Integration of Safety Technologies Into Rheumatology and Orthopedics Practices: A Randomized, Controlled Trial

Arthritis & Rheumatism. 2008;57(7):1907-1914. 


Needle-and-syringe procedures, including aspiration of synovial fluid and cortisone injections, are critical to treating patients with rheumatoid arthritis, osteoarthritis and related diseases. Though performed by medical professionals, these routine procedures have a high rate of injuries to patients and physicians. Developing formal systems to improve patient and healthcare worker safety should be a priority for all clinicians, as mandated by the Joint Commission and the Occupational Safety and Health Administration. However, the glaring lack of safety technology standardization and effectiveness studies discourages most rheumatologists and orthopedists from taking advantage of innovations that could spare their patients considerable pain, not to mention protect themselves.

The identification, evaluation, and integration of highly effective new safety technologies into rheumatology and orthopedics practices can be accelerated, as researchers with the University of New Mexico Health Sciences Center demonstrate in the July 2008 issue of Arthritis & Rheumatism ( Tapping the resources of national patient safety centers, they selected two complementary safety technologies for a randomized, controlled trial: the BD Eclipse Needle, designed to avert needlestick injuries to healthcare workers, and a reciprocating procedure device (RPD), a state-of-the-art syringe that aims to reduce patient pain by improving physician control.

Among its features, the BD Needle comes with 2 sheaths, a conventional sheath that is removed to expose and then use the needle, and a lateral rotating sheath that encloses and inactivates the used needle with the push of a finger. Superior to conventional syringes, the RPD features a set of reciprocating plungers linked by a pulley. When the accessory plunger is depressed with the thumb, the syringe aspirates, and when the dominant plunger is depressed with the thumb, the syringe injects. This allows the index and middle fingers to remain in one position during both aspiration and injection, while the thumb needs to move only in a horizontal plane to the alternative plunger in order to change the direction to suit the procedure.

37 physicians agreed to test the promise of both safety technologies, following instruction in how to use each. 141 patients who required aspiration or drug injections into joint tissue as part of their customary medical care also agreed to participate in the experiment. 566 musculoskeletal procedures involving syringes and needles were randomized—patient by patient, by flipping a coin—to either pairing the BD safety needle with either a conventional syringe or the novel RPD. As a result, 288 procedures were performed using the usual syringe and 278 procedures were performed using the combined new technologies. Directly after every procedure, an objective, non-operating observer asked the patient about his or her experience of pain, as well as noted any needlesticks to the operating physician. In addition, physicians were asked to rate their satisfaction with the performance of the syringe device they had used. Patient pain and physician satisfaction responses were each scored according to standard visual analog scales and statistical analysis was applied to the data.

After training and practice, all of the physicians performed well with both the BD safety needle and the RPD. During 566 procedures, use of the safety needle resulted in no accidental needlesticks to healthcare workers. Notably, 1 physician broke the protocol, used a conventional needle on 1 patient, and suffered a needlestick. Use of the RPD brought a 35.4 percent reduction in patient-assessed pain scores. Only 27 percent of the procedures with the RPD—75 of 278—resulted in significant pain, compared with 53.5 percent of the procedures using the conventional syringe. Overwhelmingly, physician satisfaction with the RPD and safety needle was excellent.

"Based on the results of the present study," notes its lead author, Dr. Wilmer L. Sibbitt, Jr., "the combination of the 2 technologies would be anticipated to have a positive impact on both patient and health care worker safety and quality of care when integrated into all needle-and-syringe procedures performed by physicians within the entire health system."

Beyond advocating adoption of the RPD with the BD safety needle, this trial has important implications for the systematic introduction of safety technologies into rheumatology and orthopedics practices. Following the University of New Mexico Health Science Center's lead, keys to successful integration include utilizing national and regional safety resource centers, emphasizing the early involvement and proficiency of healthcare workers, and determining relevant quality measures, especially pain assessment.

Item is available via Wiley InterScience at


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.