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IMPLEMENTATION PROJECT

Prevention of needle-stick injury among nurses in an acute ward of a hospital: a best practice implementation project

Huang, Hui-Mei MS1; Chien, Hsing-Chin MS1; Lin, Wen-ling1; Chang, Chia-Hui PhD7; Chang, Mei-Yu MS1,5; Su, Jui-Yuan RN2,3,6; Mu, Pei-Fan PhD4,5,6

Author Information
JBI Evidence Implementation: June 2022 - Volume 20 - Issue 2 - p 134-143
doi: 10.1097/XEB.0000000000000294

Abstract

What is known about the topic?

  • Needle-stick injuries (NSIs) are a common risk factor among nurses in medical wards.
  • The costs associated with NSIs are high.
  • Education and training are likely to reduce the incidents of NSIs.

What does this article add?

  • The standardized puncture prevention education and training program enhances nurses’ awareness of puncture in the acute ward.
  • Team resource management can improve teamwork to efficiently use all available resources to support well tolerated and efficient operation, including improving the project.
  • Mutual support, based on the sharing of experiences of colleagues who had sustained NSIs, can help raise awareness.

Introduction

In Taiwan, needle-stick injuries (NSIs) are one type of occupational hazard among medical hospital workers. According to the 2017 NSI survey report of the Taiwan Institute of Labor Safety and Health, nurses had an average of 2.3–4.6 NSIs annually. Nurses most commonly experience NSIs as part of the treatment process, accounting for 15%, followed by punctures from sharp objects after use, and events prior to treatment.1 Medical staff are at increased risk of contracting hepatitis, HIV, syphilis, and other diseases because of NSIs. In addition to becoming potential health risks to colleagues, NSIs also increase medical costs.2,3 According to Chen's 2011 study, when the cost of blood testing and drug administration following a puncture injury in Taiwan was calculated from 2004 to 2010, the average cost per injury was found to be US$34 500.4 In the United States, an economic analysis on NSI-related costs was undertaken in 2016 involving 14 studies that modelled data-driven direct or indirect cost classification (type of cost) in a systematic review, and the processing fee for each NSI was found to range from US$199 to $1691.5 Physical health, mental stress, and related medical costs are all heavily involved in relation to NSIs.

In a systematic review, 17 relevant studies were identified and a random effects model was applied to estimate the overall effect of the use of safety needles. The results showed that the use of safety needles could reduce the risk of NSIs by 0.53 times and, when combined with puncture prevention-related training, the risk of NSIs reduced 0.38 times.6 Through puncture prevention education and training, the chance of blood and body fluid exposure can be effectively reduced from 25 to 10%.7 This type of education and training has been recommended and needs to be engaged in by multiple parties to effectively prevent the occurrence of NSIs. Taiwan legislated on 5 December 2011 to stipulate that, starting in 2017, medical institutions had to provide comprehensive safety needles for medical staff in direct contact with patient bodily fluids or blood.8 In 2012, the Department of Disease Control of the Ministry of Health and Welfare in Taiwan also included the use of safety needles as an item in hospital evaluation and infection control reviews, allowing hospital supervisors to promote the use of safety needles to reduce occupational injuries to medical personnel and improve workplace safety.9–12 According to statistics from Taiwan's EPINet, there were 18291 incidents involving sharp objects or NSIs from 2004 to 2016. Since 2012, following the promotion of safety needle use, the number of reported NSIs dropped significantly from 2998 in 2012 to 2066 in 2016.1 According to statistics from the US EPINet notification system, 52.24% of incidents leading to punctures in 2019 still involved the use of safety needles.13 The use of safety needles alone cannot effectively reduce the occurrence of puncture injuries.9,14 Worldwide, the burden of NSI, risk factors, implications, risk assessment, prophylaxis, and treatment have been extensively studied; however, there is limited research on implementing the education and training in providing safety nee-dles.9,11,12

This project was conducted at a medical center in central Taiwan. The hospital had a total of 1515 beds. Approximately 50 000 hospitalizations occur each year. In line with national policy, the use of safety needles by medical personnel has been fully promoted since 2017. The Infection Control Center of Taichung Veterans General Hospital in Taiwan provides monthly information on the number of safety needles used by hospitals and their usage status. The Department of Nursing in this hospital undertakes Objective Structured Clinical Examination (OSCE) training on vaccinations every year, with vaccination training kits delivered to each unit. New recruits are also trained on how to use safety needles; however, in 2018, a total of 145 NSIs occurred throughout the hospital (4129 people work in the hospital), with an incidence rate of 3.5%. In 2017, there were 1799 nurses in 42 wards of the nursing department, and 29 cases of NSIs occurred, with an incidence rate of 2.3%. The average number of years over which nursing staff tended to experience skin punctures was 3.5 years, and 42.9% of the nursing staff had a seniority of less than 2 years. According to statistics from the Department of Nursing, the main causes of NSIs were inattention (23.8%) and patient restlessness (11.9%).

