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Appendices

Appendix 1. General search strategy, needle stick injury prevention interventions

Database

Period of search

Search strategy

The Cochrane Hepato‐Biliary Group Controlled Trials Register

1996 to 7 Oct 2010

('health care worker*' or 'health personnel' or 'HCWs' ) and ( 'virus disease*' or 'virus*' or 'viral infect*')

EMBASE

1974 to 17 Sept 2010

#6 #5 AND [humans]/lim AND [embase]/lim

#5 #3 AND #4

#4 [randomized controlled trial]/lim OR [controlled clinical trial]/lim OR random* OR 'double blind' OR 'single blind' OR (singl* OR doubl* OR trebl* OR tripl* AND (blind* OR mask*)) OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'triple blind procedure'/exp OR placebo* OR 'controlled study'/exp OR 'cross sectional study'/exp OR 'crossover procedure'/exp OR 'latin square design'/exp OR 'follow up'/exp OR 'comparative study'/exp OR 'evaluation studies'/exp OR 'evaluation study' OR prospectiv* OR volunteer*

#3 #1 AND #2

#2 'health care personnel'/exp OR 'health care personnel' OR 'health care worker'/exp OR 'health care worker' OR 'health care workers' OR 'health care facilities and services'/exp OR 'medical profession'/exp OR 'nursing as a profession'/exp OR ('virus transmission'/exp AND 'patient'/exp AND professional)

#1 'needlestick injury'/exp OR needlestick* OR 'needle stick'/exp OR 'sharp injury' OR 'sharp injuries' OR 'sharp medical' OR 'sharp instrument' OR 'sharp needle' OR 'sharp needles' OR sharps OR 'percutaneous exposure' OR 'percutaneous injury' OR 'percutaneous injuries' OR 'percutaneous trauma' OR 'stick injury' OR 'stick injuries' OR 'stab wound'/exp OR 'face injury'/de OR 'eye injury'/de OR 'arm injury'/de OR 'hand injury'/de OR 'needle'/exp OR (splash* AND ('blood'/exp OR blood OR secretion* OR fluid* OR 'body fluid'/exp OR 'body fluids'/exp))

Wiley InterScience
Cochrane Library Databases:
CENTRAL and NHSEED

1993 to 7 Oct 2010

#3 #1 AND #2

#2 EXP Needlestick Injuries (MeSH) OR needlestick* OR "needle stick OR "needle sticks" OR "percutaneous exposure" OR "percutaneous exposures" OR "percutaneous injury" OR "percutaneous injuries2 OR "stick injury" OR "stick injuries" OR Wounds, Stab (MeSH) OR Wounds, Penetrating (MeSH) OR Facial injuries (MeSH) OR EXP Eye Injuries, Penetrating (MeSH) OR Forearm Injuries (MeSH) OR EXP Hand Injuries (MeSH) OR [splash* AND blood OR secretion* OR fluid* OR EXP Body Fluids (MeSH)  OR EXP Bodily Secretions (MeSH)]

#1 EXP Health Occupations (MeSH) OR EXP Health Personnel (MeSH) OR EXP Health Facilities (MeSH)  OR "health care worker"  OR "health care workers"  OR Disease Transmission, patient‐to‐Professional (MeSH)

Science Citation Index Expanded

1986 to 5 October 2010

#4 #1 AND #2 AND #3

#3 TS=(random* OR control* OR trial OR trials OR "single blind" OR "double blind" OR "triple blind" OR "latin square" OR placebo* OR comparative OR "follow up" OR prospectiv* OR "cross over" OR volunteer*)

#2 TS=(needlestick* OR "needle stick" OR "needle sticks" OR "stick injury" OR "stick injuries"  OR "wound stab" OR "stab wound"  OR "penetrating wound" OR "penetrating wounds") OR TS=(sharp* AND ( injury OR injuries OR medical OR instrument*))  OR TS=(percutaneous AND (exposure OR exposures OR injury OR injuries)) OR TS=(injur* AND (facial OR eye OR eyes OR arm OR hand OR finger OR fingers)) OR TS=(splash* AND (blood OR secretion* OR fluid OR fluids)) OR TS="blood borne infection"

#1 TS=("health care worker"  OR "health care workers" OR "health occupations" OR "health personnel"  OR physician* OR nurse* OR hospital* OR clinic OR clinics)

CINAHL

1982 to 30 Sept 2010

#5 #3 AND #4

#4 "randomized controlled trial" or "clinical trials" or "clinical trial" or "random allocation" or "double blind". or "single blind" or ((singl* or doubl* or trebl* or tripl*) and (blind* or mask*)) or "latin square" or placebo# or random* or "research design" or "comparative study" or "comparative studies" or "evaluation study" or "evaluation studies" or "follow up study" or "follow up studies" or "prospective study" or "prospective studies" or "cross over study" or "cross over studies" or control* or prospective* or volunteer or (MH "Clinical Trials+") or (MH "Nonrandomized Trials") or (MH "Crossover Design")

#3 #1 AND #2

#2 TX "needlestick injury" or needlestick# or "needle stick" or "needle sticks" or "sharp injury" or "sharp injuries" or "sharp medical device" or "sharp medical devices" or "sharp instrument" or "sharp instruments" or "sharp needle" or "sharp needles" or "percutaneous exposure" or "percutaneous exposures" or "percutaneous injury" or "percutaneous injuries" or "stick injury" or "stick injuries" or "wounds, stab" or "wounds, penetrating" or "facial injuries" or "eye injuries, penetrating" or "arm injuries" or "forearm injuries" or "hand injuries" or "finger injuries" or (splash# and (blood or secretion# or fluid#)) or ("occupational exposure" and ("body fluid" or  "body fluids" or blood))

#1 (MH "Health Occupations") OR health occupations   or (MH "Health Personnel+")  or (MH "Health Facilities+") OR health facilities  or TX "health care worker"  or TX "health care workers"  or (MH "Personnel, Health Facility+") or (MH "Occupational Health Services+")  or (MH "Occupational Hazards+")  or (MH "Occupational Exposure")  or TX "health care personnel"   or  (MH "Health Personnel+") or (MH "HIV Infections+")

OSH UPDATE (NIOSHTIC‐2 and CISDOC)

NIOSHTIC‐2: 1900 to 7 Oct 2010
CISDOC: 1987 to 7 Oct 2010

#15 #13 AND #14

#14 PY{2007} OR PY{2008} OR PY{2009}

#13 #7 AND #12

#12 #8 OR #11

#11 #9 AND #10

#10 GW{blind* OR mask*}

#9 GW{singl* OR doubl* OR tripl* OR trebl*}

#8 GW{random* OR control* OR trial OR trials OR comparativ* OR evaluation* OR "latin square" OR placebo OR "follow up" OR prospectiv* OR "cross over" OR volunteer*}

#7 #1 AND #6 

#6 #2 OR #5

#5 #3 AND #4

#4 GW{splash*}

#3 GW{blood OR fluid* OR secretion*}

#2 GW{"sharp medical" OR "sharp instrument" OR "sharp instruments" OR needlestick* OR "needle stick" OR "needle sticks" OR "sharp injury" OR "sharp injuries" OR "stab wound" OR "stab wounds" OR "wound penetrating" OR "stick injury" OR "stick injuries" OR "percutaneous injury" OR "percutaneous injuries" OR "percutaneous exposure" OR "percutaneous exposures" OR "sharp needle" OR "sharp needles"}

#1 GW{nurse OR nurses OR physician OR physicians OR hospital* OR "health occupation" OR "health occupations" OR "health personnel" OR "health care personnel" OR "health care worker" OR "health care workers" OR "health worker" OR "health workers"}

MEDLINE in PubMed

from 1950 to 17 Sept 2010

#5 Search #1 AND #2 AND (#3 OR #4)

#4 Search effect*[tw] OR control[tw] OR controls*[tw] OR controla*[tw] OR controle*[tw] OR controli*[tw] OR controll*[tw] OR control'*[tw] OR evaluation*[tw] OR program*[tw]

#3 ("Randomized Controlled Trial"[pt] OR "Controlled Clinical Trial"[pt] OR "Randomized Controlled Trials as Topic"[mh] OR "Random Allocation"[mh] OR "Double‐Blind Method"[mh] OR "Single‐Blind Method"[mh] OR "Clinical Trial"[pt] OR "Clinical Trials as Topic"[mh] OR "clinical trial"[tw] OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind*[tw])) OR "latin square"[tw] OR Placebos[mh] OR placebo*[tw] OR random*[tw] OR "Research Design"[mh:noexp] OR "Comparative Study"[pt] OR "Evaluation Studies as Topic"[mh] OR "Follow‐up Studies"[mh] OR "Prospective Studies"[mh] OR "Cross‐over Studies"[mh] OR control[tw] OR controls*[tw] OR controla*[tw] OR controle*[tw] OR controli*[tw] OR controll*[tw] OR control'*[tw] OR prospectiv*[tw] OR volunteer*[tw]) NOT (Animals[mh] NOT Humans[mh)

