Injection technique and dual safety in diabetes care - a new SHBN working group to tackle safety risks

Summary

In this blog, Lotty Tizzard, Patient Safety Learning's Content and Engagement Manager, looks at some of the patient and staff safety issues surrounding insulin delivery. These issues have been identified by a new working group set up by the Safer Healthcare and Biosafety Network (SHBN), and she also highlights potential solutions the group will explore.

The SHBN is an independent forum focused on improving healthcare worker and patient safety. It has established a working group on improving injection technique and delivering dual safety in diabetes care. The working group consists of clinicians, policy-makers, charities, manufacturers and patients who are concerned about high numbers of preventable safety incidents related to diabetes treatment.

Content

A Royal College of Nursing (RCN) surveillance project estimates that there are 100,000 sharps injuries each year in the UK,[1] making sharps or needlestick injuries one of the most common safety incidents in healthcare. If a contaminated needle or other medical instrument penetrates the skin of another person, there is a serious risk that it will transmit bloodborne viruses and infections, including HIV and hepatitis. The European Biosafety Network reports that the situation has been made worse by the Covid-19 pandemic, resulting in an average 23% increase in incidents across five European countries.[2] However, we also know that these injuries are underreported, with 21% of nurses who took the RCN survey saying they had not received any education on reporting sharps injuries.[3] An additional barrier to assessing the true scale of the problem is that in the UK, there is no national obligation to report NSIs that do not carry a risk of bloodborne disease.

Accidental sharps injuries can have significant impact on mental health as well as causing serious illness and death. One study showed that the average length of psychiatric trauma related to sharps injuries among healthcare workers was nine months.[4] The cost of these injuries to the NHS in staff absence, delays to clinical work [5] and litigation is significant. One legal firm that works with the NHS has estimated that needlestick injuries cost each NHS trust £500,000 each year in legal costs.[1]

Insulin pen needles account for a significant proportion of sharps injuries in care settings due to the frequency with which they are used. As the majority of people with type 1 diabetes manage their own insulin injections at home, the risks posed by used pen needles and insulin-infusion cannulas extend beyond the walls of hospitals and clinics, into homes and public spaces.

Because of these issues, the Safer Healthcare and Biosafety Network (SHBN) has established a working group to highlight the key issues and propose solutions to reduce the risk of needlestick injuries.

Concerns raised by the group so far include:

• Lack of consistency in how sharps bins are provided to patients for home use across the UK. In some areas it is difficult to find out how to arrange clinical waste or sharps bin collections, meaning some people dispose of their needles in household waste. This poses a clear risk to refuse workers and the general public.
• Lack of knowledge of existing guidelines about safe injection technique. In 2016 the international FITTER injection technique recommendations were developed and published by a congress of international experts. Other organisations such as Trend Diabetes have also issued injection technique guidance for professionals. However, not all healthcare workers know about these guidelines, meaning that their recommendations are not always followed.
• Limited take-up of dual safety devices. There are now a range of dual safety devices available for use in the NHS - these devices protect the person delivering the injection as well as the patient. Dual safety devices conceal both ends of the needle, reducing the risk of injury from both sides, but they are not yet widely used.
• Increased costs associated with dual safety devices. Dual safety devices cost more than standard or traditional safety insulin pen needles. There are therefore potentially conflicting demands between safety, cost and sustainability in the decision-making process about the use of devices. However, price should not be a factor in whether someone is prevented from suffering a sharps injury.
• The need for a broader approach to sharps safety. In addition to diabetes, there are many other medications that require patients to use and dispose of their own needles and injection devices, from IVF treatment to biologic drugs for autoimmune conditions. The range of settings in which injections are administered is also very broad and includes inpatient and outpatient settings, social care and private homes. Every person administering insulin or other injectable medicines needs appropriate education and resources to ensure they can use and dispose of sharps safely.

Although the issues are large and wide-ranging, the working group hopes to tackle some of them by:

• developing a joined-up approach and engaging representatives from all stakeholder groups including clinicians, policy-makers, device manufacturers, charities and patients.
• drafting new, national guidance that establishes clear best practice recommendations around injection technique and safety devices.
• focusing on education at every level, from medical students and practising clinicians, to patients.
• standardising the way in which incidents are monitored to ensure we have an accurate view of the extent and nature of sharps injuries.
• making the sharps disposal process clearer and easier to access for patients.
• addressing sustainability issues related to the manufacture of safety devices.

None of these solutions will come easily, but by bringing together the expertise of so many committed to improving safety in diabetes care, the working group hopes to reduce the risk of needlestick injuries to patients and staff.

Related reading

FITTER: new insulin delivery recommendations (1 September 2016)
My Type 1 Diabetes - self-management education website
Trend diabetes: Correct injection technique in diabetes care: best practice guideline for healthcare professionals (March 2021)
Before/after intervention study to determine impact on life-cycle carbon footprint of converting from single-use to reusable sharps containers in 40 UK NHS trusts (27 September 2021)
Sharps injuries and Covid (research by Ipsos MORI on behalf of European Biosafety Network)

References

1 Safer sharps. NHS Supply Chain website, last accessed 5 January 2022
2 Sharps injuries and Covid. European Biosafety Network and Ipsos Mori, 24 July 2021
3 Pressures of pandemic and lack of training see 50% rise in sharps injuries. Royal College of Nursing, 21 May 2021
4 B Green, E Griffiths. Psychiatric consequences of needlestick injury. Occupational Medicine. 2013;63:3:183–188
5 J Timmons. The knock-on effect of sharps injuries. Hospital Times, 21 December 2021