Accidenteel bloedcontact Module 1.2 Onderzoekskarakteristieken

A. Mendelsohn 2003
B. Alvarado-Ramy 2003

C. Rogues 2004

D. Sohn 2004

E. Trapé-Cardoso & Schenck 2004

F. Moens 2004

G. Mobasherizadeh 2005

H. Adams & Elliott 2006

I. Azar-Cavanagh 2007

J. Valls 2007

K. Lamontagne 2007

L. Whitby 2008

M. Brusaferro 2009

N. Zafar 2009

O. Sossai 2010

P. Van der Molen 2011

Q. El Beltagy 2012

Type of study:

RCT, pre-post test, observational

Search date:
unknown

Number of included studies:

N=17

Country

A. USA
B. USA

C. France

D. USA

E. USA

F. Belgium

G. Iran

H. UK

I. USA

J. Spain

K. France

L. Australia

M. Italy

N. Pakistan

O. Italy

P. Netherlands

Q. Saudi Arabia

Source of funding:
Fulbright Scholarship

Inclusion criteria:
- reporting quantitative estimates of effect on needle-stick injuries (NSIs) as outcome
- include at least one of three preventive measures: safety training, satefy-engineered devices (SEDs) or combination

Exclusion criteria:
-experiences of healthcare students (but some studies do include students)

N total at baseline:

A. Not reported
B. Not reported

C. Not reported

D. Not reported

E. Not reported

F. Not reported

G. 87

H. Not reported

I. Not reported

J. 75 (received training)

K. 1506

L. Not reported

M. Not reported

N. Not reported

O. Not reported

P. 796

Q. Not reported

Age, mean (SD):

Not reported.

A. Training + SED (winged steel needle)
B. SEDs (resheathable winged steel needle, bluntable vacuum tube blood-collection needle, resheathable vacuum tube blood-collection needle)

C. SEDs (resheathable winged steel needle, Vacutainer blood-collecting tubes)

D. SEDs (devices not further specified)

E. Training + SEDs (safety hollow-bore needle devices)

F. Training

G. Training + SEDs (full text not available)

H. Training + SEDs (SafetyGlide needles, SafetyGlide TNT insulin units, blunt fill cannulae)

I. SED (intravenous catheter stylet with retractable protection shield)

J. Training + SEDs (blood-culture collection tubes with needle sheath, winged steel hooded needles, intravascular line adapters, blood-gas syringes with needle sheath, lancets with retractable single-use puncture sticks, catheters with safety-engineered introducer needles, blunt needles)

K. SEDs (SED variants of intravenous catheter, winged steel needle, vacuum tube collection device)

L. SEDs (retractable syringes, steel winged infusion sets, SmartSite needle-free system for peripheral IVs)

M. Training

N. Training

O. Training + SEDs (safety catheters)

P. Intervention Group 1: SED (injection needle with a safety device) + Training, Intervention Group 2: Training only

Q. Training

A. No control group
B. No control group

C. No control group

D. No control group

E. No control group

F. No control group

G. No control group

H. No control group

I. No control group

J. No control group

K. Conventional devices (conventional variants of intravenous catheter, winged steel needle, vacuum tube collection device)

L. No control group

M. No training

N. No control group

O. No control group

P. No training and no SED

Q. No control group

Length of follow-up:

A. Not reported
B. Not reported

C. Not reported

D. Not reported

E. Not reported

F. Not reported

G. Not reported

H. Not reported

I. Not reported

J. Not reported

K. 12 months

L. Not reported

M. Not reported

N. Not reported

O. Not reported

P. 6 months, 12 months

Q. Not reported

Loss-to-follow-up:

Not reported.

Training studies showed a summary effect of relative risk (RR) of 0.66 (95%CI 0.50-0.89), indicating that training reduced NSIs by 34%.

SEDs studies showed a summary effect of relative risk (RR) of 0.51 (95%CI 0.40-0.64), indicating that the use of SEDs reduced NSIs by 49%.

Training + SEDs studies showed a summary effect of relative risk (RR) 0.38 (95%CI 0.28-0.50), indicating that the use of training in combination with SEDs reduced NSIs by 62%.