To reduce the occurrence of NSIs, this study selected five units with a higher incidence of NSIs in their nursing sections in 2018, which ranged from 2.3 to 10.5%. To improve the quality of evidence, this project used the JBI implementation framework, as well as team resource management (TRM) as a management technique.15 TRM skills can improve team work to make the best use of all available resources in support of a safe and efficient operation, including a determination to improve the project. In the communication process, pre-explanation (brief), in-process discussion (huddle), and post-review (brief) were used to ensure that the project proceeded smoothly. The JBI Practical Application of Clinical Evidence System (JBI PACES) is a user-friendly online tool for health professionals to conduct efficient and timesaving audits in small or large health care settings, carried out in accordance with JBI guidelines to prevent NSIs among nurses.

Aim and objectives

The aim of this evidence implementation project was to contribute to the promotion of evidence-based practice in the prevention of NSIs through identifying relevant factors affecting the occurrence of NSIs.

Specific objectives of the project

  • (1) To determine current compliance with evidence-based criteria regarding best practice among nurses concerning NSIs.
  • (2) To improve knowledge regarding best practice concerning NSI prevention among nurses.
  • (3) To improve compliance with evidence-based criteria concerning NSI prevention.
  • (4) To improve outcomes concerning NSI prevention.

Methods

This evidence-based implementation project was divided into three phases, which were conducted from 15 October 2018 to 15 April 2019. The JBI Practical Application of Clinical Evidence System program (PACES), the Getting Research into Practice (GRiP) audit, and a feedback tool were used to promote evidence-based health care. The three phases are as follows:

  • (1) Team establishment and baseline audit.
  • (2) Design and implementation of strategies to improve practice using the Getting Research into Practice (GRiP) approach.
  • (3) Follow-up audit postimplementation of change strategy.

Setting

This project was implemented in the general wards of Taichung Veterans General Hospital. Five wards were selected, including three surgical (including neurosur-gery, colorectal surgery, and orthopedics) units and two internal medicine (rheumatoid arthritis, metabolism, and gastroenterology) units.

Sample

Five units participated in the plan, with 177 participating nurses (see Table 1).

Table 1 - Setting and sample
Ward Ward characteristics Number of nursing staff Number of needle stick injuries in 2018 Staff incidence % Occurrence years/ Number
W52 Surgical ward 40 2 5.0 ≤2 years/2
Colorectal ward
Neurosurgical ward
W62 Medical ward, metabolism 22 2 9.1 ≤2 years/1
Immunology and rheumatology ward ≤ 2 years/1
W65 Medical ward 38 1 2.6 ≤2 years/1
Gastroenterology ward
W72 Medical ward 38 4 10.5 ≤2 years/3
Neurology ward ≤ 2 years/1
W75 Surgical ward, orthopedics ward 39 1 2.6 ≤2 years/1

Ethical considerations

The project was registered as a quality improvement activity within the Taichung Veterans General Hospital in Taiwan; therefore, ethical approval was not required.

Phase 1: stakeholder engagement (or team establishment) and the baseline audit

The project started through engaging with individuals working in the unit to initiate changes in the unit, and through establishing an implementation team. Phase 1 was carried out between 15 October 2018 and 10 January 2019.

Establishment of the audit team

A core group of key stakeholders was formed to support this project. The project team (six members in total) consisted of a project leader (supervisor), namely, the supervisor of the Nursing Department, a qualified staff member of National Yang-Ming University for Evidence-based Practice: A JBI Centre of Excellence, and head nurses who managed the units. Each member had their own roles and responsibilities. The supervisor was responsible for project coordination, protocol writing, project design, process control and promotion, data analysis, and report writing. The head nurses were responsible for project guidance, leading the change according to the clinical audit in the project, project supervision, education implementation, questionnaire design, nurse training process control and promotion, data analysis, and report writing. The infection control nurse was responsible for education implementation, questionnaire design, and nurse training. Each member cooperated with other members to coordinate and communicate the project to promote the prevention and treatment of NSIs.

