Nurse-led design and evaluation of a retractable safety needle for injection safety

Needlestick injuries remain a significant source of bloodborne pathogen exposure in clinical settings, contributing to healthcare-associated infections among nurses. Existing safety devices rely on user compliance or administrative controls, which are insufficient under real-world pressures. This study evaluates the infection control potential of a nurse-designed retractable safety needle (RSN), developed to structurally reduce exposure risk through substitution-level engineering, as defined by the Hierarchy of Controls framework of the US National Institute for Occupational Safety and Health.

A randomized crossover trial was conducted with 76 nurses at a regional teaching hospital in eastern Taiwan. Participants completed two simulated clinical injection tasks, once with a conventional cap-type safety needle (CSN) and once with an RSN. Safety and usability outcomes were compared using generalized estimating equations, accounting for within-subject and sequencing effects.

Compared with the CSN, the RSN significantly reduced near-miss events (mean difference: -0.62 occurrences, P = 0.002), frequency of needle exposure (mean difference: -7.47 occurrences, P < 0.001), and cumulative duration of needle exposure (mean difference: -27.68 s, P < 0.001). While the RSN demonstrated improved safety outcomes, it required significantly longer preparation time (mean difference: 75.6 s, P < 0.001). Usability scores did not differ significantly between the devices (P = 0.156).

The RSN offers a practical infection control innovation by structurally eliminating exposure pathways rather than relying on downstream behaviour. This study supports nurse-led device development in advancing engineering-based strategies to reduce occupational exposure and improve injection safety. Findings may inform future implementation of medication preparation systems to mitigate healthcare-associated infections in practice.