#2 "Needlestick injuries"[mh] OR needlestick*[tw] OR "needle stick"[tw] or "needle sticks"[tw] OR "sharp injury"[tw] OR "sharp injuries"[tw] OR sharps[tw] OR "sharp medical device"[tw] OR "sharp medical devices"[tw] OR "sharp instrument"[tw] OR "sharp instruments"[tw] OR "sharp medical instrument"[tw] OR "sharp medical instruments"[tw] OR "sharp needle"[tw] OR "sharp needles"[tw] OR "percutaneous exposure"[tw] OR "percutaneous exposures"[tw] OR "percutaneous injury"[tw] OR "percutaneous injuries"[tw] OR "stick injury"[tw] OR "stick injuries"[tw] OR "Wounds, Stab"[mh:noexp] OR "Wounds, Penetrating"[mh:noexp] OR "Facial injuries"[mh:noexp] OR "Eye Injuries, Penetrating"[mh] OR "Arm Injuries"[mh:noexp] OR "Forearm Injuries"[mh:noexp] OR "Hand Injuries"[mh] OR (splash* AND (blood[tw] or secretion*[tw] OR fluid*[tw] OR "Body Fluids"[mh]))

#1 "Health Occupations"[mh] OR "Health Personnel"[mh] OR "Health Facilities"[mh] OR "health care worker"[tw] OR "health care workers"[tw] OR "Infectious Disease Transmission, Patient‐to‐Professional"[mh]

PsycINFO (OvidSP)

1967 to 6 Oct 2010

#5 limit 4 to all journals

#4 #1 AND #2 AND #3

#3 random* OR control* OR trial OR trials OR comparativ* OR evaluation* OR ((singl* OR doubl* OR tripl* OR trebl*) AND (blind* OR mask*)) OR "latin square" OR placebo* OR "follow up" OR prospectiv* OR "cross over" OR volunteer*   

#2 (splash* AND (blood OR secretion* OR fluid OR fluids)) OR ("eye injuries" AND penetrating) OR (wound* AND (stab OR penetrating)) OR "percutaneous exposure" OR "percutaneous exposures" OR "percutaneous injury" OR "percutaneous injuries" OR "stick injury" OR "stick injuries" OR "sharp injury" OR "sharp injuries" OR "sharp medical" OR "sharp instrument" OR "sharp instruments" OR "sharp needle" OR "sharp needles" OR needlestick* OR "needle stick" OR "needle sticks"

#1 (nursing or nurse or nurses or physician or physicians or "health care personnel" or "health personnel" or "health care worker" or "health care workers" or "Clinicians*" or "Dentist*" or "Health‐Personnel" or "Medical Personnel" or "Military‐Medical‐Personnel" or "Nurses*" or "Physician*" or "Psychiatric‐Hospital‐Staff*" or "medical students" or "hospitals" or "occupational exposure" or "occupational exposures").mp. [mp=title, abstract, heading word, table of contents, key concepts]

LILACS

"Health Occupations" or "Health Personnel" OR "Health Facilities" OR "health care worker" OR "health care workers" OR "Disease Transmission, Patient‐to‐Professional" OR "INJURIES" or "WOUNDS AND INJURIES/PC" or "accidents, OCCUPATIONAL" or "injuries, poisonings, and OCCUPATIONAL diseases" or "OCCUPATIONAL exposure" or "OCCUPATIONAL health policy" or "OCCUPATIONAL risks" OR "INJURIES" or "WOUNDS AND INJURIES/PC" or "accidents, OCCUPATIONAL" or "injuries, poisonings, and OCCUPATIONAL diseases" or "OCCUPATIONAL exposure" or "OCCUPATIONAL health policy" or "OCCUPATIONAL risks" [Descritor de assunto] and "CLINICAL TRIAL" OR "CLINICAL TRIAL, PHASE I" OR "CLINICAL TRIAL, PHASE II" OR "CLINICAL TRIAL, PHASE III" OR "CLINICAL TRIAL, PHASE IV" OR "COMPARATIVE STUDY" OR "CONTROLLED CLINICAL TRIAL" OR "EVALUATION STUDIES" OR "META‐ANALYSIS" OR "MULTICENTER STUDY" OR "RANDOMIZED CONTROLLED TRIAL" OR "REVIEW" [Tipo de publicação] and not "ANIMALS" or "HUMANS" [Palavras]

Appendix 2. Updated search strategy, recapping prevention

We added the following search words to the general search strategy to restrict the interventions to prevention of recapping interventions:

(recap* OR device*)

Appendix 3. Updated search strategy (2016)

Database

Period of

search

Search strategy

EMBASE

1 Jan 2014 to 1 November 2016

#6 #5 AND [humans]/lim AND [embase]/lim

#5 #1 AND #2 AND #3 AND #4

#4 [randomized controlled trial]/lim OR [controlled clinical trial]/lim OR random* OR 'double blind' OR 'single blind' OR (singl* OR doubl* OR trebl* OR tripl* NEAR1 (blind* OR mask*)) OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'triple blind procedure'/exp OR placebo* OR 'controlled study'/exp OR 'cross sectional study'/exp OR 'crossover procedure'/exp OR 'latin square design'/exp OR 'follow up'/exp OR 'comparative study'/exp OR 'evaluation studies'/exp OR 'evaluation study' OR prospectiv* OR cohort OR (comparative NEAR/1 study) OR ‘time series’/exp

#3 'health care personnel'/exp OR 'health care personnel' OR 'health care worker'/exp OR 'health care worker’ OR ‘health workers’ OR ‘health professional’ OR ‘health care professionals’ OR ‘medical care professionals’ OR dentist* OR anesth* OR anaesth* OR phlebotomist OR surgeon* OR physician* OR doctor* OR nurse* OR 'health care workers' OR 'medical profession'/exp OR 'nursing as a profession'/exp OR hospital/exp OR 'health care facilities and services’/exp

#2 (sharp NEAR/2 (instrument* OR needle*)) OR recap* OR ((medical OR safe) NEAR/1 device*) OR 'safety engineered' OR syringe* OR (iv NEAR/1 system*) OR (sharps NEAR/1 container*)

#1 'needle stick injury'/exp OR (needle NEAR/1 stick*) OR 'sharps injury' OR 'sharps injuries' OR 'percutaneous exposure' OR 'percutaneous injury' OR 'percutaneous injuries' OR 'percutaneous trauma' OR (splash* NEAR/1 (blood OR secretion* OR fluid* OR 'body fluid' OR 'body fluids'))

Science Citation Index Expanded

1 Jan 2014 to 1 November 2016

#5 #1 AND #2 AND #3 AND #4

#4 TS=(random* OR control* OR trial OR trials OR "single blind" OR "double blind" OR "triple blind" OR "latin square" OR placebo* OR comparative OR "follow up" OR prospectiv* OR "cross over" OR volunteer*)

#3 TS=(“sharps” OR “sharp medical device” OR “sharp medical devices” OR “sharp instrument” OR “sharp instruments” OR “sharp needle” OR “sharp needles” OR syringe* OR “IV‐system*” OR “sharps container*” OR “safety engineered” OR recap* OR device*)

#2 TS=(needlestick* OR "needle stick" OR "needle sticks" OR "stick injury" OR "stick injuries" OR "wound stab" OR "stab wound" OR "penetrating wound" OR "penetrating wounds") OR TS=(sharp* AND ( injury OR injuries OR medical)) OR TS=(percutaneous AND (exposure OR exposures OR injury OR injuries)) OR TS=(injur* AND (facial OR eye OR eyes OR arm OR hand OR finger OR fingers)) OR TS=(splash* AND (blood OR secretion* OR fluid OR fluids)) OR TS="blood borne infection”

#1 TS=("health care worker" OR "health care workers" OR "health occupations" OR "health personnel" OR physician* OR nurse* OR hospital* OR clinic OR clinics OR “healthcare worker” OR “health worker” OR “health professional” OR “health professionals” OR “healthcare professional” OR “health care professional” OR “medical care personnel” OR dentist* OR doctor* OR anesth* OR anaesth* OR phlebotomist* OR surgeon* OR veterinarian*)

PsycINFO (OvidSP)

1 Jan 2014 to 1 November 2016

#6 limit #5 to all journals

#5 #1 AND #2 AND #3 AND #4

#4 random* OR control* OR trial OR trials OR comparativ* OR evaluation* OR ((singl* OR doubl* OR tripl* OR trebl*) AND (blind* OR mask*)) OR "latin square" OR placebo* OR "follow up" OR prospectiv* OR "cross over" OR volunteer*

#3 (“sharps" OR "sharp medical device” OR "sharp medical devices" OR "sharp instrument" OR "sharp instruments" OR "sharp medical instrument" OR "sharp medical instruments” OR “needlestick*” OR “needle stick” OR “needle sticks” OR "sharp needle" OR "sharp needles" OR "syringe*" OR "IV‐system*" OR "sharps container*" OR "safety engineered” OR “recap*" OR “device*”)

#2 (splash* AND (blood OR secretion* OR fluid OR fluids)) OR ("eye injuries" AND penetrating) OR (wound* AND (stab OR penetrating)) OR "percutaneous exposure" OR "percutaneous exposures" OR "percutaneous injury" OR "percutaneous injuries" OR "stick injury" OR "stick injuries" OR "sharp injury" OR "sharp injuries" needlestick* OR "needle stick" OR "needle sticks”