From the list of evidence-based criteria generated from the JBI PACES (Table 2), the team adopted five of six criteria that were highly recommended and suitable for the project context. One criterion was excluded as no operating room was included in the project. A baseline audit to assess the prevention of NSIs in the units using the JBI-PACES program was conducted from 15 October 2018 to 15 November 2019. A total of 177 nurses participated in the study, and the audit tool was developed using these five criteria (Appendix I, Supplementary Digital content, https://links.lww.com/IJEBH/A66).

Table 2 - Audit criteria, sample information, and measurement criteria
Audit criteria Sample Method used to measure % compliance with best practice
1. Staff are educated about the safe use and disposal of sharps. 177 Nurses Used the questionnaire investigation to survey the knowledge, attitudes, and implementation of nurses. Yes; 1, no: 0 Goal: compliance >90%
2. Safety-engineered injection devices (such as syringes with shields or retractable needles, needles with safety features) are used. 177 Nurses Used the Questionnaire investigation to survey the implementation of safety needle device use. Yes: 1, no: 0 Goal: compliance >90%
3. An organizational procedure detailing the correct safe use and disposal of needles exists. Seniority ≤2 years: 65 nurses Seniority ≤2 years: 65 nurses Asked nurses whether they knew where to obtain information about the standard operation of safety devices. Yes: 1, no: 0 Goal: compliance >90%
4. Used needles are not recapped. 177 Nurses Used the questionnaire investigation to survey nurses on whether they had used needles that were not recapped within the last 2 months. Yes: 1, no: 0 Goal: compliance >90%
5. Used sharps are discarded into a sharps container at the point of use by the user. 177 Nurses Used the questionnaire investigation to survey nurses as to whether used sharps were discarded into a sharps container at the point of use within the last 2 months. Yes: 1, No: 0 Goal: compliance >90%

From 15 October 2018 to 15 November 2019, the project team members designed the audit tool (Appendix I, https://links.lww.com/IJEBH/A66) that constituted three evaluation measures based on the empirical recommendations of the JBI PACES system, including two types of questionnaires and one field observation. The two types of questionnaires were the ‘knowledge of needle safety questionnaire’ and ‘used safety devices questionnaire’. The knowledge of needle safety questionnaire contained 10 items evaluating the knowledge, attitudes, and skills of nurses regarding needle use, the nurses’ awareness of how to prevent NSIs, waste disposal, and puncture treatment procedures. Each item was 10 points, and a score above 80 indicated that the nurses had passed. The used safety devices questionnaire was used to evaluate whether the safety needle equipment items provided were complete with respect to the needle equipment operation process. Field observations of the nurses’ implementation of needle care, based on G-Power 3.1 and the rate of NSIs in 2018 (α = 0.05, power = 0.80), the rate of NSIs among those with 2 years or less work experience and those with more than 2 years work experience was 17.65 and 8%, respectively. Out of 130 participants who were observed in their work, 65 had 2 years or less of work experience and 65 had more than 2 years of work experience. This questionnaire consisted of five questions, with scores determined by Yes = 1 and No = 0 (Table 2).

Phase 2: design and implementation of strategies to improve practice using Getting Research into Practice

Following the baseline audit, the team members analyzed the audit results to identify gaps and barriers in relation to current practices and best practice recommendations for this implementation project. Phase 2 was carried out between 11 January 2018 and 7 April 2019.

On the basis of analysis of the pre-implementation audit results, the project team discussed the barriers to implementation for each criterion and any possible solutions available to overcome these barriers. The JBI GRiP framework was utilized to inform key stakeholders, gather opinions, and allocate the available resources to promote implementation changes. On the basis of TRM theory, the team leader guided the team members in identifying relevant issues in relation to an injury incident, analyzing the cause, communicating and coordinating with others concerning each proposed strategy and measure, and formulating a strategy to overcome obstacles to effective decision-making. The team members determined how to promote the prevention of NSIs and evaluated needle use as undertaken by clinical nurses.

Phase 3: follow-up audit postimplementation of change strategy

The postimplementation audit was conducted from 8 April to 15 April 2019. The same audit criteria and approaches as those in the baseline audit were used to measure outcomes post-implementation and to identify new practice issues that need to be addressed in future audits. The follow-up audit included 177 nurses, and the results were entered into the JBI PACES to examine any changes relative to the results of the baseline audit. Nurses were also required to answer the knowledge of needle safety questionnaire and the used safety devices questionnaire to evaluate the effectiveness of the implementation project.

