Review Article

Reducing Needle Stick Injuries in Healthcare Occupations: An Integrative Review of the Literature

Table 2

Intervention design and findings.

AuthorConsent rate (CR)/ Response rate (RR)Intervention typeSurgical procedureRandomization procedure and designStudy timelineOutcome measureResults

Punyatanasakchai et al. [18]Not reportedDouble glovingEpisiotomy repair after vaginal deliveryThe surgeons were randomly selected one of two envelopes, number 1 representing the single-gloving method and number 2 representing the double-gloving method.7 monthsGlove perforation rate, duration of operation, position level of surgeonsNo significant difference in the frequency of perforations between the double-outer gloves (22.6%) and single-gloves (18%).
A significant reduction in glove perforations between the double-inner gloves (4.6%) compared with the single-gloves (18%) ( 𝑃 < . 0 5 ).

Kovavisarach and Seedadee [19]Not reportedDouble glovingGynaecological surgeryPrimary surgeons were randomly allocated to use either the single-gloving or the double-gloving method.12 monthsGlove perforation rate, duration of operationA significant difference was found in the glove perforation rate between double-inner glove (6.09%) and single gloving group (22.73%). No significant difference between the glove perforation rates in single gloves (22.73%) and in double-outer gloves (19.5%).

Nordkam et al. [20]Not reportedBlunt needleAbdominal wall closureSurgeons were randomised by envelop to use either blunt needle or sharp needle6 monthsGlove perforation rate, evaluation of the blunt needleA significantly higher number of surgical procedures with perforations using the sharp needle ( 𝑃 = . 0 0 3 ) than with the blunt tapered needle. Detection rate was low (21%). Blunt tapered needles are less convenient

Wilson et al. [5]Not reportedBlunt needleObstetrical laceration repairPatients with obstetric lacerations were randomized to repair with either blunt or sharp needles.21 months periodGlove perforation rate, evaluation of the blunt needle, and position level of surgeonsNo significant difference in the glove perforation rate between blunt and sharp needles. There was poor correlation between reported perforations and those detected by water test. Blunt needles were reported more difficult to use ( 𝑃 = . 0 0 0 1 )

Sullivan et al. [21]Not reportedBlunt needleCesarean-delivery closurePatients requiring cesarean delivery were assigned randomly to receive closure with either blunt or sharp needles21 monthsGlove perforation rate, evaluation of the blunt needle, and duration of operationA significant reduction in total glove perforation rate for the primary surgeon with blunt needles (7.2%) compared with sharp needles (17.5%) as well as for the assistant surgeons.
Poor correlation between reported perforations and those detected by water test.
Physicians reported low satisfaction with blunt needles compared with sharp needles ( 𝑃 < . 0 0 1 )

Caillot et al. [22]Not reportedDouble glovingVisceral surgical proceduresVisceral surgical proceduresperformed in the Surgical Emergency Departmentwere randomly assigned todouble gloving or single gloving3 monthsGlove perforation rate, detection of the perforation, duration of operationDid not adequately compare the rate of glove perforation.
Double gloving allowed significantly higher detection rates of glove perforation ( 𝑃 < . 0 0 1 )

Gaujac et al. [23]Not reported2 types of double glovingArch bar placementPatients were equally divided into 2 groups. In group 1, 2, sterile surgical gloves were used; in group 2, a nonsterile disposable inner glove was used under a sterile surgical glove.Not reportedGlove perforation rate, duration of operationNo significant statistical difference was found between 2 double gloving methods in terms of inner glove perforations

Laine and Aarnio [24]Not reportedDouble glovingGeneral surgical operationsPatients born in even years were operated on with double gloving and those born in uneven years were operated on with single gloving2 monthsThe glove type, the operating time, the type of surgery, the detection rate and location of perforationA low number of perforations of the inner glove of the double-gloving system were detected.
Higher detection of perforation in double-glove system ( 𝑃 < . 0 0 1 ). The longer of the operating duration, the higher rate of perforation

Wang et al. [25]RR: 86%Educational trainingNAOne class was randomly assigned to receive the educational intervention, and the other served as a comparison group, receiving standard education.4 monthsChanges in knowledge and self-reported universal precautions behaviour, observed adherence to universal precautions, and self-reported needlestick injuriesThe group that received the intervention scored significantly higher than the standard education group on both knowledge ( 𝑃 < . 0 0 1 ) and behaviour ( 𝑃 = . 0 0 2 ), and were less likely to experience needlestick injuries ( 𝑃 = . 0 0 4 )

Naver and Gottrup [26]Not reportedDouble glovingVarious types of gastrointestinal surgeryThe surgeons, assistants and scrub nurses were randomized into one of two groups. In group one the operating team was using powder-free single gloves and group two used a powder-free double-gloving system.Not reportedGlove perforation rate, detection of the perforation, and the position of the participantsA significant difference between single gloves and inner indicator gloves ( 𝑃 < . 0 0 5 ). The surgeon in indicated gloving group obtained high detection rate of glove perforation ( 𝑃 < . 0 0 0 1 )

Thomas et al. [9]Not reportedDouble glovingGeneral surgical operationsThe gloving pattern was randomized into two groups of the equal number by sealed envelopesNot reportedGlove perforation rate, detection of the perforation, evaluation of double glovingIn double-gloving pattern, 32 glove perforations were observed, of which 22 were in the outer glove and 10 in the inner glove.
Majority of glove perforations (83.3%) went unnoticed. Double gloving was accepted by majority of surgeons.

Laine and Aarnio [27]Not reportedDouble glovingOrthopaedic and trauma surgeryBefore the operations, the surgeons were randomised to use either single gloves, double indicator gloves or a combination of two regular surgical gloves on top of each other2 monthsGlove perforation rates, detection of perforations, operation types, and duration of operationSignificant difference in perforations of the inner glove in two of indicator gloves and in the regular combination gloves when the outer glove was perforated ( 𝑃 = . 0 2 )

Lancaster and Duff [8]Not reportedDouble glovingObstetric and gynecologic surgical proceduresThe choice to single versus double glove was left to the discretion of the individual surgeon.7 monthsGlove perforation rate, the association between position of the surgeon and perforation rate11% of single glove sets contained a perforation whereas only 2% of double glove sets contained a corresponding defect in the inner and outer gloves ( 𝑃 < . 0 1 )

Na’aya et al. [28]Not reportedDouble glovingGeneral surgical procedure.The surgeons wore single or double gloves at their own discretion.Not reportedGlove perforation rate, detection rate of the perforation, and duration of operationA significant greater risk for blood-skin exposure in the single glove sets ( 𝑃 < . 0 1 )
Most perforations were not noticed during the surgery.