#1 (nursing or nurse or nurses or physician or physicians or "health care personnel" or "health personnel" or "health care worker" or "health care workers" or "Clinicians*" or "Dentist*” or “anesth*” or “anaesth*” or “phlebotomist” or “surgeon” or “veterinarian" or "Health‐Personnel" or "Medical Personnel" or "Military‐Medical‐Personnel" or "Nurses*" or "Physician*" or "Psychiatric‐Hospital‐Staff*" or "medical students" or "hospitals" or "occupational exposure" or "occupational exposures").mp. [mp=title, abstract, heading word, table of contents, key concepts]

Wiley InterScience
Cochrane Library Databases:
CENTRAL and NHSEED

1 Jan 2014 to 1 November 2016

#4 #1 AND #2 AND #3

#3 EXP Health Occupations (MeSH) OR EXP Health Personnel (MeSH) OR EXP Health Facilities (MeSH) OR "health care worker" OR "health care workers" OR Disease Transmission, patient‐to‐Professional (MeSH) OR “health workers” Or “health worker” OR “health professional” OR “health professionals” OR “healthcare professional” OR “healthcare professionals” OR “health care professional” OR “health care professionals” OR “medical care personnel” OR dentist* OR surgeon* OR physician* OR doctor* OR anesth* OR anaesth* OR phlebotomist* OR nurse* OR veterinarian*

#2 EXP Needlestick Injuries (MeSH) OR needlestick* OR “needle stick” OR “needle sticks” OR “percutaneous exposure” OR “percutaneous exposures” OR “percutaneous injury” OR “percutaneous injuries” OR “stick injury” OR “stick injuries” OR Wounds, Stab (MeSH) OR Wounds, Penetrating (MeSH) OR Facial injuries (MeSH) OR EXP Eye injuries, penetrating (MeSH) OR Forearm Injuries (MeSH) OR EXP Hand Injuries (MeSH) OR splash* AND blood OR secretion* OR fluid* OR EXP Body Fluids (MeSH) OR EXP Bodily Secretions (MeSH)

#1 sharps OR "sharp medical device” OR “sharp medical devices” OR “sharp instrument” OR “sharp instruments” OR “sharp medical instrument” OR “sharp medical instruments” OR “sharp needle” OR “sharp needles” OR syringe* OR IV‐system* OR “sharps container*” OR "safety engineered” OR “recap*” OR “device"

CINAHL

1 Jan 2014 to 1 November 2016

S5 S1 AND S2 AND S3 AND S4

S4 "randomized controlled trial" or "clinical trials" or "clinical trial" or "random allocation" or "double blind". or "single blind" or ((singl* or doubl* or trebl* or tripl*) and (blind* or mask*)) or "latin square" or placebo# or random* or "research design" or "comparative study" or "comparative studies" or "evaluation study" or "evaluation studies" or "follow up study" or "follow up studies" or "prospective study" or "prospective studies" or "cross over study" or "cross over studies" or control* or prospective* or volunteer or (MH "Clinical Trials+") or (MH "Nonrandomized Trials") or (MH "Crossover Design”)

S3 TX "sharp medical device" or "sharp medical devices" or "sharp instrument" or "sharp instruments" or "sharp needle" or "sharp needles" or "sharps" or "sharp medical instrument" or "sharp medical instruments" or “syringe*" or "IV‐system*" or "sharps container*" or "safety engineered" or “recap*" or “device*”

S2 TX "needlestick injury" or needlestick# or "needle stick" or "needle sticks" or "sharp injury" or "sharp injuries” or "percutaneous exposure" or "percutaneous exposures" or "percutaneous injury" or "percutaneous injuries" or "stick injury" or "stick injuries" or "wounds, stab" or "wounds, penetrating" or "facial injuries" or "eye injuries, penetrating" or "arm injuries" or "forearm injuries" or "hand injuries" or "finger injuries" or (splash# and (blood or secretion# or fluid#)) or ("occupational exposure" and ("body fluid" or "body fluids" or blood)

S1 (MH "Health Occupations") OR health occupations or (MH "Health Personnel+") or (MH "Health Facilities+") OR health facilities or TX "health care worker" or TX "health care workers" or (MH "Personnel, Health Facility+") or (MH "Occupational Health Services+") or (MH "Occupational Hazards+") or (MH "Occupational Exposure") or TX "health care personnel" or (MH "Health Personnel+") or (MH "HIV Infections+") or TX "medical care professionals" or (MH "Infectious Disease Transmission, Patient‐to‐Professional+") or TX “dentist" or TX “anesth*" or TX “anaesth*" or TX “phlebotomist" or TX “surgeon*" or TX “physician*" or TX “doctor*" or TX “nurse*" or TX “veterinarian*”

OSH UPDATE

1 Jan 2014 to 1 November 2016

#3 needlestick* OR "needle stick" OR "needle sticks" OR "sharps injury" OR "sharps injuries" OR "percutaneous injury" OR "percutaneous injuries" OR "percutaneous exposure" OR "percutaneous exposures" OR “blood splash” OR “blood splashes”

#2 "sharp instrument" OR "sharp instruments" OR "sharp needle" OR "sharp needles" OR recap* OR “safe device” OR “safety engineered” OR “sharps containers” OR “IV system” OR device*

#1 'health care personnel' OR 'health care worker’ OR ‘health care workers’ OR ‘health professional’ OR ‘health care professionals’ OR dentist* OR anesth* OR anaesth* OR phlebotomist OR surgeon* OR physician* OR doctor* OR nurse* OR hospital

MEDLINE in PubMed

1 Jan 2014 to 1 November 2016

#6 (#1 AND #2 AND #3 AND (#4 OR #5))

#5 (effect*[tw] OR control[tw] OR controls*[tw] OR controla*[tw] OR controle*[tw] OR controli*[tw] OR controll*[tw] OR control'*[tw] OR evaluation*[tw] OR program*[tw])

#4 (("Randomized Controlled Trial"[pt] OR "Controlled Clinical Trial"[pt] OR "Randomized Controlled Trials as Topic"[mh] OR "Random Allocation"[mh] OR "Double‐Blind Method"[mh] OR "Single‐Blind Method"[mh] OR "Clinical Trial"[pt] OR "Clinical Trials as Topic"[mh] OR "clinical trial"[tw] OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind*[tw])) OR "latin square"[tw] OR Placebos[mh] OR placebo*[tw] OR random*[tw] OR "Research Design"[mh:noexp] OR "Comparative Study"[pt] OR "Evaluation Studies as Topic"[mh] OR "Follow‐up Studies"[mh] OR "Prospective Studies"[mh] OR "Cross‐over Studies"[mh] OR control[tw] OR controls*[tw] OR controla*[tw] OR controle*[tw] OR controli*[tw] OR controll*[tw] OR control'*[tw] OR prospectiv*[tw] OR volunteer*[tw]) NOT (Animals[mh] NOT Humans[mh))

#3 ("sharps"[tw] OR "sharp medical device"[tw] OR "sharp medical devices"[tw] OR "sharp instrument"[tw] OR "sharp instruments"[tw] OR "sharp medical instrument"[tw] OR "sharp medical instruments"[tw] OR "sharp needle"[tw] OR "sharp needles"[tw] OR "syringe*"[tw] OR "IV‐system*"[tw] OR "sharps container*"[tw] OR "safety engineered"[tw] OR “recap*"[tw] OR “device*"[tw])

#2 ("Needlestick injuries"[mh] OR needlestick*[tw] OR "needle stick"[tw] or "needle sticks"[tw] OR "sharp injury"[tw] OR "sharp injuries"[tw] OR "percutaneous exposure"[tw] OR "percutaneous exposures"[tw] OR "percutaneous injury"[tw] OR "percutaneous injuries"[tw] OR "stick injury"[tw] OR "stick injuries"[tw] OR "Wounds, Stab"[mh:noexp] OR "Wounds, Penetrating"[mh:noexp] OR "Facial injuries"[mh:noexp] OR "Eye Injuries, Penetrating"[mh] OR "Arm Injuries"[mh:noexp] OR "Forearm Injuries"[mh:noexp] OR "Hand Injuries"[mh] OR (splash* AND (blood[tw] or secretion*[tw] OR fluid*[tw] OR "Body Fluids"[mh])))

#1 (("Health Personnel"[Majr] OR "health personnel"[tiab] OR "health care personnel"[tw] OR "healthcare personnel"[tw] OR "health care worker"[tw] OR "health care workers"[tw] OR "healthcare worker"[tw] OR "healthcare workers"[tw] OR "health worker"[tw] OR "health workers"[tw] OR "health professional"[tw] OR "health professionals"[tw] OR "health care professional"[tw] OR "health care professionals"[tw] OR "healthcare professional"[tw] OR "healthcare professionals"[tw] OR "medical care personnel"[tw] OR "Health Occupations"[mh] OR "Health Personnel"[mh] OR "Health Facilities”[mh] OR "Infectious Disease Transmission, Patient‐to‐Professional"[mh] OR "dentist*"[tw] OR “anesth*”[tw] OR “anaesth*”[tw] OR “phlebotomist*”[tw] OR “surgeon*”[tw] OR “physician*”[tw] OR "doctor*"[tw] OR "nurse*"[tw] OR “veterinarian*"[tw]))

Study flow diagram for 2017 update
Figuras y tablas -
Figure 1

Study flow diagram for 2017 update

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Safe blood collection systems versus regular systems RCT, Outcome 1 Needlestick injuries immediate follow up.
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Analysis 1.1

Comparison 1 Safe blood collection systems versus regular systems RCT, Outcome 1 Needlestick injuries immediate follow up.

