Reducing Needlestick

Injuries

Safety-engineered IV cannulas in perioperative practice: a WHO hierarchy of controls approach at Valley Hospital

Hellen Nyabicha, KRRN | Theatre & Endoscopy In-charge | 43rd NNAK Perioperative Nurse Conference

Background

A Persistent Occupational Hazard

Needlestick and sharps injuries remain one of the most persistent occupational hazards facing perioperative and clinical nursing staff.

A Routine, High-Frequency Risk

Intravenous cannulation is a routine, high-frequency procedure, and each cannulation carries a real risk of accidental exposure to blood and body fluids.

Behaviour-Dependent Prevention

Traditional prevention relies heavily on training and PPE, which depend on consistent human behaviour under time pressure.

A More Reliable Path

The WHO hierarchy of controls points to a more reliable path: redesigning the device itself so that the safer choice is the only choice.

Problem Statement

Conventional Cannulas

Standard intravenous cannulas leave the needle exposed during and immediately after insertion — the single highest-risk moment for a needlestick injury in routine perioperative and ward care.

Highest-Risk Moment

Needle exposure occurs during and immediately after insertion — before any safety step can intervene.

Baseline Picture

14

Needlestick injuries recorded, 19 months of baseline surveillance (2024–Jul 2025)

3

Directly related to conventional IV cannulation

IPC practice at this stage relied mainly on administrative controls and PPE, not on the device itself.

Aim and Objectives

AIM

To reduce needlestick injuries associated with intravenous cannulation by introducing safety-engineered cannulas, guided by the WHO hierarchy of controls.

OBJECTIVES

Reduce needlestick injuries associated with intravenous cannulation.

Transition from behaviour-dependent practice to an engineering control.

Monitor needlestick injury trends before and after implementation.

Improve staff confidence and safety culture during invasive procedures.

The WHO Hierarchy of Controls

The hierarchy prioritises hazard control from most to least effective:

1. Elimination

2. Substitution

3. Engineering Controls

4. Administrative Controls

5. PPE

Most Effective

Least Effective

Where This Project Focused

For a device-level hazard such as an exposed cannula needle, engineering controls sit near the top — and that is where this project focused.

Removes the Human Step

A safety-engineered cannula removes the exposed needle automatically. The safer outcome no longer depends on a nurse remembering a step under pressure.

Safety-Engineered IV Cannulas

Rationale

Conventional cannulas expose the needle during and after insertion, creating a direct sharps-exposure risk to the healthcare worker at the point of care.

The Intervention

Safety-engineered IV cannulas with automatic needle shielding were introduced hospital-wide to remove the exposure risk at the point of insertion.

This is an engineering control: staff are protected by design, not by vigilance.

How We Measured Success

01

Process

Availability on all wards

Proportion of cannulations using the new device

Training completion

02

Outcome

Total needlestick injuries

Cannula-related injuries

Trend before and after

03

Balancing

Staff acceptance

Supply continuity

Procedure time and difficulty

Needlestick Injuries: Baseline Period

BASELINE — BEFORE INTERVENTION

14

Total NSIs

Recorded across the full baseline surveillance period

3

Cannula-Related

Directly linked to conventional IV cannulation

19

Months Observed

2024 through July 2025, pre-intervention

Baseline vs Post-Intervention

POST-INTERVENTION — 12 MONTHS

100%

REDUCTION

In cannula-related injuries after implementation

0

Cannula-Related NSIs

Post-intervention, down from 3 at baseline

2

Total NSIs

Over 12 months, down from 14 at baseline

Lessons Learnt

Leadership willingness alone is insufficient to drive change without strong technical guidance from the IPC team.

Effective implementation was achieved when leadership support was matched with informed IPC advocacy that translated intent into a concrete, evidence-based device change.

Embedding the new cannula into routine procurement and workflow, not just training, is what made the change stick.

Recommendations

Start With the Hierarchy

Apply the WHO hierarchy of controls when addressing sharps and needlestick risk.

Prioritise engineering controls — that is, safety-engineered devices — over training alone.

Measure and Scale

Track cannula-related injuries specifically, not just total needlestick counts.

Scale safety-engineered cannulas across all departments performing IV access.

IN SUMMARY

Design safer systems, not just safer behaviour.

Introducing safety-engineered IV cannulas, guided by the WHO hierarchy of controls, eliminated cannula-related needlestick injuries in the post-intervention period. This is a feasible, scalable model for perioperative and nursing teams anywhere sharps exposure is a routine occupational risk.

Acknowledgements

01

Hospital Management

For leadership support and the enabling environment.

02

IPC Committee

For oversight and governance throughout implementation.

03

Clinical Teams

For their cooperation and commitment to safer practice.

Thank You

Questions & Discussion

Hellen Nyabicha | hellen.nyabicha@valleyhospital.co.ke | +254 728819335