I recently chaired a webinar discussing the impact and the risk of needle stick injuries (NSIs) with insulin injections. I sat with two other specialist nurses and we explored why these injuries still occur in practice. This is not a new problem, and we are all aware to some extent of the safety concerns of needlestick injuries as health care workers.
The NHS became bound from 11 May 2013 by the The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 which implements aspects of the European Council Directive 2010/32/EU that were not specifically addressed by previous GB legislation. The aim of this directive, amongst other things, was to further reduce risk and increase safety and protection of its workers. The legal obligations were also extended to include those surrounding the provision of sharps disposal systems whereby The Care Quality Commission (CQC) provides necessary licenses to NHS healthcare services if they meet the standards dictated by the aforementioned acts.
We have come a long way in the past few years to make considerable changes in working practice. However sharps injuries are a well-known risk in the health and social care sector. Sharps contaminated with an infected patient's blood can transmit more than 20 diseases, including hepatitis B (HBV), C (HCV) and human immunodeficiency virus (HIV). Because of this transmission risk, sharps injuries can cause worry and stress to the many thousands who receive them.
Infection prevention units or occupational health teams devote a significant portion of their practice on minimising these exposures. Still, NSIs occur and are the most efficient method of transmitting blood-borne pathogens between patients and healthcare staff.
Around 30% of nurses surveyed reported receiving an injury while conducting an insulin injection
Almost a third of nurses surveyed report receiving a NSI sometime in the past while giving an insulin injection. Worryingly, 1 in 10 nurses who received a NSI using an insulin pen reported being injured by the cartridge end of the pen needle. This opens a discussion around which type of needle should be used when administrating insulin to an individual.
Sadly, 1883 incident claims for NSIs were received by NHS resolution between 2012–2017 costing the UK NHS £4 077 441 on legal settlements. NSI also increases the financial burden on the NHS because of loss of productivity, treatment costs and litigation. In addition to the financial burden, we have the psychological and physical effects to the health care worker, the person with diabetes and also their families. This needs to be considered when dealing with an individual who has had a NSI.
Insulin administration is considered a high-risk procedure for nurses because of the number of insulin injections required and lack of training on safety devices.
How can we help reduce this risk?
There are some key fundamentals for any HCW in practice who needs to administer insulin to another individual. Regarding insulin pens, a dual ended safety pen needle should be used. This is a device that will on removal automatically protect both ends of the pen needle hence avoiding NSI. It is the responsibility of the individual employee to understand that health and safety is paramount. If the healthcare worker has not be trained to use the device, then they should seek advice and guidance before using it. This can often be done by the local diabetes team or needle company who will offer a comprehensive training programme to ensure that all health care workers are fully supported. It is also important to mention that the correct procedure for disposal of needles is carried out at all times. It is good practice to ensure a sharps bin is readily locally available.
All staff should be up to date with their vaccinations, such as Hep B for example.
During the webinar, we looked at experiences of NSIs in the workplace. Sarah shared her experience of a hospital patient who had administered her own insulin and left the used needle on the bed side table. Newspapers had been laid on top of this, and when the nurse came along to tidy around the bed space, they gathered up the papers and received a NSI from the used needle. If there had been a sharps bin next to the bedside and the appropriate advice and education given to the patient, this may have been avoided. Another example was in the community setting where a health care support worker was injured by a discarded needle. The individual endured a 3-month wait for blood results to be returned to rule out hepatitis B. This could have had life changing consequences for this health care support worker and her family.
Box 1.Testimonials
- Testimony 1: ‘Since implementing BD ASD we have had continued support from our BD representative. The rep has been instrumental in supporting us with comprehensive training for our ward staff. I feel this support really enhances the commitment to protect healthcare professionals beyond the product itself.’
- Testimony 2: ‘Since we introduced insulin safety needles BD have supported the education and guidance for all heath care workers involved in administering insulin. This is not something that can be done once and then forgotten about. There is an ongoing need to ensure that we are all protected from needle stick injuries and that education and support is part of the ongoing needs for all involved. Together we are able to look after each other.’
What else can we do?
We need to ensure that as health care workers, we assess all those with diabetes who require insulin or other injectable medications to ensure that they are capable of administering it themselves. If they are, then ensure that they are aware of the correct procedures for disposing of their sharps. Provide sharps bins, or show them where to find them.
For those individuals who can not self administer, then look at safety needles – having a dual ended safety needle can reduce the risk of a NSI. Provide education and training for health care workers, which needs to be ongoing. We have staff who move from workplace to workplace, newly qualified nurses and international staff who may not have seen safety needles before.
Provide refresher training, or an ongoing rolling programme and ensure compentices are ongoing and regularly assessed. Know where to get training – staff should contact their manager, the diabetes nurses or team or the companies who offer the training programmes. Ultimately, we are a caring community and we need to take care of ourselves and our colleagues.