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Comparison 1 Safe blood collection systems versus regular systems RCT, Outcome 2 Blood splashes.
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Analysis 1.2

Comparison 1 Safe blood collection systems versus regular systems RCT, Outcome 2 Blood splashes.

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Comparison 2 Safe blood collection systems versus regular systems ITS, Outcome 1 Number of reported sharps injuries, level.
Figuras y tablas -
Analysis 2.1

Comparison 2 Safe blood collection systems versus regular systems ITS, Outcome 1 Number of reported sharps injuries, level.

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Comparison 2 Safe blood collection systems versus regular systems ITS, Outcome 2 Number of reported sharps injuries, slope.
Figuras y tablas -
Analysis 2.2

Comparison 2 Safe blood collection systems versus regular systems ITS, Outcome 2 Number of reported sharps injuries, slope.

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Comparison 3 Safe intravenous systems versus regular systems RCT, Outcome 1 Needlestick injuries.
Figuras y tablas -
Analysis 3.1

Comparison 3 Safe intravenous systems versus regular systems RCT, Outcome 1 Needlestick injuries.

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Comparison 3 Safe intravenous systems versus regular systems RCT, Outcome 2 Incidences of blood contamination.
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Analysis 3.2

Comparison 3 Safe intravenous systems versus regular systems RCT, Outcome 2 Incidences of blood contamination.

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Comparison 3 Safe intravenous systems versus regular systems RCT, Outcome 3 Incidence of blood leakage.
Figuras y tablas -
Analysis 3.3

Comparison 3 Safe intravenous systems versus regular systems RCT, Outcome 3 Incidence of blood leakage.

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Comparison 4 Safe intravenous systems versus regular systems CBA, Outcome 1 Number of needlestick injuries.
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Analysis 4.1

Comparison 4 Safe intravenous systems versus regular systems CBA, Outcome 1 Number of needlestick injuries.

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Comparison 5 Safe intravenous systems versus regular systems ITS, Outcome 1 Number of reported sharps injuries, level.
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Analysis 5.1

Comparison 5 Safe intravenous systems versus regular systems ITS, Outcome 1 Number of reported sharps injuries, level.

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Comparison 5 Safe intravenous systems versus regular systems ITS, Outcome 2 Number of reported sharps injuries, slope.
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Analysis 5.2

Comparison 5 Safe intravenous systems versus regular systems ITS, Outcome 2 Number of reported sharps injuries, slope.

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Comparison 6 Safe injection systems versus regular systems RCT, Outcome 1 Questionnaire reported Needlestick injuries 6 mo follow up.
Figuras y tablas -
Analysis 6.1

Comparison 6 Safe injection systems versus regular systems RCT, Outcome 1 Questionnaire reported Needlestick injuries 6 mo follow up.

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Comparison 6 Safe injection systems versus regular systems RCT, Outcome 2 Hospital reported Needlestick injuries 6 mo follow up.
Figuras y tablas -
Analysis 6.2

Comparison 6 Safe injection systems versus regular systems RCT, Outcome 2 Hospital reported Needlestick injuries 6 mo follow up.

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Comparison 6 Safe injection systems versus regular systems RCT, Outcome 3 Questionnaire reported Needlestick injuries 12 mo follow up.
Figuras y tablas -
Analysis 6.3

Comparison 6 Safe injection systems versus regular systems RCT, Outcome 3 Questionnaire reported Needlestick injuries 12 mo follow up.

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Comparison 6 Safe injection systems versus regular systems RCT, Outcome 4 Hospital reported Needlestick injuries 12 mo follow up.
Figuras y tablas -
Analysis 6.4

Comparison 6 Safe injection systems versus regular systems RCT, Outcome 4 Hospital reported Needlestick injuries 12 mo follow up.

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Comparison 7 Safe injection systems versus regular systems CBA, Outcome 1 Needlestick injury rate.
Figuras y tablas -
Analysis 7.1

Comparison 7 Safe injection systems versus regular systems CBA, Outcome 1 Needlestick injury rate.

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Comparison 8 Safe passive injection systems versus safe active injection systems ITS, Outcome 1 change in level of needlestick injuries.
Figuras y tablas -
Analysis 8.1

Comparison 8 Safe passive injection systems versus safe active injection systems ITS, Outcome 1 change in level of needlestick injuries.

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Comparison 8 Safe passive injection systems versus safe active injection systems ITS, Outcome 2 Change in slope of needlestick injuries.
Figuras y tablas -
Analysis 8.2

Comparison 8 Safe passive injection systems versus safe active injection systems ITS, Outcome 2 Change in slope of needlestick injuries.

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Comparison 9 Multiple safe devices versus regular devices ITS, Outcome 1 Number of reported sharps injuries, level.
Figuras y tablas -
Analysis 9.1

Comparison 9 Multiple safe devices versus regular devices ITS, Outcome 1 Number of reported sharps injuries, level.

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Comparison 9 Multiple safe devices versus regular devices ITS, Outcome 2 Number of reported sharps injuries, slope.
Figuras y tablas -
Analysis 9.2

Comparison 9 Multiple safe devices versus regular devices ITS, Outcome 2 Number of reported sharps injuries, slope.

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Comparison 10 Multiple safe devices versus regular devices CBA, Outcome 1 Needlestick injuries.
Figuras y tablas -
Analysis 10.1

Comparison 10 Multiple safe devices versus regular devices CBA, Outcome 1 Needlestick injuries.

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Comparison 11 Sharps containers versus no containers ITS, Outcome 1 Number of reported sharps injuries, level.
Figuras y tablas -
Analysis 11.1

Comparison 11 Sharps containers versus no containers ITS, Outcome 1 Number of reported sharps injuries, level.

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Comparison 11 Sharps containers versus no containers ITS, Outcome 2 Number of reported sharps injuries, slope.
Figuras y tablas -
Analysis 11.2

Comparison 11 Sharps containers versus no containers ITS, Outcome 2 Number of reported sharps injuries, slope.

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Comparison 12 Sharps containers versus no containers CBA, Outcome 1 Number of needlestick injuries.
Figuras y tablas -
Analysis 12.1

Comparison 12 Sharps containers versus no containers CBA, Outcome 1 Number of needlestick injuries.

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Comparison 12 Sharps containers versus no containers CBA, Outcome 2 Number of container related needlestick injuries.
Figuras y tablas -
Analysis 12.2

Comparison 12 Sharps containers versus no containers CBA, Outcome 2 Number of container related needlestick injuries.

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Comparison 13 Legislation versus no legislation ITS, Outcome 1 NSI‐ change in level.
Figuras y tablas -
Analysis 13.1

Comparison 13 Legislation versus no legislation ITS, Outcome 1 NSI‐ change in level.

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Comparison 13 Legislation versus no legislation ITS, Outcome 2 NSI‐ Change in slope.
Figuras y tablas -
Analysis 13.2

Comparison 13 Legislation versus no legislation ITS, Outcome 2 NSI‐ Change in slope.

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Summary of findings for the main comparison. (RCT) Safe blood collection systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Safe blood collection systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel (RCTs)

Patient or population: preventing percutaneous exposure injuries caused by needles in healthcare personnel (RCTs)
Setting: emergency care department of hospital
Intervention: Safe blood collection systems
Comparison: regular systems

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with regular systems

Risk with Safe blood collection systems

Needlestick injuries immediate follow up

Study population

RR 0.20
(0.01 to 4.15)

550
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1 2

7 per 1 000

1 per 1 000
(0 to 30)

Blood splashes

Study population

RR 0.14
(0.02 to 1.15)

550
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1 3 4

25 per 1 000

4 per 1 000
(1 to 29)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded the quality of evidence by one level due to risk of bias (selection bias, performance bias and detection bias).
2 We downgraded the quality of evidence by two levels due to imprecision (wide confidence interval and very few events).
3 We downgraded the quality of evidence by one level due to indirectness (blood splashes were actually visible blood leakages).
4 We downgraded the quality of evidence by one level due to imprecision (confidence interval crosses 1).

Figuras y tablas -
Summary of findings for the main comparison. (RCT) Safe blood collection systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel
Ir a la tabla de la revisión
Summary of findings 2. (ITS) Safe blood collection systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Safe blood collection systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel (ITS)

Patient or population: preventing percutaneous exposure injuries caused by needles in healthcare personnel (ITS)
Setting: hospital
Intervention: Safe blood collection systems
Comparison: regular systems

Outcomes

Impact

№ of participants
(studies)

Quality of the evidence
(GRADE)

Number of reported sharps injuries, level ‐ reported seperately for needle sheath and cap shield studies

Needle sheath study: effect size ‐6.88; confidence interval ‐9.53 to ‐4.23. Cap shield study: effect size ‐1.04; confidence interval ‐2.27 to 0.19.

