Reducing the Risk of Injuries to Staff from Insulin Pens

CLINICAL DEVELOPMENT Reducing the risk of injuries to staff from insulin pens author Carmel Edwards, MA, RGN, SEN, is sen- associated with the use of insulin pen devices be- ior infection control nurse; Lesley Metcalfe BSc, tween 1 February 2003 and 31 January 2004. Out RGN, is diabetes specialist nurse and clinical risk of 80 sharps injuries to staff, 15 were related to the adviser; Joe Allan, BSc, RN, DipHE, is infection control use of insulin pen devices (Tables 1 and 2). nurse; Andre Haynes, Dip Occupational Health The infection control nurses (ICNs) were unfamil- and Safety and Environmental Management, iar with insulin pen devices and decided that fur- is health and safety adviser; all at Wirral Hospital ther investigation was necessary. They were con- NHS Trust, Merseyside. cerned that when patients were unable to abstract Edwards, C. et al (2005) Reducing administer their insulin this procedure was under- the risk to staff from insulin pens. Nursing Times; taken by health care workers who then had to dis- 101: 25, 34–36. pose of the needle. This article describes problems in the use and The consequences of patients receiving a needle- disposal of sharps used in the administration of stick injury from their own devices are not signifi- insulin therapy in a hospital setting. Subsequent cant. However, health care workers may be at risk investigation and action taken to reduce the risk of developing BBV following an injury from a of needlestick injuries in staff who administer contaminated needle. insulin therapy with an insulin pen delivery sys- Staff reported that injuries were often sustained tem are also discussed. either during the resheathing of the insulin pen needle prior to unscrewing it or when unscrewing It is estimated that 100,000 needlestick injuries the insulin pen needle before discarding it into the occur each year in the UK, although it is suspected sharps bin. It was also noted that patients did not that many others go unreported (Unison, 2003). always remove the needle when they administered The risk of exposure to bloodborne viruses (BBV), their own insulin and therefore some staff pricked in particular hepatitis B, hepatitis C and human im- themselves when they retrieved the device from munodeficiency virus (HIV) has been documented the ward drugs fridge. since the mid-1980s, when the first occupational exposure and subsequent seroconversion of a Action to reduce the risk of injury health care worker to HIV positive as the result of An urgent meeting was held to discuss the con- a needlestick injury was reported (Communicable cerns raised. It was suggested that if a member of Diseases Surveillance Centre, 2000). Furthermore, staff had to administer insulin on a patient’s be- the recent guidance document from the Depart- half, she or he should use an insulin needle and ment of Health (DoH, 2004) on post-exposure syringe and insulin vial. However, it was argued prophylaxis for HIV emphasises the importance of that this would affect the progress of introducing protecting health care workers from needlestick insulin pen devices and could confuse patients. In injuries associated with clinical practice. addition, many types of insulin are no longer avail- At Wirral Hospital NHS Trust staff are encouraged able in vials for use with a needle and syringe. to report all needlestick injuries by completing in- Therefore, a solution was needed that would allow cident or accident forms. These are sent to the the insulin pen devices to be used safely. As soon health and safety adviser, who noticed a signifi- as the risks had been identified an action plan was cant increase in the number of sharps injuries formulated (Table 3, p36). The manufacturers of insulin pens and needles were contacted to see whether a removal device Table 1. sharps injuRies from February 2003 to January 2004 was available for use in a hospital setting. The NovoFine remover was suggested for use in a pilot Number project on the diabetes ward. Total self-inflicted sharps injuries 80 However, this device requires two-handed needle removal, which is not recommended by the Accidents involving insulin pens 15 DoH (2004). This is because using two hands to Percentage involving insulin pens 18.75 remove a needle increases the likelihood of sus- taining a needlestick injury. The manufacturer of SPL 34 NT 21 June 2005 Vol 101 No 25 www.nursingtimes.net kEywORDS n Diabetes n Needlestick n Risk management TABLE 2. SELf-iNfLiCTED SHARPS iNJuRiES to Staff that occuRRED betwEEN RefeRenCes 1 fEBRuARy 2003 AND 31 JANuARy 2004 Communicable Disease Surveillance when and why injury occurred Number Centre (2000) Surveillance of health care workers exposed to bloodborne Administering/just after administering insulin 3 viruses at work: July 1997 to