Results

Phase 1: baseline audit

Compliance with the audit criteria was determined via the designed questionnaire, observations, and OSCE examinations. Figure 1 shows the compliance rates for the five audit criteria in the baseline audit.

F1
Figure 1:
Compliance with best practice audit criteria in follow-up audit compared with baseline audit (%).

The audit results (Fig. 1) showed: staff were educated about the well tolerated use and disposal of sharps (40% compliance; criterion 1); use of safety-engineered injection devices, such as syringes with shields or retractable needles and needles with safety features (16% compliance; criterion 2); following an organizational procedure detailing the correct safe use and disposal of needles (14% compliance; criterion 3); not recapping needles after use (47% compliance; criterion 4); and sharps discarded into a sharps container at the point of use by the user (75% compliance; criterion 5). The findings indicated that there were four barriers: incomplete knowledge of puncture prevention, insufficient numbers of safe injection devices, a lack of a complete operation manual, and lack of awareness of puncture risk.

Phase 2: design and engagement of strategies to improve practice using Getting Research into Practice

Following the baseline audit, the project team analyzed the audit results concerning the four identified barriers and developed strategies to improve practice. Table 3 lists the relevant strategies, resources, and tracked results.

Table 3 - Getting Research into Practice matrix
Barrier Strategy Resources Outcomes
Incomplete needle-stick injury knowledge 1. Produce versions of standardized textbooks for common use 2. OSCE education and training concerning needle-stick Injury 1. Safety needle operation 2. Cause analysis of acupuncture cases 3. Standardization lectures 4. Physical courses 1. In 2019, 77 people completed OSCE training. 2. The knowledge test was 90.6–93.2 in 177 people. 3. In 2019, a total of 1660 people participated in a prevention education program (written test score: 97.3; objective structured clinical examination score: 95.5).
Insufficient safety injection devices 1. Check the safety injection device items 2. Identify under-purchased or absent items 3. Educational training 1. Confirm sufficient safety needle devices and how many 2. Interdepartmental assistance sought, involving the Pharmacy Department, the Medical Enterprise Department, the Sensory Management Center, and the Information Room. 1. Safety injection devices increased from 10 to 12. 2. A total of 42 on-the-job education sessions were held in 2019.
Lack of a complete operating manual 1. Manufacturer to provide an operating manual 2. Create a simple operation manual with icon painting for use in the unit 1. Manufacturer provides the operation manual, including video tape, online version, and written information 2. Needle operation steps increased from 4 to 7. 3. Insulin pen needle 1 operation video.
Did not think needle-stick injury would happen 1. Design games: pinching contests, threading needles. Seek agreement that clinical work is easily disrupted and there is a risk of puncturing. 2. Hold a workshop. 1. Case study of on-the-job education. 2. Pinpoint colleagues’ feelings about the film. 1. Developed a lesson plan 2. The need to prevent needle-stick injuries and awareness of them increased from 79.7% to 83.6%. 3. The needle-stick injury rate was 2.13% in 2019.
OSCE, Objective Structured Clinical Examination.

With respect to the issue of incomplete knowledge of NSI prevention, it was proposed that a readily accessible version of standardized teaching materials be made available for the unit's reference and that OSCE education and training for NSI prevention be organized. The members discussed how to provide standardized education using PowerPoint training, which would include the reasons for the occurrence of NSIs. The team sought to improve measures in relation to the operational steps and precautions concerning various safety needles, organize a core group of 77 nurses in the hospital as key guides to assist with NSI prevention, provide guidance on how to ensure consistent practice in the units, and arrangea practical training course of approximately 1.5 h to enable unit colleagues to understand the hospital's policy on safety needles and to familiarize themselves with the operation of various safety needles.

Regarding insufficient safe injection devices, the improvement strategies were as follows: project members checked the number of safe injection devices provided by the hospital, determined which items of safe injection devices were in short supply, and ensured they received enough funding to purchase the required devices. We purchased new products including insulin safety retractable needles, blood collection adapters, and safety electric razors.

On the lack of a complete operation manual, the improvement measures were as follows: when signing a contract for needles and equipment, the standard manufacturer has to provide a simple operation manual with graphic drawings or an audiovisual teaching manual, which will be reviewed and revised by the project members and then printed out for use by the providing unit. This will occur particularly for procedures concerning insulin safety retraction needles, blood collection adapters, and safety electric razors, and provide readily available information.