(2 observational studies)

⊕⊝⊝⊝
VERY LOW 1 2 3

Number of reported sharps injuries, slope ‐ reported seperately for needle sheath and cap shield studies

Needle sheath study: effect size ‐1.19; confidence interval ‐2.50 to 0.12. Cap shield study: effect size ‐1.00; confidence interval ‐2.22 to ‐0.22.

(2 observational studies)

⊕⊝⊝⊝
VERY LOW 2 3

Interpretation of effect size: small (0‐0.2) medium (0.2‐0.5) large (0.6 and above), an effect size with negative sign implies decrease and positive sign implies increase of effect.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded the quality of evidence by two levels due to heterogeneity (I² = 93%).
2 We downgraded the quality of evidence by one level due to imprecision (wide confidence interval).
3 We downgraded the quality of evidence by one level due to risk of bias (incomplete data set in one study and use of SED in the intervention period varied in another).

Figuras y tablas -
Summary of findings 2. (ITS) Safe blood collection systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel
Ir a la tabla de la revisión
Summary of findings 3. (RCT) Safe intravenous systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Safe intravenous systems compared to regular systems RCT for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Patient or population: preventing percutaneous exposure injuries caused by needles in healthcare personnel
Setting: hospital (general, medical, surgical and intensive care units)
Intervention: Safe intravenous systems
Comparison: regular systems RCT

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with regular systems RCT

Risk with Safe intravenous systems

Needlestick injuries

Study population

Rate ratio 0.62
(0.27 to 1.41)

(1 RCT, three arms)

⊕⊝⊝⊝
VERY LOW 1 2

Calculated based on 1000 patient days

0.71 per 1 000

0.44 per 1 000
(0.19 to 1.00)

Incidences of blood contamination ‐ Active systems

Study population

RR 1.60
(1.08 to 2.36)

961
(4 RCTs)

⊕⊕⊝⊝
LOW 3 4

92 per 1 000

148 per 1 000
(100 to 218)

Incidences of blood contamination ‐ Passive systems

Study population

RR 0.94
(0.50 to 1.75)

528
(2 RCTs)

⊕⊕⊝⊝
LOW 3 4

79 per 1 000

74 per 1 000
(40 to 138)

Incidence of blood leakage ‐ Active systems

Study population

RR 0.21
(0.11 to 0.37)

147
(1 RCT)

⊕⊕⊝⊝
LOW 5

684 per 1 000

144 per 1 000
(75 to 253)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded the quality of evidence by two levels due to risk of bias (serious attrition).
2 We downgraded the quality of evidence by one level due to imprecision (confidence interval includes 25% benefit and harm).
3 We downgraded the quality of evidence by one level due to risk of bias (studies with high risk of bias contribute most to summary estimate).
4 We downgraded the quality of evidence by one level due to imprecision (wide confidence interval).
5 We downgraded the quality of evidence by two levels due to risk of bias (no random sequence generation, allocation concealment or blinding).

Figuras y tablas -
Summary of findings 3. (RCT) Safe intravenous systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel
Ir a la tabla de la revisión
Summary of findings 4. (CBA) Safe intravenous systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Safe intravenous systems compared to regular systems CBA for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Patient or population: preventing percutaneous exposure injuries caused by needles in healthcare personnel
Setting: hospital
Intervention: Safe intravenous systems
Comparison: regular systems CBA

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with regular systems CBA

Risk with Safe intravenous systems

Number of needlestick injuries

Study population

Rate ratio 0.06
(0.00 to 1.09)

(1 observational study)

⊕⊝⊝⊝
VERY LOW 1 2

36.36 per 1 000

2.18 per 1 000
(0.00 to 39.63)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded the quality of evidence by two levels due to risk of bias (no random sequence generation or allocation concealment).
2 We downgraded the quality of evidence by one level due to imprecision (wide confidence interval).

Figuras y tablas -
Summary of findings 4. (CBA) Safe intravenous systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel
Ir a la tabla de la revisión
Summary of findings 5. (ITS) Safe intravenous systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Safe intravenous systems compared to regular systems ITS for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Patient or population: preventing percutaneous exposure injuries caused by needles in healthcare personnel
Setting: healthcare
Intervention: Safe intravenous systems
Comparison: regular systems ITS

Outcomes

Impact

№ of participants
(studies)

Quality of the evidence
(GRADE)

Number of reported sharps injuries, level

Study 1: effect size ‐5.20; confidence interval ‐7.98 to ‐2.42. Study 2: effect size ‐1.78; confidence interval ‐3.09 to ‐0.47.

(2 observational studies)

⊕⊝⊝⊝
VERY LOW 1 2 3

Number of reported sharps injuries, slope

Study 1: Effect size ‐7.86; confidence interval ‐9.13 to ‐6.59. Study 2: Effect size 0.35; confidence interval ‐0.20 to 0.90.

(2 observational studies)

⊕⊝⊝⊝
VERY LOW 1 3 4

Interpretation of effect size: small (0‐0.2) medium (0.2‐0.5) large (0.6 and above), a effect size with negative sign implies decrease and positive sign implies increase of effect.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded the quality of evidence by one level due to risk of bias caused by lacking intervention fidelity (in the second study conventional devices were used during intervention period).
2 We downgraded the quality of evidence by one level due to heterogeneity (I² = 79%).
3 We downgraded the quality of evidence by one level due to imprecision (wide confidence interval).
4 We downgraded the quality of evidence by two levels due to heterogeneity (I² = 99%).

Figuras y tablas -
Summary of findings 5. (ITS) Safe intravenous systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel
Ir a la tabla de la revisión
Summary of findings 6. (RCT) Safe injection systems compared to regular systems RCT for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Safe injection systems compared to regular systems RCT for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Patient or population: preventing percutaneous exposure injuries caused by needles in healthcare personnel
Setting: hospital
Intervention: Safe injection systems
Comparison: regular systems RCT

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with regular systems RCT

Risk with Safe injection systems

Questionnaire reported Needlestick injuries 6 mo follow up

Study population

RR 0.42
(0.14 to 1.25)

154
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1 2

140 per 1 000

59 per 1 000
(20 to 174)

Questionnaire reported Needlestick injuries 12 mo follow up

Study population

OR 0.20
(0.04 to 0.96)

144
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1 2

119 per 1 000

26 per 1 000
(5 to 115)

Hospital reported Needlestick injuries 6 mo follow up

Study population

OR 1.20
(0.51 to 2.84)

533
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1 2

38 per 1 000

45 per 1 000
(20 to 100)

Hospital reported Needlestick injuries 12 mo follow up

Study population

OR 0.72
(0.28 to 1.81)

533
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1 2

41 per 1 000

30 per 1 000
(12 to 72)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded the quality of evidence by two levels due to risk of bias (high attrition).
2 We downgraded the quality of evidence by one level due to imprecision (wide confidence interval).

Figuras y tablas -
Summary of findings 6. (RCT) Safe injection systems compared to regular systems RCT for preventing percutaneous exposure injuries caused by needles in healthcare personnel
Ir a la tabla de la revisión
Summary of findings 7. (CBA) Safe injection systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Safe injection systems compared to regular systems CBA for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Patient or population: preventing percutaneous exposure injuries caused by needles in healthcare personnel
Setting: dental clinic
Intervention: Safe injection systems
Comparison: regular systems CBA

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with regular systems CBA

Risk with Safe injection systems

Needlestick injury rate

Study population

Rate ratio 0.34
(0.04 to 3.28)

(1 observational study)

⊕⊝⊝⊝
VERY LOW 1 2

Calculated based on 1000 person years

236 per 1 000

80.24 per 1 000
(9.44 to 774)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded the quality of evidence by two levels due to risk of bias (no random sequence generation or allocation concealment).
2 We downgraded the quality of evidence by two levels due to imprecision (wide confidence interval).

Figuras y tablas -
Summary of findings 7. (CBA) Safe injection systems compared to regular systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel
Ir a la tabla de la revisión
Summary of findings 8. (ITS) Safe passive injection systems compared to safe active injection systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Safe passive injection systems compared to safe active injection systems ITS for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Patient or population: preventing percutaneous exposure injuries caused by needles in healthcare personnel
Setting: hospital
Intervention: Safe passive injection systems
Comparison: safe active injection systems ITS

Outcomes

Impact

№ of participants
(studies)

Quality of the evidence
(GRADE)

Change in level of needlestick injuries

Effect size 0.23; confidence interval ‐1.89 to 2.35.

(1 observational study)

⊕⊝⊝⊝
VERY LOW 1

Change in slope of needlestick injuries

Effect size ‐0.74; confidence interval ‐1.66 to 0.18.

(1 observational study)

⊕⊕⊝⊝
LOW 1

Interpretation of effect size: small (0‐0.2) medium (0.2‐0.5) large (0.6 and above), a effect size with negative sign implies decrease and positive sign implies increase of effect.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded the quality of evidence by one level due to imprecision (wide confidence interval).

