00889-9/pdf http://www.ajicjournal.org/article/S0196...	2013 USA	Passive protection safety device	Quantitative, Exploratory	42.9% of accidents with the safety device occurred after device use and are probably avoidable through effective use of safety technology and 45.8% of injuries occurred with phlebotomists when the device was not properly activated.	5
Study 5 Needlestick Injury Rates According to Different Types of Safety Engineered Devices: Results of a French Multicenter Study ⁽³⁰⁾30 Tosini W, Ciotti C, Goyer F, Lolom I, L'Hériteau F, Abiteboul D, et al. Needlestick injury rates according to different types of safety engineered devices: results of a French Multicenter Study. Infect Control Hosp Epidemiol[Internet]. 2010[cited 2017 Apr 25];31(4):402-7. Available from: http://www.hscgp.org/upload/documents/2010_Needlestick_Injury_Rates_According_to_Different_Types_of_Safety.pdf http://www.hscgp.org/upload/documents/20...	2014 France	As security device active as passive protection	Quantitative, Exploratory	Passive devices are associated with lower incidence rates. In particular, the automatic retraction lancets presented the lowest incidence rate of injuries of all safety devices. And the use of needlesticks without safety has been associated with very high injury rates.	4
Study 6 Effect of the introduction of a engineered sharps injury prevent device on the percutaneous injury rate in healthcare workers ⁽²⁷⁾27 Azar-Cavanagh M, Burdt P, Green-Mckenzie J. Effect of the introduction of an engineered sharps injury prevention device on the percutaneous injury rate in healthcare workers. Infect Control Hosp Epidemiol[Internet]. 2014[cited 2017 Apr 25];28(2):165-70. Available from: https://www.cambridge.org/core/product/identifier/ICHE2005028/type/journal_article https://www.cambridge.org/core/product/i...	2014 USA	Passive protection safety device	Quantitative, Quasi - Experimental	The rate of percutaneous injuries of the IV catheter with the safety device decreased over each consecutive month, while the rate of injuries suffered by suture needlesticks without a safety device increased significantly.	3
Study 7 Impact of a single safety-engineered device on the occurrence of percutaneous injuries in a general hospital in Brazil ⁽²⁹⁾29 Menezes JA, Bandeira CS, Quintana M, Stat JCLS, Calvet GA. Impact of a single safety-engineered device on the occurrence of percutaneous injuries in a general hospital in Brazil. Am J Infect Control[Internet]. 2014[cited 2017 Apr 25];42(2):174-7. Available from: http://www.ajicjournal.org/article/S0196-6553(13)01154-1/pdf http://www.ajicjournal.org/article/S0196...	2014 Brazil	Passive protection safety device	Quantitative, Descriptive	A significant decrease in the rate of percutaneous injuries was observed while the introduction of safety lancet reduced the number of small and hollow needlesticks purchased by the hospital.	3
Study 8 Cost-effectiveness of needle and catheter over needle with active protection devices in the hospital setting ⁽²⁸⁾28 Mendes RNC, Silva LGC, Haddad MCL, Moreno FN, Gil RB. Custo-Efetividade de Agulhas e Cateteres sobre agulha com dispositivos de proteção ativa no contexto hospitalar[Internet]. Texto Contexto Enferm[Internet]. 2015[cited 2017 Apr 25];24(3):867-74. Available from: http://www.scielo.br/pdf/tce/v24n3/pt_0104-0707-tce-24-03-00867.pdf http://www.scielo.br/pdf/tce/v24n3/pt_01...	2015 Brazil	Active protection safety device	Quantitative, Descriptive	Even with the device there was a 30% increase in accidents. The cost increased by 211.08%.	4

Title	Year/Country	Type of percutaneous material analyzed	Methodological outline	Main Results	Evidence Level
Study 9 Effect of Implementing Safety-Engineered Devices on Percutaneous Injury Epidemiology ⁽²⁴⁾24 Sohn SJ, Eagan J, Sepkowitz KA, Zuccotti G. Effect of Implementing Safety-Engineered Devices on Percutaneous Injury Epidemiology. Infect Control Hosp Epidemiol[Internet]. 2004[cited 2017 Apr 25];25(7):536-42. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15301024 https://www.ncbi.nlm.nih.gov/pubmed/1530...	2004 USA	Needlesticks for blood collection, IV inserts, IM and SC and injections	Quantitative, Quasi-Experimental	The implementation of safety engineering devices has reduced rates of percutaneous injuries among professions, activities, injury times and devices.	3
Study 10 Potential for reported needlestick injury prevention among healthcare workers through safety device usage and improvement of guideline adherence: expert panel assessment ⁽³²⁾32 Cullen BL, Genasi F, Symington I, Bagg J, McCreaddie M, Taylor A, et al. Potential for reported needlestick injury prevention among healthcare workers through safety device usage and improvement of guideline adherence: expert panel assessment. J Hosp Infect[Internet]. 2006[cited 2017 Apr 25];63(4):446-51. Available from: http://www.journalofhospitalinfection.com/article/S0195-6701(06)00215-5/pdf http://www.journalofhospitalinfection.co...	2006 Scotland	Syringes with safety engineering devices	Quantitative, Descriptive	Multifactorial analysis indicated that injuries were significantly more likely to be prevented by the use of safety devices than those that occurred through other procedures.	4
Study 11 Use of safety-engineered devices by healthcare workers for intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-analysis ⁽³³⁾33 Ballout RA, Diab B, Harb AC, Tarabay R, Khamassi S, Akl BA. Use of safety-engineered devices by healthcare workers for intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-analysis. BMC Health Serv Res[Internet]. 2016[cited 2017 Apr 25];16:458. Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1705-y https://bmchealthservres.biomedcentral.c...	2016 Lebanon	Variety of IV systems of needlesticks and catheters, portable needlesticks, arteriovenous fistula needlesticks, vacuum collection device, steel needlesticks and syringes	Systematic Review	We identified 22 eligible studies: 12 evaluated devices for intravenous procedures, 5 for phlebotomy and 5 for both. Of the 22 studies, 21 were observational and 1 randomized. All studies evaluated the reduction of injuries by needlesticks.	1

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[1] CORRESPONDING AUTHOR: Lívia Tech dos Santos. E-mail: livia.tech.santos@usp.br