June 2000. CDR Weekly; 10: 33. Available at: Removing needle from insulin pen 4 www.cdc.gov Resheathing the needle 3 Department of Health (2004) HIV Post- Priming insulin pen 1 Exposure Prophylaxis: Guidance from the UK Chief Medical Officers’ Expert Needle sticking through sheath 1 Advisory Group on AIDS. London: Stationery Office. Disposing of needle 1 Taking insulin pen from patient 2 Health and Safety Executive (1974) Health and Safety at Work Act. London: Total 15 HSE. Available at: www.hse.gov.uk/ healthservices/index.htm the device said it was working towards a safer injection. Often the insulin pen devices did not dis- Health and Safety Executive (1999) needle device and this would be made available to play patient identification details. Management of Health and Safety at the trust for trial once it was ready to pilot. Questioning the nursing staff revealed a general Work Regulations 1999. Approved Meanwhile, it was noted that the 1L rectangular lack of understanding and knowledge about insu- Code of Practice and Guidance L21 (2nd sharps bins used within the trust had devices on lin pen delivery systems, including the frequency ed). London: HSE. their lids that could be used to unscrew needles. In and process for changing needles. With the excep- practice staff are encouraged to dispose of sharps tion of those working on the diabetes ward, staff Unison (2003) Take a Lead From the US to Stop Needlestick Injuries. London: at the bedside, using the 2.5L sharps bin and tray. may only look after patients with insulin-depend- Unison. Available at: www.unison.org. It was agreed that manufacturers should be con- ent diabetes occasionally and therefore rely on the uk/asppresspack/pressrelease tacted and asked to redesign the top of the 2.5L patient to instruct them on the use of their insulin bin to incorporate the unscrewing device. delivery device. In addition a warning sticker was designed and On admission to hospital, patients may not be displayed on all drug fridges alerting staff to the well enough to administer their own insulin, let potential injuries associated with the use of insulin alone dispose of needles safely. Therefore, it is pen devices and the removal and disposal of their essential that staff seek advice from the diabetes needles. A poster was designed and displayed in specialist nurses or link nurses, or refer to the all clinical areas giving step-by-step instructions on trust’s clinical procedures manual. how to remove pen needles safely using the 1L Anecdotally, there have been reports that pa- sharps bins. tients who administer their own insulin have Diabetes and infection control link nurses were discarded used needles in lockers, potentially also alerted to the potential risks associated with putting others, including domestic staff, at risk the use of insulin pen devices. Safe practice was of needlestick injuries. Inpatients with diabetes discussed and the link nurses were asked to cas- need to be instructed on safe needle disposal cade the information to their colleagues. and ward staff need to ensure sharps bins are readily available. Changes to practice Section 2 of the Health and Safety at Work Act As can be seen from the action plan, it was not a (1974) states: ‘It shall be the duty of every em- single action that proved successful – a number of ployer to ensure, so far as reasonably practicable, interventions were required. A multidisciplinary the health, safety and welfare at work of all his/ approach to risk management was considered es- her employees’. The employer is required to pro- sential, as were strong networks for communicat- vide appropriate information and instruction to- ing with and listening to others to ensure changes gether with appropriate safety equipment, training to practice were initiated. and supervision to ensure employees are protected While undertaking routine ward audits, the ICNs at work (Health and Safety Executive, 1974). Fur- observed that insulin pen devices were regularly thermore, the Management of Health and Safety stored in the ward drug fridges with needles at- at Work Regulations (HSE, 1999) require employers This article has been double-blind tached. These had not been removed after the to assess and control adequately all risks to which peer-reviewed. previous injection as patients regularly use nee- employees may be exposed. For related articles on this subject dles several times at home, even though they To manage identified risks successfully, appropri- and links to relevant websites see are taught to remove the needle after a single ate assessments must be undertaken so that risk www.nursingtimes.net NT 21 June 2005 Vol 101 No 25 www.nursingtimes.net 35 DEVELOPMENT TABLE 3. ACTiON PLAN fOR REDuCiNG iNSuLiN PEN-RELATED NEEDLESTiCk iNJuRiES

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