Meta-analysis of the efficacy and cost-effectiveness of measures for the prevention of needlestick injuries to health care workers

Status:

completed 12/2005

Aims:

About 500,000 needlestick injuries are estimated to happen annually to health care workers in Germany. The infection risk associated with these injuries presents a potentially high health risk to those concerned. Hepatitis B, C or HIV infections, in particular, may cause acute and in some cases chronic diseases in the infected persons; this in turn gives rise to high costs. Different preventive measures were applied since the 1990s to avoid and reduce needlestick injuries. These prevention strategies seemed to differ in their effectiveness. A meta-analysis was performed in which the existing prevention programmes in the health services of different countries are considered and their efficacy and cost-effectiveness evaluated. Based upon the analysis, recommendations were to be formulated for the use of needles and cannulas and considered in the TRBA 250 technical rules for biological agents.

Activities/Methods:

In the first step, an overview was created of the epidemiology of occupational needlestick injuries, from which conclusions may be drawn regarding their distribution and nature. In the second stage, the existing prevention programmes in the health services of different countries for reduction of needlestick injuries were compiled and their efficacy and cost-effectiveness evaluated. The use of safe devices was emphasized. With regard to both issues, comprehensive searches were conducted in international databases and the relevant literature was analysed and evaluated.

Results:

The studies, which evaluated the efficacy of instruments introduced for protection against needlestick injuries, show a clear drop in the incidence of such injuries following the introduction of safe instruments. They therefore constitute an effective protective measure. Needlestick injuries were reported most frequently by nurses and doctors with the most frequent contact to patients, particularly in patient rooms and operating rooms. Precise risk estimates are made difficult by the fact that, as experience has shown, not all injuries are reported. The disposal of used cannulas constitutes a further area of risk. The few cost-benefit analyses that have been performed are methodically inconsistent and are limited to hospitals. A conclusive economic evaluation is not therefore possible at the present time. An overall evaluation should cover social and non-economic damage, and also the benefits.

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