The Effectiveness of a Needleless Intravenous Connection System: An Assessment by Injury Rate and User Satisfaction

Objective: To assess the impact of a needleless intravenous (IV) connection system on the rate of reported intravenous-connection-related (IVCR) percutaneous injuries, and to assess user satisfaction, frequency of use, and barriers to use. Design: A pre-post intervention Design, with injury incidence rates being compared 3 years before and 1 year after hospitalwide device implementation; and a crosssectional descriptive user satisfaction survey. Setting: Two tertiary-care teaching hospitals, one general and one pediatric, located in a large metropolitan medical center. Outcome variable: All IVCR percutaneous injuries reported to the employee health services at both hospitals during the years from 1989 to 1991 and 1993. Study population: Survey Participants were selected randomly from licensed nursing employees at both hospitals. Intervention: IV connection system consisting of blunt plastic cannulas and compressed latex injection sites. Results: After device implementation, the IVCR injury rate was reduced 62.4% (rate ratio [RR], 0.38; 95% confidence interval [$CI_{95}$], 0.27-0.53) at the general hospital and 70.2% (RR, 0.30; $CI_{95}$, 0.17-0.53) at the pediatric hospital. After adjusting for thie reduction in injury rate due to factors other than device implementation, the IVCR injury rate was reduced 54.5% (adjusted RR, 0.46; $CI_{95}$, 0.32-0.65) at the general hospital and 57.2% (adjusted RR, 0.43; $CI_{95}$, 0.24-0.78) at the pediatric hospital. Approximately 94% of survey respondents (n=478, response rate=51%) were satisfied with the device and recommended continued use. However, needles still were being used for activities that could have been performed with the needleless system because of compatibility, accessibility, and other technical problems related to the device. Conclusions: The device was effective in reducing the rate of reported IVCR percutaneous injuries and users were satisfied with the device, but barriers to universal use were identified.