Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. The overall quality of the evidence in the studies was good even though the reporting of the older studies could have been better. Given the technical nature of the intervention and the objective method of ascertaining that the gloves had holes, used in all studies, we believe that there is no reason to assume a high risk of bias. The newer studies that are better reported and thus score better with regard to risk of bias show similar results to the older studies. It was however disturbing to notice that the habit of testing for perforations has changed over time to water tests only, which were originally reported to be less sensitive than the air test and even less so than the combination of the two tests ( Smith 1988; Smith 1990). Everyone who has once repaired a bicycle tyre might know from experience that the air test is very sensitive. Very disturbingly, to support the validity of the water test used most authors referred to an article in which the water test had been described but not validated and stated with great certainty that: "the gloves were tested with a previously validated method". Because all authors tested both study arms with the same test, we don't think that this has influenced the results of this review. A possible effect of detecting fewer perforations could be that the effectiveness of blunt needles has been underestimated. The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

Information from author:The surgeon called the study nurse while changing his gloves before closure of the laparotomy. Therefore, only elective surgery has been included in this study. If you have chosen the ‘signed for’ delivery option, you will have to sign for your parcel upon receipt. TS=(random* OR control* OR trial OR trials OR "single blind" OR "double blind" OR "triple blind" OR "latin square" OR placebo* OR comparative OR "follow up" OR prospectiv* OR "cross over" OR volunteer*) UK. HCWs performing suturing of perineal tears and episiotomies including perineal skin. Intervention group n = 104 surgeon‐operations. Control group n = 91 surgeon operations. Number observed: 195 pairs of gloves.

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TS=("health care worker" OR "health care workers" OR "health occupations" OR "health personnel" OR physician* OR nurse* OR hospital* OR clinic OR clinics) Outcome 1. Number of perforations in gloves. 2. Force needed to use the needle 3. Ease of use of the needle. Gloves were filled with water and perforations were noted as jets of water health care worker*' or 'health personnel' or 'HCWs' ) and ( 'virus disease*' or 'virus*' or 'viral infect*') randomized controlled trial" or "clinical trials" or "clinical trial" or "random allocation" or "double blind". or "single blind" or ((singl* or doubl* or trebl* or tripl*) and (blind* or mask*)) or "latin square" or placebo# or random* or "research design" or "comparative study" or "comparative studies" or "evaluation study" or "evaluation studies" or "follow up study" or "follow up studies" or "prospective study" or "prospective studies" or "cross over study" or "cross over studies" or control* or prospective* or volunteer or (MH "Clinical Trials+") or (MH "Nonrandomized Trials") or (MH "Crossover Design")

The strategy was used to search MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) ( The Cochrane Library) and the Occupational Safety and Health Review Group Specialised Register, NHSEED, Science Citation Index Expanded, CINAHL, Nioshtic, CISdoc, LILACS and PsycINFO (up until September 2010). Search effect*[tw] OR control[tw] OR controls*[tw] OR controla*[tw] OR controle*[tw] OR controli*[tw] OR controll*[tw] OR control'*[tw] OR evaluation*[tw] OR program*[tw] MH "Health Occupations") OR health occupations or (MH "Health Personnel+") or (MH "Health Facilities+") OR health facilities or TX "health care worker" or TX "health care workers" or (MH "Personnel, Health Facility+") or (MH "Occupational Health Services+") or (MH "Occupational Hazards+") or (MH "Occupational Exposure") or TX "health care personnel" or (MH "Health Personnel+") or (MH "HIV Infections+") High quality: Further research is very unlikely to change our confidence in the estimate of effect. surgeons not blinded to randomisation outcome; blinding to type of needle is impossible for surgeons

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Use of suture needles with blunted end. Control group used conventional sharp pointed suture needles. nursing or nurse or nurses or physician or physicians or "health care personnel" or "health personnel" or "health care worker" or "health care workers" or "Clinicians*" or "Dentist*" or "Health‐Personnel" or "Medical Personnel" or "Military‐Medical‐Personnel" or "Nurses*" or "Physician*" or "Psychiatric‐Hospital‐Staff*" or "medical students" or "hospitals" or "occupational exposure" or "occupational exposures").mp. [mp=title, abstract, heading word, table of contents, key concepts]

Blunt filter needles , which are filler needles with an extra filter attachment. This filter keeps out any solid particles from the liquid solution, especially if it’s been mixed from a powdered form. Blunt needles are almost identical to sharp-tip needles, with the key difference of having an unbevelled (or pointed) tip. There are two kinds of blunt needles: Netherlands. Surgeons and assistants performing laparotomies, abdominal closure: fascia. Number studied: 200 procedures, 400 operators and 406 pairs of gloves. Intervention group n = 200 surgeon‐operations. Control group n = 100 surgeon‐operations. Gloves changed before skin closure.Outcome: percentage of perforated gloves. Detection method not reported but we assumed that this was the combined air and water method developed by one of the authors. In five studies ( Ablett 1998; Hartley 1996; Rice 1996; Wilson 2008; Wright 1993) one surgeon per operation participated in the study, in three studies there was a surgeon and an assistant ( Meyer 1996; Nordkam 2005; Sullivan 2009), in one study there was a surgeon and two assistants ( Mingoli 1996), and in one study it was unclear how many participated ( Thomas 1995). In some studies the number of participants was partly inferred from the number of gloves used. Perforation detection: The gloves were filled with water and perforations were noted as jets of water. Secondary outcome: Ease of use of the needles. We intended to use a random‐effects model in the meta‐analysis when studies were statistically heterogeneous, but they weren't. We used a fixed‐effect model to pool study results.