Interventions to Prevent Needle Stick Injuries Assignment 2022

Running head: INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
Interventions to prevent needle stick injuries
Name of the student:
Name of the University:
Author’s note

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
Literature review: interventions to prevent needle stick injuries
Introduction:
Needle stick and sharp injuries (NSIs) are the most occupational hazards in health care
setting, that expose health care workers to percutaneous exposure to infection. Such injury is
caused by suture or hollow-bore needles or any other sharp equipment. Transmission of many
blood borne-infections occurs through NSIs (Motaarefi et al., 2016). For example, the
transmission of hepatitis C virus (HCV), hepatitis B virus (HBV) and the human
immunodeficiency virus (HIV) occurs through NSIs which ultimately result in impaired quality
of life, incurring health care cost and poor life expectancy. The burden of NSIs, in understood
from the fact that every year large number of health care workers are exposed such blood-borne
diseases because of NSIs (Bhardwaj et al., 2014). For registered nurse too, it is a main job related
injury that has serious long-term impact on their health. As such injuries threaten physical and
psychosocial well-being of nurses, there is a need to identify best interventions that can helps to
prevent such injuries (Motaarefi et al., 2016). This literature review is focused on the research
problem of high incidence of NSIs and it aims to find the best available interventions that can
prevent NSIs.
Research question:
The main research question that will guide the literature review process and systematic
review of papers include:
For health care workers (P), what is the most effective strategy or interventions (I) compared to
no intervention (C) to prevent risk of NSIs (O) during clinical practice?

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
The significance of the question is that it is based on PICO (Population, intervention,
comparator and outcome) approach and it defines each of the PICO elements effectively. The
PICO elements for the questions are as follows:
Population (P): Health care workers
Intervention (I): Strategies or interventions to prevent NSI
Comparator (C): No intervention
Outcome (O): Preventing risk of NSIs
Search strategy:
The search for articles was done in CINAHL and PubMed and search terms were created
by identify phrases from the research question. The key search terms that was used to retrieved
articles from the database included ‘prevention of NSIs’, ‘intervention to prevent NSI’, ‘Nursing
staff’ and ‘health care workers. The key terms were combined with Boolean operators like
‘AND’ and ‘OR’ to get more number of papers specific to the research questions. For example,
some of the key search terms were combined in the following ways:
● Prevention of NSIs AND nursing
● Prevention of NSIs AND health care workers
● NSI interventions AND nursing
To further enhance the efficacy of the search process, advanced search filters from the
database were used to define language, publication date and types of articles to be searched. The
language for the papers were set to English, type of papers were set to ‘journal articles and the
publication date was set to ‘2011 to 2019”.

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
The PRISMA framework was followed to screen all the research articles and find the papers
eligible for the systematic review. All the research identified through database search were first
screened by identifying number of duplicate papers. The articles remaining after excluding
duplicates were reviewed by checking the abstract and titles. Those articles were included which
gave no idea about interventions related to NSIs. In addition, eligibility of the remaining articles
for inclusion in the literature review was done by reviewing the full text articles and identifying
whether the paper gives answer to the research question or not. The flow chart for the search
process is given in table 1. The analysis of quality and validity of the papers were done using the
CASP tool.
Table 1: Literature flow chart

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Step 1: Literature search using broad key terms
(n = 80)
Step 2: Papers not meeting the inclusion
criteria by title and abstract
(n =25 )
Step 3: Selection of papers review by
authors: Records screened
(n = 55)
Step 4: Full-text articles assessed by authors
(n = 50 )
Step 5: Total number of
papers exploring needle
stick injuries
(n =50 )
Step 6: 45 papers excluded due to poor research
rigour
Step 7: Papers reviewed for
interventions related to NSI
(n=5)
Key findings and discussion:
Study selection:
By using the search terms as mentioned in the search strategy, 80 articles were identified

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
from CINAHL and PubMed. After combing all the articles and assessing for duplicates, 15
duplicate articles were removed. The remaining 65 articles were screened based on inclusion and
exclusion criteria. 40 records were excluded as these papers did not fulfill the inclusion and
exclusion criteria. Full text articles of 24 papers were then analyzed for eligibility by looking at
research design, sample type and interventions. By the use of this approach, 20 articles were
excluded and the rest five was selected for the literature review. The summary of search is given
in PRISMA flowchart in table 1.
By the review of literature using a systematic review approach, five papers were found
relevant to the research question. Out of these five papers, four of them were experiment based
studies and one was a meta-analysis. A short summary of each of the papers taken giving details
about author, methodology, participants, key findings and detailed description of key findings
has been provided in table 2. From the analysis of five papers, it has been found that many
varieties of interventions or preventive steps have been taken to prevent NSIs. These include use
of safety engineered devices (SED), educational training or preventive training to prevent NSI.
Table 2: Literature table
Author/
year/
country
Methodology Participants/
samples
Key findings Detailed description
of key findings
Grimmond
(2014)
Five
Australian
Quantitative
research by
conducting
sharp
102 sharp
containers
were samples
from 27
Most of the
sharp devices
were found to be
contaminated
The research findings
of large proportion of
naked sharps give the
indication that large