Figuras y tablas -
Summary of findings 8. (ITS) Safe passive injection systems compared to safe active injection systems for preventing percutaneous exposure injuries caused by needles in healthcare personnel
Ir a la tabla de la revisión
Summary of findings 9. (ITS) Multiple safe devices compared to regular devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Multiple safe devices compared to regular devices ITS for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Patient or population: preventing percutaneous exposure injuries caused by needles in healthcare personnel
Setting: healthcare
Intervention: Multiple safe devices
Comparison: regular devices ITS

Outcomes

Impact

№ of participants
(studies)

Quality of the evidence
(GRADE)

Number of reported sharps injuries, level

Study 1: effect size ‐1.04; confidence interval ‐2.20 to 0.12. Study 2: effect size 0.43; confidence interval ‐0.30 to 1.16.

(2 observational studies)

⊕⊝⊝⊝
VERY LOW 1 2 3

Number of reported sharps injuries, slope

Study 1: effect size ‐0.01; confidence interval ‐0.15 to 0.13. Study 2: effect size 0.56; confidence interval 0.23 to 0.89.

(2 observational studies)

⊕⊝⊝⊝
VERY LOW 1 4

Interpretation of effect size: small (0‐0.2) medium (0.2‐0.5) large (0.6 and above), a effect size with negative sign implies decrease and positive sign implies increase of effect.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded the quality of evidence by one level due to risk of bias (One study had a low risk of bias but the other study had a high risk as conventional devices were still available after the intervention began).
2 We downgraded the quality of evidence by one level due to heterogeneity (I² = 78%).
3 We downgraded the quality of evidence by one level due to imprecision (wide confidence interval).
4 We downgraded the quality of evidence by one level due to heterogeneity (I² = 90%).

Figuras y tablas -
Summary of findings 9. (ITS) Multiple safe devices compared to regular devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel
Ir a la tabla de la revisión
Summary of findings 10. (CBA) Multiple safe devices compared to regular devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Multiple safe devices compared to regular devices CBA for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Patient or population: preventing percutaneous exposure injuries caused by needles in healthcare personnel
Setting: hospital
Intervention: Multiple safe devices
Comparison: regular devices CBA

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with regular devices CBA

Risk with Multiple safe devices

Needle stick injuries

Study population

Rate ratio 0.11
(0.01 to 0.81)

(1 observational study)

⊕⊝⊝⊝
VERY LOW 1 2

Calculated based on 1000 patient days

0.44 per 1 000

0.052 per 1 000
(0.004 to 0.35)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded the quality of evidence by two levels due to risk of bias (no random sequence generation or allocation concealment).
2 We downgraded the quality of evidence by one level due to imprecision (wide confidence interval).

Figuras y tablas -
Summary of findings 10. (CBA) Multiple safe devices compared to regular devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel
Ir a la tabla de la revisión
Summary of findings 11. (ITS) Sharps containers compared to no containers for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Sharps containers compared to no containers ITS for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Patient or population: preventing percutaneous exposure injuries caused by needles in healthcare personnel
Setting: hospital
Intervention: Sharps containers
Comparison: no containers ITS

Outcomes

Impact

№ of participants
(studies)

Quality of the evidence
(GRADE)

Number of reported sharps injuries, level

Study 1: effect size 3.29; confidence interval 0.68 to 5.90. Study 2: effect size 1.35; confidence interval ‐1.75 to 4.45.

(2 observational studies)

⊕⊝⊝⊝
VERY LOW 1 2

Number of reported sharps injuries, slope

Study 1: effect size 0.02; confidence interval ‐1.06 to 1.10. Study 2: effect size 2.55; confidence interval 1.20 to 3.90.

(2 observational studies)

⊕⊝⊝⊝
VERY LOW 1 2 3

Interpretation of effect size: small (0‐0.2) medium (0.2‐0.5) large (0.6 and above), a effect size with negative sign implies decrease and positive sign implies increase of effect.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded the quality of evidence by one level due to inconsistency (study 2 showed an increase in reporting).
2 We downgraded the quality of evidence by two levels due to imprecision (wide confidence interval).
3 We downgraded the quality of evidence by one level due to heterogeneity (I² = 88%).

Figuras y tablas -
Summary of findings 11. (ITS) Sharps containers compared to no containers for preventing percutaneous exposure injuries caused by needles in healthcare personnel
Ir a la tabla de la revisión
Summary of findings 12. (CBA) Sharps containers compared to no containers for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Sharps containers compared to no containers CBA for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Patient or population: preventing percutaneous exposure injuries caused by needles in healthcare personnel
Setting: hospital
Intervention: Sharps containers
Comparison: no containers CBA

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with no containers CBA

Risk with Sharps containers

Number of needlestick injuries

Study population

Rate ratio 0.88
(0.78 to 0.99)

(1 observational study)

⊕⊝⊝⊝
VERY LOW 1 2

28.3 per 1 000

24.9 per 1 000
(22 to 28)

Number of container related needlestick injuries

Study population

Rate ratio 0.22
(0.11 to 0.41)

(1 observational study)

⊕⊝⊝⊝
VERY LOW 1 2

2.6 per 1 000

0.6 per 1 000
(0.28 to 1.06)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded the quality of evidence by two levels due to risk of bias (no random sequence generation or allocation concealment).
2 We downgraded the quality of evidence by one level due to imprecision (wide confidence interval).

Figuras y tablas -
Summary of findings 12. (CBA) Sharps containers compared to no containers for preventing percutaneous exposure injuries caused by needles in healthcare personnel
Ir a la tabla de la revisión
Summary of findings 13. (ITS) Legislation compared to no legislation for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Legislation compared to no legislation ITS for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Patient or population: preventing percutaneous exposure injuries caused by needles in healthcare personnel
Setting: healthcare
Intervention: Legislation
Comparison: no legislation ITS

Outcomes

Impact

№ of participants
(studies)

Quality of the evidence
(GRADE)

NSI‐ change in level ‐ Interruption

Effect size ‐6.15; confidence interval ‐7.76 to ‐4.54.

(2 observational studies)

⊕⊕⊕⊝
MODERATE 1

NSI‐ change in level ‐ Gradual introduction

Effect size 0.80; confidence interval 0.41 to 1.19.

(1 observational study)

⊕⊕⊝⊝
LOW 1

NSI‐ Change in slope ‐ Interruption

Effect size ‐0.94; confidence interval ‐1.97 to 0.09

(2 observational studies)

⊕⊝⊝⊝
VERY LOW 1 2

NSI‐ Change in slope ‐ Gradual introduction

Effect size 0.50; confidence interval 0.36 to 0.64

(1 observational study)

⊕⊕⊝⊝
LOW 1

Interpretation of effect size: small (0‐0.2) medium (0.2‐0.5) large (0.6 and above), a effect size with negative sign implies decrease and positive sign implies increase of effect.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded the quality of evidence by one level due to risk of bias (dataset did not represent the whole sample).
2 We downgraded the quality of evidence by one level due to imprecision (wide confidence interval).

Figuras y tablas -
Summary of findings 13. (ITS) Legislation compared to no legislation for preventing percutaneous exposure injuries caused by needles in healthcare personnel
Ir a la tabla de la revisión
Table 1. Content of the interventions

Study name

Device Commercial Names

Device Category

Safety Device type

passive/

active

For sale?

Asai 1999 active

Insyte AutoGuard intravenous cannula

Safe IV system (insertion)

button for actively retracting the needle

active

Yes

Asai 2002 active

Insyte Autoguard intravenous cannula

Safe IV system (insertion)

button for actively retracting the needle

active

Yes

Asai 2002 passive

Protective Acuvance

Safe IV system (insertion)

automated retraction of needle

passive

Yes

Azar‐Cavanagh 2007

Unnamed intravenous catheter stylet

Safe IV system (insertion)

retractable protection shield

active?

?

Baskin 2014

BD Eclipse injector 3‐mL, BD preset syringe with BD Luer‐Lok tip 25G×1

Blood collection

cannula protection shield is activated with one hand after puncture and clicks irreversibly over the cannula

active

Yes

Chambers 2015 hospitals

not reported

Multiple safe devices

safety engineered needles and needleless devices

passive or semi‐automatic

?

Chambers 2015 long‐term nursing care

nor reported

Multiple safe devices

safety engineered needles and needleless devices

passive or semi‐automatic

?

Cote 2003

Angiocath Autoguard IV catheters

Safe IV system (insertion)

button for actively retracting the needle

active

Yes

Edmond 1988

Winfield sharpsguard

Sharps container

bedside sharps container

n.a.

No

Gaballah 2010

Unnamed safety dental syringes

Injection system

does not require re‐sheating or removal of the needle from its syringe

passive?

?

Goldwater 1989

Needle guard Biosafe New Zealand

Blood collection

shield on cap prevents injury while recapping

n.a.

No

Goris 2015

Unnamed safety engineered passive retractable syringes

Injection system

automatically and instantly retracts the needle from the patient into the barrel of the syringe

passive

?

Grimmond 2010

Daniels sharpsmart

Sharps container

bedside sharps container

n.a.

