Abstract
Healthcare worker safety remains a significant and ongoing challenge, particularly in clinical environments where routine procedures involve sharp instruments and repeated manual handling. Needlestick injuries are one of the most common occupational hazards in these settings, exposing healthcare workers to serious bloodborne pathogens such as hepatitis and HIV. Despite the development of safety-engineered devices intended to reduce these risks, injuries continue to occur at substantial rates across healthcare systems. Research shows that a large proportion of healthcare workers experience at least one needlestick injury, with especially high exposure in fast-paced environments such as surgical and interventional settings . This persistence suggests that the issue is not simply due to a lack of safer technology, but reflects a gap between technological capability and real-world use. One example is the continued use of the 21-gauge Chiba needle in image-guided biopsy procedures. While effective, its design requires repeated removal and reinsertion of a metal stylet, increasing opportunities for accidental injury. At the same time, factors such as cost, workflow compatibility, training requirements, and physician preferences influence whether safer devices are adopted . In many cases, unsafe practices become normalized, and injuries may be underreported or treated as unavoidable. Together, these issues point to a broader problem of how to reduce preventable occupational harm in healthcare systems where both technical design and institutional context shape outcomes.
The technical component of this thesis focuses on redesigning the 21-gauge Chiba needle to reduce the risk of provider injury during image-guided biopsy procedures. The current device requires repeated manual handling of a metal stylet, which creates multiple points of exposure during insertion and reinsertion. The goal of this project was to develop a redesigned needle that
minimizes these steps while maintaining the precision required for accurate biopsies. The design process began with observation of existing clinical workflows to identify high-risk moments. These observations informed iterative prototyping and testing using simulated tissue models to evaluate usability, safety, and efficiency. Human factors and ergonomic considerations were incorporated to ensure the device aligns with clinical practice and does not increase cognitive or physical burden. Results suggest that reducing manual handling steps can decrease exposure risk without compromising functionality. However, the project also identified constraints that affect real-world feasibility, including cost, regulatory requirements, and compatibility with existing workflows. Overall, the technical work shows that design improvements can reduce injury risk, but must be developed with attention to how devices are actually used in practice.
The STS research component examines why safer medical devices are not consistently adopted in clinical settings, even when they offer clear safety benefits. The central research question asks how institutional decision-making, training systems, and professional norms shape adoption. Drawing on clinical studies, policy documents, and STS literature, the analysis shows that needlestick injuries persist not only because of design limitations, but because of how risk is managed within healthcare systems. Evidence indicates that injuries are often underreported, which reduces their visibility and urgency. Hospitals must also balance safety with financial pressures and workflow efficiency, which can discourage adoption of more expensive or disruptive technologies. Physician preferences further influence outcomes, as clinicians tend to rely on familiar tools that fit established routines. Training systems reinforce these patterns by embedding traditional devices into practice, making alternatives harder to adopt. Together, these factors contribute to the normalization of risk, where injuries are seen as an expected part of clinical work rather than a preventable problem. The research concludes that adoption is a complex process shaped by institutional structures and professional culture, not simply a response to improved design.
Together, these projects provide a more complete understanding of healthcare worker safety by addressing both device design and the systems in which devices are used. The technical project demonstrates that it is possible to reduce injury risk through targeted design changes, while the STS research explains why those changes do not always translate into practice. This combined approach highlights the need for alignment between engineering design, clinical workflows, and institutional priorities. While the technical project achieved its goal of developing a safer needle concept, it also revealed constraints that may limit implementation. The STS research shows that without changes to institutional decision-making, training practices, and perceptions of risk, even effective technologies may remain underused. Future work should focus on better integrating these perspectives, including involving clinicians in design processes, improving training systems, and addressing institutional barriers to adoption. Overall, this thesis suggests that reducing preventable occupational harm in healthcare requires not only better devices, but also better alignment between technology and the environments in which it is used.