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
capital
cities
instrument
content audits
in Australian
capital cities.
hospitals in
Australia.
and 19.4% of
these devices
were found to be
inactivated. The
most significant
outcome was
that 75.5% of the
hollow bore
needles were
capped or naked
number of Australian
health care workers
are at risk of sharp
injuries. The high rate
of non application of
SED and non-
activation was also a
concern. However,
limitations like one
day audit period and
sampling of small
number of sharp
contained makes the
research finding
unreliable.
Kable, A.
K., Guest,
M., &
McLeod,
M. (2011).
New South
Wales,
Australia
Cross sectional
survey method
to evaluate
perception of
work place risk
due to needle
stick injuries
Nurses from
the New South
Wales Nurses
Association
Nurse’ s had
variable
perception
regarding risk
associated with
use of NSI and
organizational
practices like
The study mainly
gave indication
regarding
organization factors
to prevent NSI such
as presence of sharps
safety culture and
safety prevention

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
provision of safe
work practices,
workplace
culture and
policies were
found to have
major role in
preventing
occupational
injuries.
programs. It gives the
recommendation to
implement safety
training program and
increase availability
of SEDs for health
care workers.
Marjadi et
al. (2017)
Australian
university
Cross sectional
study using
online
questionnaire
to assess NSI-
related,
attitude,
practice and
follow up
among medical
students
Clinical
students (year
3-6) who are
part a 6-year
medical
program in
Australia
The participant’s
response
revealed that
medical students
have used
strategies like
disposal of
needles, use of
various sharp
containers and
SEDs as part of
safety measures
to prevent NSI.
The study gives the
implication that
appropriate device
related support and
education programs
exist in Australian
hospitals to prevent
NSI. However, the
effectiveness of these
programs has been
hampered by lack of
students involvement
and long term

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
67.1% were also
aware regarding
NSI prevention
program in
hospital and its
effectiveness in
informing
students about
best strategies to
promote safety.
evaluation of the
program. It gives the
implication to
improve training and
reporting process.
Murphy
(2014)
Australia
health care
setting
Literature
review
Australian
health care
workers
The study
revealed that
Australian
hospitals follow
Australian
Commission on
Safety and
Quality in Health
Care’s Standard
3 to prevent NSI.
This review
revealed that
education along
This study gives the
implication to
increase advocacy
regarding NSI
prevention and
enhance the role of
Australian
government in
improving
standardized national
surveillance, ongoing
education and
adaption of safer

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
with SEDs are
most effective in
reducing NSI
technology to
improve practice
Martinelli&
Frazer
(2018).
Hunter
New
England
Region of
Australia
Cohort study Health care
workers
The study found
revealed use of
safety products
and safety device
audit as some
organizational
strategy to
reduce NSI
The study gave the
indication that there
is a need for
improving
organizational
policies to prevent
NSI
Discussion:
From the review of papers, it has been identified that education, use of safety devices,
safety programs and organizational strategies are some interventions used to prevent NSIs in
different settings of Australia. Grimmond (2014) gave evidence regarding the frequency of use
of SEDs and sharp containers in Australia. By conducting sharp container audit, the study
revealed certain limitations in effective use of such devices. For example, high rate of non-
activation of device was found and non-use of SED was also high in hospital setting. Lu et al.
(2014) argues that non-activation of SED is high in other settings too because of poor training
and perceptions regarding patient adverse event due to such devices. This gives the implication
that health care workers lack awareness regarding benefits of SEDs and have poor skills in

