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Mohamed M, Tandon N, Kim Y, Kopp I, Tanaka N, Mikamo H, Friedman K, Bajpai S. Needlestick Injuries With Insulin Injections: Risk Factors, Concerns, and Implications of the Use of Safety Pen Needles in the Asia-Pacific Region. J Diabetes Sci Technol 2023:19322968231186402. [PMID: 37475682 DOI: 10.1177/19322968231186402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Globally, health care workers (HCWs) are at a high risk of occupational exposure to needlestick injuries (NSIs). Needlestick injuries not only are associated with an increased risk of infections caused by bloodborne pathogens but are also a primary source of emotional distress and job burnout for HCWs and patients. Insulin injection-related NSIs are common among HCWs working in hospitals in the Asia-Pacific (APAC) region and impose a significant burden. Insulin pen needles have a high risk of transmitting infections (at both the patient-end and cartridge end of the sharp) after use. Recapping a needle after administering an insulin injection poses a major risk to HCWs. Currently, several safety-engineered needle devices (SENDs) are available with active or passive safety mechanisms. Passive insulin safety pen needles with dual-ended protection and automatic recapping capabilities have resulted in a significant drop in accidental punctures to HCWs while administering insulin to patients with diabetes. In this article, we have reviewed the burden and common causes of NSIs with insulin injections among HCWs in the APAC region. We have discussed current approaches to address the issues associated with NSIs and the benefits of introducing SENDs in health care settings, including long-term care facilities, nursing homes, and home care settings where patients may require assisted insulin injections. This review also summarizes key strategies/recommendations to prevent NSIs in HCWs and patients with diabetes in the APAC region.
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Affiliation(s)
- Mafauzy Mohamed
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Youngsoon Kim
- Kangwon National University Hospital, Gangwon-do, South Korea
| | - Irene Kopp
- Nepean Diabetes Service, Nepean Hospital, Kingswood, NSW, Australia
| | - Nagaaki Tanaka
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Kevin Friedman
- embecta (formerly BD Diabetes Care), Parsippany, NJ, USA
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Dong Y, Li F, Li J, Li R, Wang Q. Multicenter cross-sectional study on the reporting status and influencing factors of needlestick injuries caused by insulin injection devices among nurses in Peking, China. Am J Infect Control 2020; 48:805-809. [PMID: 31919009 DOI: 10.1016/j.ajic.2019.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Needlestick injuries (NSIs) most commonly occur in conjunction with insulin injections, and nurses had the highest rate of NSIs among different occupational groups. However, only few nurses have the awareness to report these incidents. We aimed to investigate the current reporting status and influencing factors of NSIs caused by insulin injection pen devices among nurses and nursing interns in Peking, China. METHODS The study consisted of 4,609 nurses and nursing interns in different hospital departments, namely endocrinology wards, medical (except endocrinology) and surgical departments, emergency, outpatient departments, operation theaters, intensive care units, and other departments from 16 districts of Peking, China. A researcher-devised questionnaire was designed to assess the rate of reporting of accidental NSIs and its influencing factors. Descriptive statistics, the χ2 tests, and univariate and multivariate regression were used to analyze the independent influencing factors of reports on NSIs caused by insulin injection pen devices. RESULTS Among all participants, most of them were women (97.61%). More than half of the participants had been working as nurses over 5 years (59.58%). Approximately 63.66% of participants had been trained to prevent and deal with accidental NSIs within 1 year. Approximately 19.33% of the participants experienced NSIs before, but only 30.30% of them reported the injury to the management department or director. The main reasons for not reporting were complex/cumbersome reporting procedure (317 of 621; 51.05%), being too busy at work at the time of injury (301 of 621; 48.47%), and low-risk for personal health (197 of 621; 31.72%). Multivariate analysis showed that age (P = .014; odds ratios [OR; 1.063, 1.736]), prior needlestick training education (P = .018; OR [0.406, 0.917]), and written system for preventing (P < .001; OR [0.289, 0.622]) were independent factors associated with reporting of NSIs caused by insulin injection pen devices. CONCLUSIONS NSIs caused by insulin injection pen devices are common among nurses and are often not reported. It is necessary to provide nurses with regular training to prevent and deal with NSIs. Hospital management departments should adopt a simpler reporting procedure to understand the actual occurrence of NSIs to develop better prevention and improvement measures.
