Minimising sharps injuries in diabetes care: FIT4Safety

Nurse Consultant – Diabetes

Somerset Partnership NHS Foundation

Trust, UK

Nurse Consultant – Diabetes

Enfield Community Services, BEH-MHT, UK

Independent Consultant Advisor/Programme Specialist, Healthcare Associated Infection,

NHS Midland and East, Birmingham, UK

Email: [email protected]

The European Directive on sharps injury prevention to healthcare workers will require all healthcare organisations to implement mandatory healthcare worker safety standards.(1) On 10 May 2010, the EU Directive was introduced to prevent injuries and blood-borne infections to hospital and healthcare workers, downstream workers and others who are at risk of sharps injuries whilst administering to patients with diabetes. The main risks of exposure to blood-borne viruses that are of most concern to healthcare professionals include hepatitis B, hepatitis C and HIV.(2) The EU describes sharps injuries as one of the most serious health and safety threats in European workplaces, estimated to cause one million injuries annually.(3) More than 100,000 of these injuries take place in the UK alone.(4)

The new EU Directive legislates a framework agreement on the prevention of sharps injuries in hospitals and the healthcare sector. The Member States, including the UK, will have until 11 May 2013 to ensure that the provisions of the Directive have been implemented into UK and Irish law. The Directive stipulates that, wherever there is a risk of sharps injury, the user and all healthcare workers must be protected by adequate safety precautions, including the use of “medical devices incorporating safety-engineered protection mechanisms”.(1)

The Directive aims to:

• Achieve the safest possible working environment for employees in the sector and protect workers at risk, as well as patients;
• Prevent injuries to workers caused by all types of sharp medical object (including needle sticks);
• Set up an integrated approach to assessing and preventing risks as well as to training and informing workers.(3)

Global recommendations on safety in the diabetes setting were informed by the results of a large four-month survey of sharps injuries among 634 nurses from 13 Western European countries and Russia, and the outcome of the October 2011 Workshop on Injection Safety in Endocrinology (WISE)(1), which brought together a diverse group of 57 leaders in the field of diabetes safety from 13 countries. The group of UK delegates included Consultant Nurses and Specialist Nurses in Diabetes along with an Infection Control and Prevention Specialist and a Medical General Practitioner.(5) This group later established itself to become the FIT4Safety group.

The initial draft of the global recommendations was presented at the WISE meeting, and delegates of the high-level forum discussed and explored data from a large survey of sharps injuries, which took place in Europe in 2010.(5) Data from this survey demonstrated clearly that diabetes care has one of the highest risks for sharps injury across all healthcare settings.(5)

The WISE recommendations are intended as a roadmap for implementing the EU Directive in diabetes care settings, and include a scale, which shows the strength of the recommendations. The new global recommendations published as a result of the WISE were designed to ensure the safety of patients, professionals and all persons in potential contact with sharps used in the treatment of diabetes.

The Forum for Injection Technique (FIT) acknowledges the need to reduce or eliminate the risk of sharps injuries and to improve injection technique, and has taken the initiative to use the EU Directive and WISE recommendations to develop specific diabetes safety recommendations for the UK and Ireland. FIT will now extend its remit to include sharps safety as a natural progression and development of its body through a range of evidence-based recommendations, education, training and materials and support.(5)

In diabetes care settings, the EU Directive draws attention to the fact that sharps injury and blood exposure risks must be prevented by a number of methods, including use of safety-engineered devices. The WISE recommendations were significantly re-shaped by the collective input of FIT4Safety.(5) An autonomous organisation involving a wide group of interested parties and experienced diabetes specialist nurses, FIT4Safety’s purpose is to help people with diabetes using injectable therapies achieve the best health outcomes that can be influenced by correct injection technique and safe procedures.(6)

FIT4Safety is fully committed to supporting best practice to minimise risk of sharps injuries and accidental blood exposure, and to promoting safer practice in diabetes care settings through the implementation of the new recommendations. The present work for the recommendations is based on a review and analysis of all peer-reviewed studies and publications that bear on the subject of sharps safety in diabetes. There are different sections, including risk assessment and prevention.

Unsafe medical care is a major source of morbidity and mortality throughout the world. Patient safety is the most critical component in the quality of healthcare. However, the care of people with diabetes depends on maintaining a safe working environment for the many workers who provide that care. FIT4Safety has taken the initiative to use the EU Directive and WISE recommendations to develop the recommendations with a wide group of interested parties. Welcoming as many people as possible to comment, make suggestions and advise, FIT4Safety is ensuring that the recommendations are fully informed, contemporaneous and pragmatic, both in the present and in the future.(5)

The WISE recommendations include a scale that shows the strength of the recommendations that apply to the majority of people with diabetes using injectable therapy, but there will inevitably be individual exceptions for which these rules must be adjusted. Attendees to WISE agreed that, for the strength of a recommendation, the following scale would be used:

A.