A. Tosini 2010**
B. Hoffman 2013

C. Sossai 2016

Type of study:

RCT [Van der Molen 2011], observational

Search date:

Not reported

Number of included studies:

N=6

Country

A. France
B. Germany

C. Italy

Source of funding:

Not reported

Inclusion criteria:-only European studies

-studies showing significant reduction in needle-stick injuries (NSIs)

Exclusion criteria:
-studies evaluating only training or only needle-safety device (NSD) as intervention
-studies on blunt needles, double gloving, splashes and body fluid exposure risk

N total at baseline:

Not reported.

Age, mean (SD):

Not reported.

A. Active safety feature (manually activated sliding shield, manually activated toppling shield, or semiautomatic safety feature)
B. Training (not specified)

+ SEDs (manually activated hypodermic needles and butterfly systems; passive SED for peripheral venous catheters, lancets, port needles)

C.SED used (Introcan Safety IV Catheter Straight, with fully automatic safety shield)

A. Passive safety features (automatic safety feature)
B. No control group

C. Conventional
catheter used

Length of follow-up:

Not reported

Loss-to-follow-up:

Not reported.

As this was a narrative review, no effect sizes are reported.

[Tosini 2010] SEDs with manually activated safety features were associated with 10.7 times more NSIs than SEDs with (semi)automatic safety features (no significance given). Within active SEDs: semi-automatic safety feature associated with fewer NSIs than manually sliding and toppling shields (p<.001).

[Hoffman 2013] Introduction of SEDs and training was found to significantly decrease NSI rates in nurses (p=.008), doctors (p=.003), and ‘other’ medical personnel (i.e., not being students or lab personnel) (p=.025), with an overall average NSI decrease of 21.9% following introduction of SEDs and training.

[Sossai 2016] Significant reduction in risk ratio (RR) found between conventional catheters (RR=12.5) and safety catheters (RR=1, p<.0010).

Risk of bias introduced as result of only including studies with significant NSI reductions.

*Originally included six studies. Only three are reported here due to overlap with Tarigan 2015 of the other studies (Valls 2007; Sossai 2010; Van der Molen 2011).

** Technically not in line with Aziz’s PICO (and not with PICO of this literature review)

A. Clarke 2008
B. Sibbitt 2011

C. Menezes 2014

D. Mendes 2015

E. Ballout 2016

Type of study:

Observational, quasi-experimental, and systematic review

Search date:

April 2017

Number of included studies:

N=11*

Country

A. USA
B. USA

C. Brazil

D. Brazil

E. Lebanon

Source of funding:

Programa Institucional de Bolsas de Iniciação Científica of the CNPq

Inclusion criteria:-any full open access original article or systematic review in English, Portuguese, or Spanish

Exclusion criteria:-not answering the authors’ research question

N total at baseline:

A. 2287
B. Not reported

C. Not reported

D. 53

E. Not reported

Age, mean (SD):

A. 37.5 (9.9)
B. Not reported

C. Not reported

D. Not reported

E. Not reported

A. SEDs (not specified)
B. SEDs (safety needles, mechanical safety syringe, automatic retractable syringes, manual retractable syringes, shielded syringes)

C. SED (safety lancet)

D. SED (hypodermal needles and peripheral catheters with active protection)

E. SEDs (passive only)

A. No comparison, only survey associations
B. No control

C. No control

D. No control

E. Conventional devices

Length of follow-up:

Not reported.

Loss-to-follow-up:

Not reported.

As this was a narrative review, no effect sizes are reported.

[Clarke 2008] Use of protective equipment for blood draws (OR=0.69, 95%CI 0.49;0.96), general protective equipment (OR=0.89, 95%CI 0.54;1.45) and capless-valve (OR=0.76, 95%CI 0.48;1.21) associated with lower risk of NSIs (no p-values provided).

[Sibbitt 2011] No NSIs occurred during study, regardless of used SEDs.

[Menezes 2014] Significant reduction in NSIs following introduction of safety lancet for nurses (p<.001), but not for medical residents and other medical staff.

[Mendes 2015] report increase of 30% in NSI’s in period after introduction of SED (30 accidents) compared to pre-SED introduction period (23 accidents).

[Ballout 2016] report a pooled relative risk (RR) of NSIs for SEDs of 0.28 [0.13, 0.59].

*Originally included 11 studies. Only seven are reported here. Four studies were excluded from this report due to overlap with Tarigan 2015 and Aziz 2018 (Sohn 2004; Sossai 2010; Tosini 2010; Azer-Cavanagh 2007).

Additionally, two studies (Black 2013 and Cullen 2006) were excluded from this report because they did not investigate effectiveness of SEDS or training in preventing NSIs.