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Affiliation(s)
- Yingyue Dong
- Department of Endocrinology, Peking Union Medical College Hospital, Peking, China
| | - Fangfang Li
- Department of Endocrinology, Peking Union Medical College Hospital, Peking, China
| | - Jing Li
- School of Nursing, Peking Union Medical College, Peking, China
| | - Rui Li
- Department of Endocrinology, Peking Union Medical College Hospital, Peking, China
| | - Qun Wang
- Department of Endocrinology, Peking University Third Hospital, Peking, China.
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Tandon N, Kalra S, Balhara YPS, Baruah MP, Chadha M, Chandalia HB, Prasanna Kumar KM, Madhu SV, Mithal A, Sahay R, Shukla R, Sundaram A, Unnikrishnan AG, Saboo B, Gupta V, Chowdhury S, Kesavadev J, Wangnoo SK. Forum for Injection Technique and Therapy Expert Recommendations, India: The Indian Recommendations for Best Practice in Insulin Injection Technique, 2017. Indian J Endocrinol Metab 2017; 21:600-617. [PMID: 28670547 PMCID: PMC5477451 DOI: 10.4103/ijem.ijem_97_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Health-care professionals in India frequently manage injection or infusion therapies in persons with diabetes (PWD). Patients taking insulin should know the importance of proper needle size, correct injection process, complication avoidance, and all other aspects of injection technique from the first visit onward. To assist health-care practitioners in their clinical practice, Forum for Injection Technique and Therapy Expert Recommendations, India, has updated the practical advice and made it more comprehensive evidence-based best practice information. Adherence to these updated recommendations, learning, and translating them into clinical practice should lead to effective therapies, improved outcomes, and lower costs for PWD.
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Affiliation(s)
- Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Manash P. Baruah
- Department of Endocrinology, Excel Center (Unit of Excel Care Hospitals), Guwahati, Assam, India
| | - Manoj Chadha
- Department of Endocrinology, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Hemraj B. Chandalia
- Department of Endocrinology, Diabetes Endocrinology Nutrition Management and Research Centre, Mumbai, Maharashtra, India
| | - K. M. Prasanna Kumar
- Department of Endocrinology and Metabolism, M S Ramaiah Medical College, CEO-Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
| | - S. V. Madhu
- Department of Medicine, Division of Endocrinology and Metabolism, University College of Medical Sciences, New Delhi, India
| | - Ambrish Mithal
- Department of Endocrinology, Medanta Medicity, Gurugram, Haryana, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Osmania General Hospital, Hyderabad, Telangana, India
| | - Rishi Shukla
- Department of Endocrinology, Regency Hospital, Private Ltd. and Centre for Diabetes and Endocrinology, Kanpur, Uttar Pradesh, India
| | - Annamalai Sundaram
- Department of Endocrinology, Ambedkar Institute of Diabetes, Government Kilpauk Medical College, Chennai, Tamil Nadu, India
| | - Ambika G. Unnikrishnan
- Department of Clinical Diabetology and Endocrinology, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Banshi Saboo
- Diabetologist and Endocrine and Metabolic Physician, Diacare-Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | | | - Subhankar Chowdhury
- Department of Endocrinology, IPGME & R and SSKM Hospital, Kolkata, West Bengal, India
| | - Jothydev Kesavadev
- Jothydev's Diabetes and Reserarch Center, Thiruvananthapuram, Kerala, India
| | - Subhash K. Wangnoo
- Apollo Centre for Obesity, Diabetes and Endocrinology, Indraprastha Apollo Hospital, New Delhi, India
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Frid AH, Kreugel G, Grassi G, Halimi S, Hicks D, Hirsch LJ, Smith MJ, Wellhoener R, Bode BW, Hirsch IB, Kalra S, Ji L, Strauss KW. New Insulin Delivery Recommendations. Mayo Clin Proc 2016; 91:1231-55. [PMID: 27594187 DOI: 10.1016/j.mayocp.2016.06.010] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/15/2016] [Accepted: 06/22/2016] [Indexed: 12/14/2022]
Abstract
Many primary care professionals manage injection or infusion therapies in patients with diabetes. Few published guidelines have been available to help such professionals and their patients manage these therapies. Herein, we present new, practical, and comprehensive recommendations for diabetes injections and infusions. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, in 2015. Recommendations are organized around the themes of anatomy, physiology, pathology, psychology, and technology. Key among the recommendations are that the shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and, therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them; effective long-term therapy with insulin is critically dependent on addressing psychological hurdles upstream, even before insulin has been started; inappropriate disposal of used sharps poses a risk of infection with blood-borne pathogens; and mitigation is possible with proper training, effective disposal strategies, and the use of safety devices. Adherence to these new recommendations should lead to more effective therapies, improved outcomes, and lower costs for patients with diabetes.