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
effective use of such devices. The review of study shows that situation is serious in Australia as
SEDs have not been effectively utilized to prevent NSIs indicates urgent changes in existing
educational programs.
The review of literature highlighted the potential of organizational practices to prevent
NSI. Kable, Guest and McLeod (2011) used cross sectional study design to prove that Australian
hospitals have sharps safety oriented organization, routine training and availability of SEDs to
support health care workers. However, one major drawback is that very few nurses actually took
part in sharp related training. Another cross sectional study of strategies used by medical nurse
revealed that clinical students have poor attitude towards safe handling of sharps (Marjadi et al.,
2017). This gives the implication that health care organizations have a wider role in improving
surveillance and ensuring that all nurses take part in sharp injury training. Akyol and Kargin
(2016) argue health care organization can help to establish a culture of safety and improve
competencies in relation to sharp instrument safety. The two cross sectional study highlights the
need for policy makers to implement appropriate training programs so that all nurses are clear
regarding the steps needed to prevent NSIs. (Marjadi et al., 2017) shows that changes should
initiate from medical programs only so that medical students develop competency in handling
sharp objects before entering medical practices only.
The literature review by Murphy (2014) gave the outcome that use of SEDs along with
education and training of staffs is the most effective strategy to reduce rate of NSIs. The
evidence shows that appropriate standards exists to take actions in the area of NSI prevention.
However, what is lacking currently is that current strategies are not yet cost effective. Martinelli
and Frazer (2018) also revealed similar problems as by conducting cost-benefit analysis of
strategies to keep staffs safe from NSI, it was found that current safety products were not cost-

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
effective. The main cause behind this was poor utilization of SEDs among health care
professionals. Hence, it gives the implication to develop deep understanding of multiple factors
leading to NSI and use innovative strategies to better educate health workers and promote
adoption of safer devices.
Hence, as majority of paper revealed positive outcomes through training, it cannot be
denied that training is most efficacious in changing behavior of health care staffs. This can then
be supported by other interventions to further improve the results. Veronesi et al. (2018) also
highlighted the need for improving training to promote acquisition of knowledge and skills
among nursing students. Hence, developing appropriate training from nursing schools can reduce
the time associated with training during actual practice. The below CASP table further provided
evidence regarding the methodological quality of each of the papers:
Table 3: Critical appraisal using the CASP tools
Author: Grimmond (2014)
CASP questions Response
1. Did the title of the paper clearly describe the study? Yes
2. Did the study address a clearly focused issue? Yes
3. Was the recruitment strategy appropriate to the aims of the
research
Yes
4. Were there an appropriate number and quality of participants
recruited for the study?
Yes

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
5. Is the research methodology appropriate? Yes
6. Was the research design appropriate to address research aims? Yes
7. Was the data collected in a way that addressed the research issue? No
8. Were the study bias or limitations clearly described? No
9. Did the discussion link the available literature to the current study
clearly?
Yes
10. Have ethical issues been taken into considerations? Yes
Total score 8
Author: Kable, Guest & McLeod (2011)
CASP questions Response
1. Did the title of the paper clearly describe the study? Yes
2. Did the study address a clearly focused issue? Yes
3. Was the recruitment strategy appropriate to the aims of the
research
Yes
4. Were there an appropriate number and quality of participants
recruited for the study?
Yes
5. Is the research methodology appropriate? Yes
6. Was the research design appropriate to address research aims? Yes
7. Was the data collected in a way that addressed the research issue? Yes
8. Were the study bias or limitations clearly described? Unclear
9. Did the discussion link the available literature to the current study Yes

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
clearly?
10. Have ethical issues been taken into considerations? Yes
Total score 9
Author: Marjadi et al. (2017)
CASP questions Response
1. Did the title of the paper clearly describe the study? Yes
2. Did the study address a clearly focused issue? Yes
3. Was the recruitment strategy appropriate to the aims of the
research
Yes
4. Were there an appropriate number and quality of participants
recruited for the study?
Yes
5. Is the research methodology appropriate? Yes
6. Was the research design appropriate to address research aims? Yes
7. Was the data collected in a way that addressed the research issue? No
8. Were the study bias or limitations clearly described? Yes
9. Did the discussion link the available literature to the current study
clearly?
Yes
10. Have ethical issues been taken into considerations? Yes
Total score 9
Author: Martinelli and Frazer (2018)

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
CASP questions Response
1. Did the title of the paper clearly describe the study? Yes
2. Did the study address a clearly focused issue? Yes
3. Was the recruitment strategy appropriate to the aims of the
research
Yes
4. Were there an appropriate number and quality of participants
recruited for the study?
Yes
5. Is the research methodology appropriate? Yes
6. Was the research design appropriate to address research aims? Yes
7. Was the data collected in a way that addressed the research issue? Yes
8. Were the study bias or limitations clearly described? Yes
9. Did the discussion link the available literature to the current study
clearly?
Yes
10. Have ethical issues been taken into considerations? Yes
Total score 10
Author: Murphy (2014)
CASP questions Response
1. Did the title of the paper clearly describe the study? Yes
2. Did the study address a clearly focused issue? Yes
3. Was the recruitment strategy appropriate to the aims of the research Yes
4. Were there an appropriate number and quality of participants recruited
for the study?
Yes
5. Is the research methodology appropriate? Yes

