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Meta-Analysis
. 2016 Sep 1:16:458.
doi: 10.1186/s12913-016-1705-y.

Use of safety-engineered devices by healthcare workers for intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-analysis

Rami A Ballout  1 , Batoul Diab  2 , Alain C Harb  3 , Rami Tarabay  2 , Selma Khamassi  4 , Elie A Akl  5
Affiliations
Meta-Analysis

Use of safety-engineered devices by healthcare workers for intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-analysis

Rami A Ballout et al. BMC Health Serv Res. .

Abstract

Background: The acquisition of needle-stick injuries (NSI) in a healthcare setting poses an occupational hazard of transmitting blood-borne pathogens from patients to healthcare workers (HCWs). The objective of this study was to systematically review the evidence about the efficacy and safety of using safety-engineered intravenous devices and safety-engineered phlebotomy devices by HCWs.

Methods: We included randomized and non-randomized studies comparing safety-engineered devices to conventional/standard devices that lack safety features for delivering intravenous injections and/or for blood-withdrawal procedures (phlebotomy). The outcomes of interest included NSI rates, and blood-borne infections rates among HCWs and patients. We conducted an extensive literature search strategy using the OVID interface in October 2013. We followed the standard methods for study selection and data abstraction. When possible, we conducted meta-analyses using a random-effects model. We used the GRADE methodology to assess the quality of evidence by outcome.

Results: We identified twenty-two eligible studies: Twelve assessed safety-engineered devices for intravenous procedures, five for phlebotomy procedures, and five for both. Twenty-one of those studies were observational while one was a randomized trial. All studies assessed the reduction in NSIs among HCWs. For safety-engineered intravenous devices, the pooled relative risk for NSI per HCW was 0.28 [0.13, 0.59] (moderate quality evidence). The pooled relative risk for NSI per device used or procedure performed was 0.34 [0.08,1.49] (low quality evidence). For safety-engineered phlebotomy devices, the pooled relative risk for NSI per HCW was 0.57 [0.38, 0.84] (moderate quality evidence). The pooled relative risk for NSI per device used or procedure performed was 0.53 [0.43,0.65] (moderate quality evidence). We identified no studies assessing the outcome of blood-borne infections among healthcare workers or patients.

Conclusion: There is moderate-quality evidence that the use of safety-engineered devices in intravenous injections and infusions, and phlebotomy (blood-drawing) procedures reduces NSI rates of HCWs.

Keywords: Blood-borne pathogens; Healthcare setting; Healthcare workers; Intravenous; Meta-analysis; Needle-stick injuries; Phlebotomy; Safety-engineered devices; Systematic review.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Risk of bias summary diagram for the single included randomized study assessing IV safety devices
Fig. 3
Fig. 3
Risk of bias summary diagram for all the included non-randomized studies assessing IV safety devices
Fig. 4
Fig. 4
Risk of bias summary diagram for all the included non-randomized studies assessing Phlebotomy (blood-drawing) safety devices
Fig. 5
Fig. 5
Needle stick injury data of the studies assessing IV safety devices reported as rates of injuries per number of healthcare workers
Fig. 6
Fig. 6
Needle stick injury data of the studies assessing IV safety devices reported as rates of injuries per number of devices or procedures performed
Fig. 7
Fig. 7
Needle stick injury data of the studies assessing IV safety devices reported as rates of injuries per year
Fig. 8
Fig. 8
Needle stick injury data of the randomized trial assessing IV safety devices, reported as rates of injuries per patient-days
Fig. 9
Fig. 9
Needle stick injury data of the studies assessing phlebotomy safety devices reported as rates of injuries per number of healthcare workers
Fig. 10
Fig. 10
Needle stick injury data of the studies assessing phlebotomy safety devices reported as rates of injuries per number of devices or procedures performed
See this image and copyright information in PMC

References

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