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Affiliation(s)
- Anders H Frid
- Department of Endocrinology, Skane University Hospital, Malmö, Sweden
| | - Gillian Kreugel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Giorgio Grassi
- Città della Salute e della Scienza Torino, Torino, Italy
| | - Serge Halimi
- University for Sciences and Medicine Joseph Fourier Grenoble and Diabetology Department CHU Grenoble, Grenoble Cedex, France
| | - Debbie Hicks
- Barnet, Enfield & Haringey Mental Health Trust, London, UK
| | | | | | | | | | - Irl B Hirsch
- University of Washington Medical Center-Roosevelt, Seattle
| | | | - Linong Ji
- Peking University Peoples Hospital, Beijing, China
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Adams D, Down S, Hicks D. FIT4Safety: recommendations in the diabetes care setting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2013; 22:997-1000. [PMID: 24067308 DOI: 10.12968/bjon.2013.22.17.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sharps injuries pose a serious threat to health professionals, patients, and downstream workers. FIT4Safety is an initiative that seeks to promote safety and best practice in the diabetes setting. An Introduction to FIT4Safety and its Recommendations for the Safety of Sharps in the Diabetes Care Setting explains how and why the FIT4Safety initiative was formed, what it aims to achieve, and the importance of ensuring safety in the diabetes care setting. Outputs from FIT4Safety include Injection Safety in UK and Ireland: Safety of Sharps in Diabetes Recommendations. These recommendations were developed to provide a resource for all those directly involved in, or overseeing, diabetes care. The main topics and guidance detailed within the recommendations are discussed, as well as EU Directive 2010/32 on sharps injury prevention and the UK's Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
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Affiliation(s)
- Debra Adams
- Independent Consultant Advisor/Head of Infection Prevention and Control (Midlands and East) at NHS Trust Development Authority
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Kalra S, Balhara YPS, Baruah MP, Chadha M, Chandalia HB, Chowdhury S, Kumar KMP, Modi S, Pitale S, Shukla R, Sahay R, Sundaram A, Unnikrishnan AG, Wangnoo SK. Forum for injection techniques, India: the first Indian recommendations for best practice in insulin injection technique. Indian J Endocrinol Metab 2012; 16:876-885. [PMID: 23226630 PMCID: PMC3510955 DOI: 10.4103/2230-8210.102929] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Advances in the treatment of diabetes have led to an increase in the number of injectable therapies, such as human insulin, insulin analogues, and glucagon-like peptide-1 analogues. The efficacy of injection therapy in diabetes depends on correct injection technique, among many other factors. Good injection technique is vital in achieving glycemic control and thus preventing complications of diabetes. From the patients' and health-care providers' perspective, it is essential to have guidelines to understand injections and injection techniques. The abridged version of the First Indian Insulin Injection technique guidelines developed by the Forum for Injection Technique (FIT) India presented here acknowledge good insulin injection techniques and provide evidence-based recommendations to assist diabetes care providers in improving their clinical practice.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Manash P. Baruah
- Department of Endocrinology, Excel Center (unit of Excel Care Hospitals), Guwahati, Assam, India
| | - Manoj Chadha
- Department of Endocrinology, P.D. Hinduja Hospital and Research Centre, Mumbai, India
| | - Hemraj B. Chandalia
- Department of Endocrinology, Diabetes Endocrinology Nutrition Management and Research Centre (DENMARC), Mumbai, Maharashtra, India
| | | | - K. M. Prasanna Kumar
- Department of Endocrinology and Metabolism, M S Ramiah Medical College, Bangalore, Karnataka, India
| | - Sonal Modi
- Department of Nutrition, Diabetes Endocrinology Nutrition Management and Research Centre (DENMARC), Mumbai, India
| | - Shailesh Pitale
- Department of Endocrinology, Pitale Diabetes and Hormone Center, Nagpur, India
| | - Rishi Shukla
- Department of Endocrinology, Regency Hospital Private Ltd and Centre for Diabetes and Endocrinology, Kanpur, Uttar Pradesh, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - Annamalai Sundaram
- Department of Endocrinology, Ambedkar Institute of Diabetes, Govt. Kilpauk Medical College, Kilpauk, Chennai, India
| | | | - Subhash K. Wangnoo
- Department of Endocrinology, Apollo Centre for Obesity, Diabetes and Endocrinology (ACODE), Indraprastha Apollo Hospital, New Delhi, India
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