Parantainen Annika, Verbeek Jos H, Lavoie Marie-Claude, Pahwa Manisha
Health Care and Social Services, Finnish Institute of Occupational Health, Turku, Finland.
Cochrane Database Syst Rev. 2011 Nov 9;2011(11):CD009170. doi: 10.1002/14651858.CD009170.pub2.
Surgeons and their assistants are especially at risk of exposure to blood due to glove perforations and needle stick injuries during operations. The use of blunt needles can reduce this risk because they don't penetrate skin easily but still perform sufficiently in other tissues.
To determine the effectiveness of blunt needles compared to sharp needles for preventing percutaneous exposure incidents among surgical staff.
We searched MEDLINE and EMBASE (until May 2011), CENTRAL, NHSEED, Science Citation Index Expanded, CINAHL, Nioshtic, CISdoc, PsycINFO, and LILACS (until September 2010).
Randomised controlled trials (RCTs) of blunt versus sharp suture needles for preventing needle stick injuries among surgical staff measured as glove perforations or self-reported needle stick injuries.
Two authors independently assessed study eligibility and risk of bias in trials and extracted data. We synthesized study results with a fixed-effect model meta-analysis.
We located 10 RCTs involving 2961 participating surgeons performing an operation in which the use of blunt needles was compared to the use of sharp needles. Four studies focused on abdominal closure, two on caesarean section, two on vaginal repair and two on hip replacement. On average, a surgeon that used sharp needles sustained one glove perforation in three operations. The use of blunt needles reduced the risk of glove perforations with a relative risk (RR) of 0.46 (95% confidence interval (CI) 0.38 to 0.54) compared to sharp needles. The use of blunt needles will thus prevent one glove perforation in every six operations.In four studies, the use of blunt needles reduced the number of self-reported needle stick injuries with a RR of 0.31 (95% CI 0.14 to 0.68). Because the force needed for the blunt needles is higher, their use was rated as more difficult but still acceptable in five out of six studies.The quality of the evidence was rated as high.
AUTHORS' CONCLUSIONS: There is high quality evidence that the use of blunt needles appreciably reduces the risk of exposure to blood and bodily fluids for surgeons and their assistants over a range of operations. It is unlikely that future research will change this conclusion.
在手术过程中，外科医生及其助手因手套穿孔和针刺伤而面临血液暴露的风险尤其高。使用钝针可以降低这种风险，因为钝针不容易穿透皮肤，但在其他组织中仍能充分发挥作用。
确定与锐针相比，钝针在预防外科工作人员经皮暴露事件方面的有效性。
我们检索了MEDLINE和EMBASE（截至2011年5月）、CENTRAL、NHSEED、科学引文索引扩展版、CINAHL、Nioshtic、CISdoc、PsycINFO和LILACS（截至2010年9月）。
比较钝针和锐针缝合针预防外科工作人员针刺伤的随机对照试验（RCT），针刺伤以手套穿孔或自我报告的针刺伤来衡量。
两位作者独立评估研究的纳入资格和试验中的偏倚风险，并提取数据。我们采用固定效应模型荟萃分析来综合研究结果。
我们找到了10项随机对照试验，涉及2961名参与手术的外科医生，这些试验比较了钝针和锐针的使用情况。四项研究聚焦于腹部缝合，两项聚焦于剖宫产，两项聚焦于阴道修复，两项聚焦于髋关节置换。平均而言，使用锐针的外科医生在三次手术中会出现一次手套穿孔。与锐针相比，使用钝针可降低手套穿孔的风险，相对风险（RR）为0.46（95%置信区间（CI）为0.38至0.54）。因此，使用钝针每六次手术可预防一次手套穿孔。在四项研究中，使用钝针使自我报告的针刺伤数量减少，相对风险为0.31（95%CI为0.14至0.68）。由于钝针所需的力量更大，在六项研究中有五项将其使用评为更困难但仍可接受。证据质量被评为高。
有高质量证据表明，在一系列手术中，使用钝针可显著降低外科医生及其助手接触血液和体液的风险。未来的研究不太可能改变这一结论。