Regarding unawareness or inattentiveness concerning puncture risk, the improvement measures were: design a situational lesson plan, invite three colleagues from each of the five units to participate in needle-threading and bean-clamping competitions, raise awareness of the many disruptions in clinical work and that needle use requires careful attention; and report on the feelings expressed after NSI to heighten awareness of negative effects. Finally, this part of the process was developed into a 10 min video, which was shown to multiple staff members as part of on-the-job education concerning NSI prevention.

Phase 3: follow-up audit post-implementation of change strategy

The post-implementation audit results at 6 months are shown in Fig. 2. The sample size was the same as the baseline. The follow-up check involved 177 nurses from five nursing units from whom 177 questionnaires and written examinations were collected, and 130 were observed in their work. Compared with the baseline review, the following results were obtained.

F2
Figure 2:
Baseline audit and follow-up audit results of nursing staff's cognition to prevent needle-stick injury (SCORE: point).

In terms of criterion 1, there were 170 (96%) nurses who were in compliance with increasing the awareness regarding new educational content concerning NSI prevention. The content concerned the hospital's policy on safety needles and increasing familiarity with various safety needle operations. Targeted training to develop a core group of nurses specifically informed on NSI prevention was completed, as well as general training on how to prevent NSIs through OSCE training. A total of 173 nurses participated in education and training, with 4 not participating because of sick leave but who will complete what is required on their return to work. Knowledge regarding the prevention of piercings from sharp objects increased from 90.6 points to 93.2 points (Fig. 2).

In terms of criterion 2, the results showed 95% compliance. In the survey, 169 nurses indicated that safety needles can be used when they are at risk of exposure to patients’ blood and body fluids.

In terms of criterion 3, there was 96% compliance. The team collaborated in designing a manual that outlined the instructions for three safety needles, including a blood transfer device, an insulin auto shield, and safety electric razors. During an on-site visit, nurses had expressed doubts concerning needle use and whether they could check the operational steps for needle use in time.

In terms of criterion 4, there was 85% compliance. In terms of criterion 5, there was 80% compliance. Nurses agreed that needles were not to be recapped after use and were willing to carry a sharp object collection box with them. Through the project, the incidence of nursing staff experiencing safety NSIs decreased from 1.67% to 0 (Fig. 3).

F3
Figure 3:
Needle-stick injury rate.

Discussion

This project aimed to implement empirical guidance to improve the management of NSIs among nursing staff, using five recommendations of the PACES system to implement improvement measures and tracking over 6 months. Compared with the initial situation, significant progress was shown postimplementation. The nursing staff were educated about the safe use and disposal of sharps and the improved compliance rate ranged from 40 to 96.6%, with safety needle use increasing from 16 to 95.5%; the safety needle operation procedure awareness increased from 14 to 96%; the amount of needles not recapped after use increased from 47 to 85%; and the practice of placing used needles in the sharps collection box increased from 75 to 80%.

Success factors in the implementation

Before this evidence implementation project was carried out, we found that although the hospital provided training content and knowledge testing questions for unit NSI preventive education every year, the content team members re-discussed and revised the content in accordance with current laws and regulations, occurrence of NSI cases, and requirement for new needles or medical materials, and so forth. However, the incidence rate of NSIs was still high. In this project, we used the JBI PACES model, observing that TRM leadership effectively enhances colleagues’ attention towards the prevention of NSI.

Success factors during the procedural implementation

The following success factors were utilized to improve the management of NSIs.

Leadership

NSIs are an important factor affecting occupational safety. This project used TRM leadership to build consensus and develop the commitment of the nurses to promote evidence-based management of NSIs. The team initially identified NSI prevention recommendations from the JBI PACES and after reviewing the empirical literature according to the recommendations, the team members identified the barriers and areas of improvement, along with determining a higher requirement for active participation from the staff. Although the units had organized on-the-job education every year, only 40% of the nursing staff participated in the training, with new recruits easily missed. Therefore, education and training concerning NSI prevention now form part of initial training for new recruits.