Yes

L'Ecuyer 1996 2wva

2‐way valve Safsite Braun medical

Safe IV system (insertion and needleless)

two valve system with plastic sharp that remains in the device

passive

Yes

L'Ecuyer 1996 mbc

Lifeshield metal blunt cannula

Safe IV system (needleless iv system)

metal blunt cannula

passive

Yes

L'Ecuyer 1996 pbc

Interlink PBC plastic cannula

Safe IV system (insertion and needleless)

plastic sharp covered by blunt plastic cannula

passive

Yes

Mendelson 1998

1‐valve Safsite Braun medical

Safe IV system (needleless)

valve of IV system incompatible with needle

passive

Yes

Phillips 2013

safety engineered sharps

Multiple safe devices

not explained

?

?

Prunet 2008 active

Insyte Autoguard intravenous cannula

Safe IV system (insertion)

button for actively retracting the needle

active

Yes

Prunet 2008 passive

Introcan Safety IV system (Braun)

Safe IV system (insertion)

automatic shield on needle tip at withdrawing

passive

Yes

Reddy 2001

'safety syringes and needleless IV'

Multiple safe devices

not explained

?

?

Richard 2001

'sharps containers'

Sharps container

first in treatment rooms later bedside placements

?

?

Rogues 2004

SafetyLock BD, resheathable winged steel needle

Blood collection

after pushing (two handed) needle retracts into sheath

active

Yes

Seiberlich 2016

ViaValve safety I.V. catheter

Safe IV system

(insertion)

contains a valve that is designed to restrict blood flow back out of the catheter hub upon initial venipuncture

active

Yes

Sossai 2010

Introcan safety IV system (Braun)

Safe IV system (insertion)

automatic shield on needle tip at withdrawing

passive

Yes

Valls 2007

Eclipse BD; Saf‐T‐ E‐Z Set, BD; Surshield, Terumo; Preserts BD; Provent plus, Smiths; Genie BD; Surgilance Terumo; Blunt administration needles BD

Multiple systems

n.a.

active and passive

Yes

van der Molen 2011

Eclipse BD

Injection system

after injection needle covered with shield

active

Yes

Whitby 2008

VanishPoint; VanishPoint blood tube holders; BD Safety‐Lok; SmartSite needle‐free system; Smartsite Plus

Multiple systems

retractable syringes, needle‐free IV systems and safety winged butterfly needles.

passive

Yes

Zakrzweska 2001

Safety Plus Septodont (Dental injections)

Injection system

Protective sheaths can be temporarily or definitely protect the needle

active

Yes
Figuras y tablas -
Table 1. Content of the interventions
Ir a la tabla de la revisión
Table 2. Risk of bias in ITS studies

Study

Intervention independent of other changes

Sufficient data points

Test for trend

Intervention did not affect data collection

Blinded outcome assessment

Complete data set

Reliable outcome measure

Total score

Goldwater 1989

Not done (0)

Comment: staff turnover during study period. Staff preference for the use of the intervention devices varied across study periods.

Done (1)

Comment: inlcusion of 3 data points before and after, the study was reanalysed using ARIMA model.

Done (1)

Comment: we reanalysed the study for trend.

Done (1)

Data collection seems to remained the same pre and post‐intervention.

Not clear (0)

Authors do not provide information on blinding.

Done (1)

Not clear (0):

Comment: no system for NSI seems to have been in placed during the study period. Uncertain about the consistency of the reporting during the study period.

4

Rogues 2004

Done (1)

Quote: "Conventional phlebotomy non‐safety devices were removed from all departments, and the new products were in place on implementation"

Comment: only one device seems to have been introduced during intervention but authors do not specify if additional changes occurred during the study.

Done (1)

Comment: inlcusion of 3 data points before and after, the study was reanalysed using ARIMA model.

Done (1)

Comment: we reanalysed the study for trend.

Done (1)

Comment: the method of data collection remains the same throughout the study. It does not appears to be influenced by the intervention.

Not clear (0)

Comment

No information is available on blinding.

Not done (0)

Comment: data not available for the estimated number of phlebotomies performed for 1993 and 1994.

Done (1)

Comment: hospital has a sharp injury surveillance system prior and after intervention. Althought not ideal as possibility of underreporting but appropriate for the study outcome.

5

Reddy 2001

Not done (0)

Quote: one of the confounder present throughout the post intervention phase was the availability of traditional needles devices.

Comment:

intervention occurs simultaneously with the availability of non‐safety device.

Done (1)

Comment:

inlcusion of 3 data points before and after, the study was reanalysed using ARIMA model.

Done (1)

Comment: we reanalysed the study for trend.

Done (1)

Comment: the method of data collection remains the same throughout the study. It does not appears to be influenced by the intervention.

Not clear (0)

Comment:

no information available on blinding

Not done (0)

Comment: physicians were excluded from analysis as no information on FTE.

Done (1)

Comment: hospital had a sharp injury surveillance system prior and after intervention. Althought no ideal as possibility of underreporting but appropriate for the study outcome.

4

Azar‐Cavanagh 2007

Done (1)

Comment: safety devices seem to have systematically replaced the conventional devices. Authors do not specify if additional changes occurred during the study.

Done (1)

Comment:

inlcusion of 3 data points before and after, the study was reanalysed using ARIMA model.

Done (1)

Comment: we reanalysed the study for trend.

Done (1)

Comment: the method of data collection remains the same throughout the study. It does not appears to be influenced by the intervention.

Not clear (0)

Comment: authors do not specify if data analysts were blinded to the study. Healthcare workers could not have been blinded to the introduction of the new devices.

Done (1)

Comment: data is available for all health workers.

Done (1)

Coment:

6

Sosai 2010

Not done (0)

Comment: authors indicated that some conventional devices were still used during the intervention period despite study which aimed to replace all conventional devices by new safety devices.

Done (1)

comment:

inlcusion of 3 data points before and after, the study was reanalysed using ARIMA model.

Done (1)

Comment: we reanalysed the study for trend.

Not done (0)

Quote: "after launching the sharps awareness campaign in 2003, # of injuries increased possibility because of sharps awareness campaign"

Comment: intervention seems to have affected reporting of NSI.

Not clear (0)

Comment: information on blinding is not reported.

Done (1)

Comment: all hospital employees were included in the study.

Done (1)

Comment: used the incident reporting system throughout the study which appears to be adequate measure for NSI.

4

Edmond 1988

Not clear (0)

Comment:

no information if additional changes were introduced during the same period at the hospital.

Done (1)

Comment:

inlcusion of 3 data points before and after, the study was reanalysed using ARIMA model.

Done (1)

Comment: we reanalysed the study for trend.

Done (1)

Comment: intervention does not appears to have affected method of data collection.

Not clear (0)

Quote: "the subjects were unaware of the nature of the study".

Comment: the reporting of the NSI was not likely to be affected by the staff knowing of the study. However, health workers would be aware of the change in the type of devices used.

Not clear (0)

Comment: information about the number of nurses for pre‐intervention but not for post‐intervention. For NSI, the number of staff per year is not available.

Done (1)

Comment: authors used employee health records for pre and post intervention. For NSI, this system appears reliable for the outcome of interest.

4

Richard 2001

Not clear (0)

Comment:

no information if additional changes were introduced during the same period at the hospital.

Done (1)

Comment:

inlcusion of 3 data points before and after, the study was reanalysed using ARIMA model.

Done (1)

Comment: we reanalysed the study for trend.

Not done (0)

Quote: the increase in total injuries reported in 1998 followed a better reporting stimulated by the second educational program.

Comment: the reporting system started in 1993, it is possible that as more people became aware of the surveillance system, there was an increase in reporting.

Not clear (0)

Comment:

No information is available on blinding

Not clear (0)

Comment: no information on the actual number of healthcare workers included during pre and post intervention.

Not clear (0)

Comment: it is unclear if the reporting system was used consistently throughout the years especially as it was launched during the early phase of the study.

2

Chambers 2015 hospitals

Done (1)

Comment: safety devices seem to have replaced the conventional devices due to legislation.

Done (1)

Comment:

inlcusion of 3 data points before and after, the study was reanalysed using ARIMA model.

Done (1)

Comment: we reanalysed the study for trend.

Not clear (0)

Comment: Increased attention to needle stick injury prevention during the period of regulatory change may have resulted in increased reporting.

Done (1)

Comment: data was obtained from an administrative source.

Not done (0)

Comment: the data set represented 63 percent of all needlestick injury claims.

Done (1)

Comment: authors used work place safety and insurance board data for compensation claims. For NSI, this system appears reliable for the outcome of interest.

5

Chambers 2015 long‐term nursing care

Done (1)

Comment: safety devices seem to have replaced the conventional devices due to legislation.

Done (1)

Comment:

inlcusion of 3 data points before and after, the study was reanalysed using ARIMA model.

Done (1)

Comment: we reanalysed the study for trend.

Not clear (0)

Comment: Increased attention to needle stick injury prevention during the period of regulatory change may have resulted in increased reporting.

Done (1)

Comment: data was obtained from an administrative source.

Not done (0)

Comment: the data set represented 63 percent of all needlestick injury claims.

Done (1)

Comment: authors used work place safety and insurance board data for compensation claims. For NSI, this system appears reliable for the outcome of interest.

5

Goris 2015

Done (1)

Quote: "The existing inventories of subcutaneous active safety‐engineered devices were removed and replaced with subcutaneous passive safety‐engineered devices"

Comment: All conventional devices were replaced by safety‐engineered devices at the start of the intervention.