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
6. Was the research design appropriate to address research aims? Yes
7. Was the data collected in a way that addressed the research issue? No
8. Were the study bias or limitations clearly described? No
9. Did the discussion link the available literature to the current study
clearly?
Yes
10. Have ethical issues been taken into considerations? Yes
Total score 8
Conclusion:
To conclude, the review of literature related to interventions to prevent NSIs resulted in
the retrieval of five papers related to the research question. These papers gave evidence
regarding the use of different interventions such as safety devices, training and educational
intervention and combination intervention. From the evaluation of each of the papers, it can be
concluded that safety devices can prevent NSIs. However, best result is possible only when
health care staffs are adequately trained regarding infection control and procedures to prevent
infection during handling needles. On review of methodological quality of the papers, one of the
common limitations was that no study considered doing long term follow-up. Hence, future
research must focus on evaluating long-term effectiveness of each intervention.
References:
Akyol, A., & Kargin, C. (2016). Needle Stick and sharp injuries among nurses. Glob J Nurs
Forensic Stud, 1(109), 2.

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
Bhardwaj, A., Sivapathasundaram, N., Yusof, M. F., Minghat, A. H., Swe, K. M. M., & Sinha,
N. K. (2014). The prevalence of accidental needle stick injury and their reporting among
healthcare workers in orthopaedic wards in general hospital Melaka, Malaysia. Malaysian
orthopaedic journal, 8(2), 6.
Fukuda, H., & Yamanaka, N. (2016). Reducing needlestick injuries through safety-engineered
devices: results of a Japanese multi-centre study. Journal of Hospital Infection, 92(2),
147-153.
Garcia, V. H., & Radon, K. (2017). Preventive training among medical interns in Mexico City
and its association with needlestick and sharp injuries–A Cross Sectional Study. Journal
of Clinical and Diagnostic Research: JCDR, 11(3), IC05.
Grimmond, T. (2014). Frequency of use and activation of safety-engineered sharps devices: a
sharps container audit in five Australian capital cities. Healthcare infection, 19(3), 95-
100.
Kable, A. K., Guest, M., & McLeod, M. (2011). Organizational risk management and nurses'
perceptions of workplace risk associated with sharps including needlestick injuries in
nurses in New South Wales, Australia. Nursing & health sciences, 13(3), 246-254.
Lu, Y., Senthilselvan, A., Joffe, A. M., & Beach, J. (2014). Effectiveness of safety-engineered
devices in reducing sharp object injuries. Occupational Medicine, 65(1), 39-44.
Marjadi, B., Nguyen, J. D., Hoppett, P., & McLaws, M. L. (2017). Needlestick injury among
medical students in an Australian university. Journal of Infectious Diseases and
Epidemiology, 3(2).

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INTERVENTIONS TO PREVENT NEEDLE STICK INJURIES
Martinelli, J., & Frazer, L. (2018). Keeping our staff safe (preventing acquisition of blood borne
viruses)–Reducing needle-stick injuries in healthcare workers. Infection, Disease &
Health, 23, S8.
Motaarefi, H., Mahmoudi, H., Mohammadi, E., & Hasanpour-Dehkordi, A. (2016). Factors
associated with needlestick injuries in health care occupations: a systematic
review. Journal of clinical and diagnostic research: JCDR, 10(8), IE01.
Murphy, C. L. (2014). The serious and ongoing issue of needlestick in Australian healthcare
settings. Collegian, 21(4), 295-299.
Tarigan, L. H., Cifuentes, M., Quinn, M., & Kriebel, D. (2015). Prevention of needle-stick
injuries in healthcare facilities: a meta-analysis. infection control & hospital
epidemiology, 36(7), 823-829.
Veronesi, L., Giudice, L., Agodi, A., Arrigoni, C., Baldovin, T., Barchitta, M., ... & D'Errico, M.
(2018). A multicentre study on epidemiology and prevention of needle stick injuries
among students of nursing schools. Annali di igiene: medicina preventiva e di comunita,
30(5 Supple 2), 99-110.
Yao, W. X., Wu, Y. L., Yang, B., Zhang, L. Y., Yao, C., Huang, C. H., & Qian, Y. R. (2013).
Occupational safety training and education for needlestick injuries among nursing
students in China: intervention study. Nurse education today, 33(8), 834-837.

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Appendix:
CASP tool for Cohort study:

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