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Prevention of Needle-Stick Injuries in Healthcare Facilities: A Meta-Analysis

  • Lukman H. Tarigan (a1) (a2), Manuel Cifuentes (a2), Margaret Quinn (a2) and David Kriebel (a2)

To estimate the summary effectiveness of different needle-stick injury (NSI)-prevention interventions.


We conducted a meta-analysis of English-language articles evaluating methods for reducing needle stick, sharp, or percutaneous injuries published from 2002 to 2012 identified using PubMed and Medline EBSCO databases. Data were extracted using a standardized instrument. Random effects models were used to estimate the summary effectiveness of 3 interventions: training alone, safety-engineered devices (SEDs) alone, and the combination of training and SEDs.


Healthcare facilities, mainly hospitals


Healthcare workers including physicians, midwives, and nurses


From an initial pool of 250 potentially relevant studies, 17 studies met our inclusion criteria. Six eligible studies evaluated the effectiveness of training interventions, and the summary effect of the training intervention was 0.66 (95% CI, 0.50–0.89). The summary effect across the 5 studies that assessed the efficacy of SEDs was 0.51 (95% CI, 0.40–0.64). A total of 8 studies evaluated the effectiveness of training plus SEDs, with a summary effect of 0.38 (95% CI, 0.28–0.50).


Training combined with SEDs can substantially reduce the risk of NSIs.

Infect Control Hosp Epidemiol 2015;36(7):823–829

Corresponding author
Address all correspondence to David Kriebel, 1 University Ave, RM K202D, Lowell, MA 01854 (
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NOTE. Dr. Tarigan passed away suddenly on December 5, 2014, after completing this work and submitting the paper for publication. Dr. Tarigan was deeply committed to improving public health in Indonesia and his untimely passing is a great loss to his country. The coauthors dedicate this paper to his memory and to his family.