Multiple education methods

On the basis of the updated theoretical and evidence-based knowledge and practical skills, the team members developed teaching and learning strategies that included the OSCE, manuals of prevention of NSIs, and situational simulations. Due to situation monitoring and OSCE training, there was greater understanding on how to operate the safety needles provided by the hospital, and NSIs are reviewed more comprehensively. Through revising the content of education and training and the OSCE training plan, the safety of staff has improved concerning needle use. To avoid the absence of a complete manual of prevention of NSIs, the team members will review the suitability of the manual's content annually, and modify or adjust the content according to the needs of staff, as well as remind staff that if they encounter needles that they do not know how to use, they should contact a pharmacist colleague to confirm the method of use before administering medication. Furthermore, throughout the learning process, mutual support based on the sharing of experiences between colleagues who had sustained NSIs was developed to raise awareness. Simulations, such as ‘thread the needle on a mobile desktop’, were undertaken to prompt insight into disruptions that can occur while injecting and to allow staff to experience the possibility of an NSI and become more interested in self-care and mutual care.

Following puncture prevention education, the nursing staff's knowledge, behavior, and equipment provision in terms of the five criteria concerning NSI prevention had all improved. However, two subjects, ‘Used needles are not recapped’ and ‘Sharps are immediately discarded in the sharp objects collection’, did not achieve goals. Therefore, we need more contextual investigation of punctures and experiential teaching plans, to improve NSIs. To further improve needle recapping, a change in the work processes or habits of nurses is needed, with experience-sharing methods recommended to obtain consensus.

Teamwork communication

Teamwork is the ability to work together toward a common goal. Communication in employee teamwork is an important part of preventing occupational injuries. During the communication process, our team members showed enthusiasm, active listening, and multi-directional communication with executives, peers, and other departments, to achieve the purpose of the project.16 First, we used an open questionnaire to understand the problems of the nurses, and after discussing with the unit head nurse, we reported the problems to the sensory management center, supply room, pharmacy department, medical enterprise department and information room, for responses and solutions concerning the OSCE training course. Support measures allowed all nurses to cooperate with the smooth implementation of the policy.

Organizational support

In terms of institutional support, the project leader in conjunction with various related departments and centers jointly worked to overcome administrative challenges in purchasing safety needles. After checking the safety injection device items provided, it was found that, the National Health Insurance Bureau encourages new safety needle products to be continuously added; this may result in increased medical costs. In addition to the need for special personnel to check and confirm on a regular basis that new items may be needed, it has been recommended that an application be submitted to the hospital for a cost-benefit analysis, to determine what can be obtained with assistance from related departments, such as the Department of Pharmacy, the Department of Medical Enterprise, the Sensory Management Centre, and the Information Room. In terms of needle suppliers as different brands of safety needles have different activation methods, new needles will be used to confirm the official use method with the needle suppliers and provide operating instructions to ensure the safety of the colleagues in the use process. Regarding support from the nursing department, the head nurse along with the nursing department assistants will conduct training to promote the use of safety needles by all the nurses in all the wards. In terms of colleagues, through the reflection of past incidents, nurses were guided to reach a consensus on the prevention of NSIs by formulating new teaching plans to change the previous needle-using habits, cultivate more appropriate behaviors, and reduce the occurrence of NSIs.

Challenge

The compliance of the five criteria on the follow-up audit was more than 80%. We learned that the knowledge and behavior of the nurses on the prevention of puncture injuries had indeed improved, reaching the target value on the postimplementation audit. The concept of ‘acupuncture’ must also be continuously promoted to draw the attention of colleagues to the topic, and thus improve their concentration when using needles.

Conclusion

The concept and implementation of NSI prevention is important. This implementation project applied the JBI PACES, and goals were set in terms of implementing education and training and in providing safety needles. To improve the correct use of needles by nursing staff and reduce NSIs, active training strategies were applied to strengthen relevant knowledge and skills. Empowerment of staff through mutual support and training was applied to improve the usage methods of safety needles and reduce NSIs. Other medical personnel will be included in future, based on empirical recommendations, to help continuously monitor NSI occurrence and work to ensure a safe workplace.

Acknowledgements

We thank the Chief of Taichung Veterans General Hospital in Taiwan, Infection Control nurse, and the participating head nurses for their assistance in the project.

Conflicts of interest

The authors report no conflicts of interest.

References

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Keywords:

evidence-based practice; needle-stick injury; nursing education; prevention

Supplemental Digital Content

© 2022 JBI. Unauthorized reproduction of this article is prohibited.

A video commentary on implementation project titled: How do health professionals prioritise clinical areas for implementation of evidence into practice? The commentary is provided by Andrea Rochon RN, MNSc, Research Assistant, Queen's University, Ontario, Canada