Blunt needles for the reduction of needlestick injuries during cesarean delivery: a randomized controlled trial.

OBJECTIVE

To compare the rate of glove perforation as a proxy for needlestick injuries between blunt and sharp needles used during cesarean-delivery closure and to survey physician satisfaction with blunt needles.

METHODS

Patients requiring cesarean delivery were assigned randomly to receive closure with either blunt (study group) or sharp needles (control group). Patient demographics, operator experience, and other clinical variables were collected. Physicians reported any percutaneous injuries and were surveyed regarding satisfaction with the assigned needles. Glove perforation was determined using a validated water-test method. Differences between patient groups were tested using chi and Fisher exact test for categorical variables and Student t-test or Wilcoxon rank-sum test for continuous variables.

RESULTS

There were 194 patients enrolled in the trial: 97 in the control group and 97 in the study group. There were no statistical differences between groups in patient demographics. There were no differences between groups in clinical variables, type of cesarean delivery, or experience level of the surgeon. There was a significant reduction in total glove perforation rate for the primary surgeon with blunt needles (7.2%) compared with sharp needles (17.5%) (relative risk [RR] 0.66, 95% confidence interval [CI] 0.49-0.89) as well as for the assistant surgeon (RR 0.54, 95% CI 0.41-0.71). There was poor correlation between reported perforations and those detected by water test (R=0.3). Physicians reported that they were not as satisfied with blunt needles compared with sharp needles (P=.001).

CONCLUSION

There was a significant decrease in the rate of glove perforation for surgeons and assistants performing cesarean-delivery closure with blunt needles. Assistant surgeons had the greatest reduction in glove perforations. However, physicians reported decreased satisfaction performing the surgery with blunt needles.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, www.clinicaltrials.gov, NCT00844636

LEVEL OF EVIDENCE

I.