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1. Prüss-Ustün, A, Rapiti, E, Hutin, Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Am J Ind Med 2005;48:482490.
2. Tarantola, A, Abiteboul, D, Rachline, A. Infection risks following accidental exposure to blood or body fluids in health care workers: a review of pathogens transmitted in published cases. Am J Infect Control 2006;34:367375.
3. Beekmann, SE, Vlahov, D, Koziol, DE, McShalley, ED, Schmitt, JM, Henderson, DK. Temporal association between implementation of universal precautions and a sustained, progressive decrease in percutaneous exposures to blood. Clin Infect Dis 1994;18:562569.
4. Trim, JC, Elliott, TSJ. A review of sharps injuries and preventative strategies. J Hosp Infect 2003;53:237242.
5. Tuma, S, Sepkowitz, KA. Efficacy of safety-engineered device implementation in the prevention of percutaneous injuries: a review of published studies. Clin Infect Dis 2006;42:11591170.
6. Yang, L, Mullan, B. Reducing needle stick injuries in healthcare occupations: an integrative review of the literature. ISRN Nurs 2011;2011:315432315432.
7. Trapé-Cardoso, M, Schenck, P. Reducing percutaneous injuries at an academic health center: a 5-year review. Am J Infect Control 2004;32:301305.
8. Azar-Cavanagh, M, Burdt, P, Green-McKenzie, J. Effect of the introduction of an engineered sharps injury prevention device on the percutaneous injury rate in healthcare workers. Infect Control Hosp Epidemiol 2007;28:165170.
9. Valls, V, Lozano, MS, Yánez, R, Martínez, MJ, Pascual, F, Lloret, J, et al. Use of safety devices and the prevention of percutaneous injuries among healthcare workers. Infect Control Hosp Epidemiol 2007;28:13521360.
10. Moens, G, Mylle, G, Johannik, K, Van Hoof, R, Helsen, G. Analysing and interpreting routinely collected data on sharps injuries in assessing preventative actions. Occup Med (Lond) 2004;54:245249.
11. Lamontagne, F, Abiteboul, D, Lolom, I, Pellissier, G, Tarantola, A, Descamps, JM, et al. Role of safety-engineered devices in preventing needlestick injuries in 32 French hospitals. Infect Control Hosp Epidemiol 2007;28:1823.
12. Sossai, D, Puro, V, Chiappatoli, L, Dagnino, G, Odone, B, Polimeri, A, et al. Using an intravenous catheter system to prevent needlestick injury. Nurs Stand 2010;24:4246.
13. Alvarado-Ramy, F, Beltrami, EM, Short, LJ, Srivastava, PU, Henry, K, Mendelson, M, et al. A comprehensive approach to percutaneous injury prevention during phlebotomy: results of a multicenter study, 1993–1995. Infect Control Hosp Epidemiol 2003;24:97104.
14. Borenstein, M. Introduction to Meta-analysis. Chichester, UK: John Wiley & Sons; 2009.
15. Neyeloff, JL, Fuchs, SC, Moreira, LB. Meta-analyses and forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Res Notes 2012;5:52.
16. Higgins, JP, Green, S. Cochrane handbook for systematic reviews of interventions version 5.0.1. Cochrane Handbook website. Published 2008. Accessed February 19, 2014.
17. Van der Molen, HF, Zwinderman, KAH, Sluiter, JK, Frings-Dresen, M. Interventions to prevent needle stick injuries among health care workers. Work 2012;41:19691971.
18. El Beltagy, K, El-Saed, A, Sallah, M, Balkhy, HH. Impact of infection control educational activities on rates and frequencies of percutaneous injuries (PIs) at a tertiary care hospital in Saudi Arabia. J Infect Public Health 2012;5:297303.
19. Mobasherizadeh, S, Ebneshahidi, SA, Mohammadi, NA, Abazari, F. Intervention study of needle stick injury in Iran. Saudi Med J 2005;26:12251227.
20. Zafar, A, Habib, F, Hadwani, R, Ejaz, M, Khowaja, K, Khowaja, R, et al. Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study. BMC Infect Dis 2009;9:7878.
21. Adams, D, Elliott, TS. Impact of safety needle devices on occupationally acquired needlestick injurdies: a four year prospective study. J Hosp Infect 2006;64:5055.
22. Brusaferro, S, Calligaris, L, Farneti, F, Gubian, F, Londero, C, Baldo, V. Educational programmes and sharpes injuries in health care workers. Occup Med 2009;59:512514.
23. Mendelson, MH, Lin-Chen, BY, Solomon, R, Bailey, E, Kogan, G, Goldbold, J. Evaluation of a safety resheathable winged steel needle for prevention of percutaneous injuries associated with intravascular-access procedures among healthcare workers. Infect Control Hosp Epidemiol 2003;24:105112.
24. Rogues, AM, Verdun-Esquer, C, Buisson-Valles, I, Laville, MF, Lasheras, A, Sarrat, A, Beaudelle, H, Brochard, P, Gachie, JP. Impact of safety devices for preventing percutaneous injuries related to phlebotomy procedures in health care workers. Am J Infect Control 2004;32:441444.
25. Sohn, S, Eagan, J, Sepkowitz, KA, Zuccotti, G. Effect of implementing safety-engineered devices on percutaneous injury epidemiology. Infect Control Hosp Epidemiol 2004;25:536542.
26. Whitby, M, McLaws, ML, Slater, K. Needlestick injuries in a major teaching hospital: the worthwhile effect of hospital-wide replacement of hollow-bore needles. Am J Infect Control 2008;36:180186.
27. Wicker, S, Cinatl, J, Berger, A, Doerr, HW, Gottschalk, R, Rabenau, HF. Determination of risk of infection with blood-borne pathogens following a needlestick injury in hospital workers. Ann Occup Hyg 2008;52:615622.
28. Babcock, HM, Fraser, V. Differences in percutaneous injury patterns in a multi-hospital system. Infect Control Hosp Epidemiol 2003;24:731736.
29. Chakravarthy, MM, Singh, SS, Arora, AA, Sengupta, SS, Munshi, NN. The epinet data of four Indian hospitals on incidence of exposure of healthcare workers to blood and body fluid: a multicentric prospective analysis. Indian J Med Sci 2010;64:540548.
30. Leigh, JP, Wiatrowski, WJ, Gillen, M, Steenland, NK. Characteristics of persons and jobs with needlestick injuries in a national data set. Am J Infect Control 2008;36:414420.
31. Ippolito, G, Puro, V, De Carli, G. The Italian Study Group on Occupational Risk of HIV Infection. The risk of occupational human immunodeficiency virus infection in health care workers. Italian multicenter study. Arch Intern Med 1993;153:14511458.
32. Elder, A, Paterson, C. Sharps injuries in UK health care: a review of injury rates, viral transmission and potential efficacy of safety devices. Occup Med (Lond) 2006;56:566574.
33. Tosini, W, Ciotti, C, Goyer, F, Lolom, I, L'Hériteau, F, Abiteboul, D, et al. Needlestick injury rates according to different types of safety-engineered devices: results of a French multicenter study. Infect Control Hosp Epidemiol 2010;31:402407.
34. Sagoe-Moses, C, Pearson, RD, Perry, J, Jagger, J. Risks to health care workers in developing countries. N Engl J Med 2001;345:538541.
35. Simonsen, L, Kane, A, Lloyd, J, Zaffran, M, Kane, M. Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bull World Health Organ 1999;77:789800.
36. Tan, L, Hawk, JC 3rd, Sterling, ML. Report of the Council on Scientific Affairs: preventing needlestick injuries in health care settings. Arch Intern Med 2001;161:929936.
37. Occupational Safety: Selected Cost and Benefit Implications of Needlestick Prevention Devices for Hospital. Washington, DC: General Accounting Office; 2000. GAO-01-60R.
38. Glenngård, AH, Persson, U. Costs associated with sharps injuries in the Swedish health care setting and potential cost savings from needle-stick prevention devices with needle and syringe. Scand J Infect Dis 2009;41:296302.
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