Done (1)

Comment:

inlcusion of 3 data points before and after, the study was reanalysed using ARIMA model.

Done (1)

Comment: we reanalysed the study for trend.

Not clear (0)

Comment: the reporting might have increased after inrodcution of the passive safety‐engineered device due to heightened awareness.

Done (1)

Comment: data was obtained from an administrative source.

Done (1)

Comment: data for all the healthcare workers was provided in the form of employee productive hours in the pre and post intervention phase.

Done(1)

Comment: authors used BJC occupational health database records for pre and post intervention. This being administrative data appears to be reliable for the outcome of interest.

6

Phillips 2013

Done (1)

Comment: safety devices seem to have replaced the conventional devices due to legislation.

Done (1)

Comment:

inlcusion of 3 data points before and after, the study was reanalysed using ARIMA model.

Done (1)

Comment: we reanalysed the study for trend.

Not clear (0)

Done (1)

Comment: data was obtained from an administrative source.

Not done (0)

Comment: Data set represented only 73% of the total sample.

Done (1)

Comment: Data was obtained from the US Exposure Prevention Information Network (EPINet) sharps injury surveillance database. This appears to be adequate measure for NSIs.

5

Whitby 2008

Not clear (0)

Done (1)

Comment:

inlcusion of 3 data points before and after, the study was reanalysed using ARIMA model.

Done (1)

Comment: we reanalysed the study for trend.

Done (1)

Comment: the constant and unchanging rate of NSI with solid suture needles implies that reduction of NSI relates neither to the education program associated or increased reporting rates.

Not done (0)

Comment: health workers were aware of the change in the type of devices used.

Done (1)

Comment: data is available for all health workers.

Done (1)

Comment: used the same system of reporting of NSI in pre and post intervention period to the infectious diseases department which has been in place since 1996.

5
Figuras y tablas -
Table 2. Risk of bias in ITS studies
Ir a la tabla de la revisión
Table 3. Grading of the evidence

Comparison and outcome

Starting level

Risk of bias

Consistency

Directness

Precision

Publication bias

Quality of evidence

Safe versus traditional blood collection systems RCT ‐ all outcomes

high

1 RCT high RoB

consistent

direct

wide CI

impossible

to determine

very low

Safe versus traditional blood collection systems ITS

low

2 ITS high RoB

consistent

direct

wide CI

impossible

to determine

very low

Safe versus traditional IV systems RCT ‐ all outcomes

high

5 RCT high RoB, 1 RCT low RoB

consistent

direct

wide CI

impossible to determine

very low

Safe versus traditional IV systems CBA

low

1 CBA high RoB

consistent

direct

wide CI

impossible to determine

very low

Safe versus traditional IV systems ITS

low

1 ITS low RoB, 1 ITS high RoB

consistent

direct

wide CI

impossible to determine

very low

Safe versus traditional injection systems RCT

high

1 RCT high RoB

consistent

indirect; hospital

wide CI

impossible to determine

very low

Safe versus traditional injection systems CBA

low

1 CBA high RoB

consistent

indirect; dentists

wdie CI

impossible to determine

very low

Safe pasive injection systems versus safe active injection systems ITS

low

1 ITS low RoB

consistent

direct

wide CI

impossible to determine

very low

Multiple safe versus traditional devices ITS

low

2 ITS high RoB

inconsistent

direct

wide CI

impossible to determine

very low

Multiple safe versus traditional devices CBA

low

1 CBA high RoB

consistent

direct

wide CI

impossible to determine

very low

Sharps containers versus no containers ITS

low

1 ITS low RoB, 1 ITS high RoB

inconsistent

direct

wide CI

impossible to determine

very low

Sharps containers versus no containers CBA ‐ all outcomes

low

1 CBA high RoB

consistent

direct

wide CI

impossible to determine

very low

Legislation versus no legislation ITS

low

2 ITS high RoB

consistent

direct

wide CI

impossible to determine

low
Figuras y tablas -
Table 3. Grading of the evidence
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Comparison 1. Safe blood collection systems versus regular systems RCT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Needlestick injuries immediate follow up Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Blood splashes Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. Safe blood collection systems versus regular systems RCT
Ir a la tabla de la revisión
Comparison 2. Safe blood collection systems versus regular systems ITS

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of reported sharps injuries, level Show forest plot

2

Effect Size (Random, 95% CI)

‐3.84 [‐9.56, 1.88]

1.1 Cap shield

1

Effect Size (Random, 95% CI)

‐1.04 [‐2.27, 0.19]

1.2 Needle sheath

1

Effect Size (Random, 95% CI)

‐6.88 [‐9.53, ‐4.23]

2 Number of reported sharps injuries, slope Show forest plot

2

Effect Size (Fixed, 95% CI)

Totals not selected

2.1 Cap shield

1

Effect Size (Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 Needle sheath

1

Effect Size (Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 2. Safe blood collection systems versus regular systems ITS
Ir a la tabla de la revisión
Comparison 3. Safe intravenous systems versus regular systems RCT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Needlestick injuries Show forest plot

3

Rate Ratio (Fixed, 95% CI)

0.62 [0.27, 1.41]

2 Incidences of blood contamination Show forest plot

6

1489

Risk Ratio (M‐H, Fixed, 95% CI)

1.38 [1.00, 1.92]

2.1 Active systems

4

961

Risk Ratio (M‐H, Fixed, 95% CI)

1.60 [1.08, 2.36]

2.2 Passive systems

2

528

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.50, 1.75]

3 Incidence of blood leakage Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Active systems

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 3. Safe intravenous systems versus regular systems RCT
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Comparison 4. Safe intravenous systems versus regular systems CBA

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of needlestick injuries Show forest plot

1

Rate Ratio (Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 4. Safe intravenous systems versus regular systems CBA
Ir a la tabla de la revisión
Comparison 5. Safe intravenous systems versus regular systems ITS

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of reported sharps injuries, level Show forest plot

2

Effect Size (Random, 95% CI)

Totals not selected

2 Number of reported sharps injuries, slope Show forest plot

2

Effect Size (Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 5. Safe intravenous systems versus regular systems ITS
Ir a la tabla de la revisión
Comparison 6. Safe injection systems versus regular systems RCT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Questionnaire reported Needlestick injuries 6 mo follow up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2 Hospital reported Needlestick injuries 6 mo follow up Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Questionnaire reported Needlestick injuries 12 mo follow up Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4 Hospital reported Needlestick injuries 12 mo follow up Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 6. Safe injection systems versus regular systems RCT
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Comparison 7. Safe injection systems versus regular systems CBA

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Needlestick injury rate Show forest plot

1

Rate Ratio (Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 7. Safe injection systems versus regular systems CBA
Ir a la tabla de la revisión
Comparison 8. Safe passive injection systems versus safe active injection systems ITS

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 change in level of needlestick injuries Show forest plot

1

Effect size (Random, 95% CI)

Totals not selected

2 Change in slope of needlestick injuries Show forest plot

1

Effect Size (Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 8. Safe passive injection systems versus safe active injection systems ITS
Ir a la tabla de la revisión
Comparison 9. Multiple safe devices versus regular devices ITS

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of reported sharps injuries, level Show forest plot

2

Effect Size (Random, 95% CI)

Totals not selected

2 Number of reported sharps injuries, slope Show forest plot

2

Effect Size (Random, 95% CI)

0.25 [‐0.30, 0.81]
Figuras y tablas -
Comparison 9. Multiple safe devices versus regular devices ITS
Ir a la tabla de la revisión
Comparison 10. Multiple safe devices versus regular devices CBA

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Needlestick injuries Show forest plot

1

Rate Ratio (Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 10. Multiple safe devices versus regular devices CBA
Ir a la tabla de la revisión
Comparison 11. Sharps containers versus no containers ITS

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of reported sharps injuries, level Show forest plot

2

Effect Size (Random, 95% CI)

2.49 [0.49, 4.48]

2 Number of reported sharps injuries, slope Show forest plot

2

Effect Size (Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 11. Sharps containers versus no containers ITS
Ir a la tabla de la revisión
Comparison 12. Sharps containers versus no containers CBA

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of needlestick injuries Show forest plot

1

Rate Ratio (Fixed, 95% CI)

Totals not selected

2 Number of container related needlestick injuries Show forest plot

1

Rate Ratio (Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 12. Sharps containers versus no containers CBA
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Comparison 13. Legislation versus no legislation ITS

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 NSI‐ change in level Show forest plot

3

Effect Size (Random, 95% CI)

Subtotals only

1.1 Interruption

2

Effect Size (Random, 95% CI)

‐6.15 [‐7.76, ‐4.54]

1.2 Gradual introduction

1

Effect Size (Random, 95% CI)

0.80 [0.41, 1.19]

2 NSI‐ Change in slope Show forest plot

3

Effect Size (Random, 95% CI)

Subtotals only

2.1 Interruption

2

Effect Size (Random, 95% CI)

‐0.94 [‐1.97, 0.09]

2.2 Gradual introduction

1

Effect Size (Random, 95% CI)

0.5 [0.36, 0.64]
Figuras y tablas -
Comparison 13. Legislation versus no legislation ITS
Ir a la tabla de la revisión