RANDOMIZED PROSPECTIVE-STUDY OF THE IMPACT OF 3 NEEDLELESS INTRAVENOUS SYSTEMS ON NEEDLESTICK INJURY RATES

OBJECTIVE: To determine the impact of three needleless intravenous sys tems on needlestick injury rates. DESIGN: Randomized controlled trial. SETTING: 1,000-bed tertiary-care Midwestern hospital. PARTICIPANTS: N ursing personnel from general medical, general surgical, and intensive -care units. INTERVENTIONS: From June 1992 through March 1994, a metal blunt cannula (MBC), two-way valve (2-way), and plastic blunt cannula (PBC) were introduced into three study areas, and needlestick injury rates were compared to three control areas using traditional needled d evices. RESULTS: 24 and 29 needlestick injuries were reported in study and control areas. Intravenous-therapy-related injuries comprised 45. 8% and 57.1% of injuries in each area Thirty-seven percent and 20.7% o f study and control area needlestick injuries were considered to pose a high risk of bloodborne infection. The 2-way group had similar rates of total and intravenous-related needlestick injuries compared to con trol groups. The PBC group had lower rates of total and intravenous-re lated needlestick injuries per 1,000 patient-days (rate ratios [RR], 0 .32 and 0.24; 95% confidence intervals [CI95], 0.12-0.81 and 0.09-0.61 ; P=.02 and P=.003, respectively) and per 1,000 productive hours worke d (RR, 0.11 and 0.08; CI95, 0.01-0.92 and 0.01-0.69; P=.03 and P=.005, respectively) compared to controls. CONCLUSIONS: Needlestick injuries continued in study areas despite the introduction of needleless devic es, and risks of bloodborne pathogen transmission were similar to cont rol areas. The PBC device group noted lower rates of needlestick injur ies compared to controls, but there were problems with product accepta nce, correct product use, and continued traditional device use in stud y areas. Low needlestick injury rates make interpretations difficult. Further studies of safety devices are needed and should attempt greate r control of worker behavior to aid interpretation.