Part 2 in a series dedicated to protecting healthcare personnel
Editor’s note: As a follow-up to the authors’ first article in this series, “Insulin injection and changing injury trends” and their 2018 article, “Building programs to reduce sharps injuries from insulin injection”, this article aims to summarize the growing need to address the health and safety of those who care for people who require insulin. The authors provide current needlestick data along with suggestions for preventing future injuries and exposures among nurses and other patient care providers.
- Needlestick injuries continue to occur at high rates, especially when using disposable syringes for insulin injections.
- Increasing incidence of type 2 diabetes remains a public health crisis, resulting in more injuries to nurses injecting people with insulin than any other procedure and device type. Devices with sharps injury prevention features must be used to both comply with the OSHA Bloodborne Pathogens Standard and to prevent high-frequency injuries.
Much has changed in the 5 years since publication of our 2018 article—we’ve experienced a global pandemic, and the rates of type 2 diabetes and other metabolic disorders have increased. According to the Centers for Disease Control and Prevention, nearly 15% of people 18 years and older in the United States have type 2 diabetes, and nearly 30% of adults 65 and older have the disease. That’s an astronomical increase in the last generation.
Insulin injection and changing injury trends
Building programs to reduce sharps injuries from insulin injection
The pandemic limited people’s access to routine medical care around the world, so these numbers and new diagnoses are likely higher. The International Diabetes Foundation (IDF) projects that by 2045, one in eight adults will have diabetes—a 46% increase from today. The IDF also notes that almost half of those with diabetes are unaware that they have the condition.
Many people living with diabetes either self-inject insulin or other non-insulin injectables, or they rely on a healthcare or home provider. The use of syringes and pens for medication delivery has grown along with the increase in diabetes, especially in acute and long-term care organizations. This increase in injections can present unacceptable risk of needlestick injury and exposure to bloodborne pathogens for nurses.
In Part 1 of this series, published in August 2023, we provided detailed information about the latest sharps injury incident data from the International Safety Center’s Exposure Prevention Information Network (EPINet®). In 2022 alone, 26.2% of all injuries from syringes resulted from insulin needles. From 2018 to 2022, insulin needles represented 22% of all disposable syringe injuries on average. Pens accounted for less than 2%, which indicates that their use may result in fewer injuries.
We must do more to reduce insulin needle injuries, which are more frequent than all other needlestick or sharps injuries. Using data from our 2023 article, we’ll offer recommendations for how your organization can build (or shore up) programs and take action. Some recommendations haven’t changed (because they’re tried and true); we based newer recommendations on current data and practices.
Shore up your sharps safety plan
With regard to sharps injuries and needlesticks from devices used to diagnose, treat, and manage diabetes, the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard requires that organizations take several important steps, including developing exposure determination strategies, updating written exposure control plans, creating engineering and work practice controls, following regulated waste rules, maintaining hepatitis B vaccinations, performing post-exposure evaluation and follow-up, communicating hazards with employees, and recordkeeping.
Exposure determination includes taking steps to identify all job classifications, tasks, and procedures where injections or blood testing occur. In addition, organizations must create a written exposure control plan and update it every year as well as when devices, procedures, or controls change. The plan must include the exposure determination to ensure employees have access to this critical information. It also must provide information on safety-device evaluation and selection by frontline nonmanagerial employees.
Engineering and work practice controls include the evaluation and selection of safer medical devices, such as needles with safety-engineered features and pen needles with safety features on both front (patient) and back (device) ends. Because 66% of all injuries occur from devices with safety features that users haven’t activated, work practice controls dictate the importance of not just having a safer device but also activating the safety feature to protect both the worker and anyone downstream.
Requirements regarding regulated waste include not just safe sharps disposal, but also parameters for the containers themselves. For example, they must be leak proof, color-coded, and labeled. Because nearly 25% of all sharps injuries occur downstream, safe disposal serves as a critical preventive step. Users should avoid overfilling containers and regularly check the container fill status.
Nurses and other healthcare providers working in organizations such as long-term, residential care facilities and homes use smaller portable sharps containers because of their high volumes of insulin injections. These organizations must ensure that they’re supplying appropriate containers for safe disposal of syringes and pens and that pen needles are permanently covered on both ends after use.
Because individuals with diabetes have an increased risk of developing hepatitis B, an organization’s sharps safety plan must include maintaining hepatitis B vaccination information and performing post-injury follow-up. The limited hours of most employee health offices/clinics require addressing immediate care for injuries that occur during night and weekend shifts or in ambulatory or long-term care facilities without a formal employee health office. Organizations that use an urgent care office or emergency department to triage workers with injuries must ensure no deterrents exist to immediate, accessible post-exposure care. Delaying care puts workers in danger.
Communicating hazards to employees includes providing access to not just the exposure control plan, but also to information and training related to safe and effective device use, safety feature activation, and disposal. Caring for individuals with diabetes may require using several types of devices. When everyone who’s responsible for performing procedures with these patients feels confident, the puzzle pieces of engineering and work practice controls fall into place.
The Bloodborne Pathogens Standard for recordkeeping, unlike other OSHA standards, requires that employers keep a Sharps Injury Log, which must include the date of injury, the type of device used, its brand name, the work area where the injury occurred, and a brief description of the incident. However, the log can include more, as demonstrated by EPINet. We believe that more information allows for more details about how injuries occur, which can help us work together to prevent them.
OSHA requires that employers submit their OSHA 300 and 301 logs electronically. Because these logs include sharps injuries, we recommend creating quality recordkeeping systems that serve double duty—adherence with OSHA regulations and as thorough injury investigation and prevention tools.
Device evaluation program
OSHA requires that frontline, nonmanagerial employees participate in device evaluation and selection. Formalizing an evaluation program can prove critical to shoring up an organization’s sharps safety plan, especially given the many new technologies available for safe insulin delivery.
The Training for Development of Innovative Control Technologies Project offers the free Sharps with Injury Prevention Evaluation Form for Safer Injections (bit.ly/
4attNtH), which includes a specific section for insulin delivery using syringes and pen needles. Organizations can create similar checklists for design features and blood glucose testing devices. (See Design feature checklist.)
Design feature checklist
A checklist related to insulin device features could include the following items:
- Does the insulin syringe offer a one-handed recapping option to transport a clean needle to the patient or resident?
- Does the needle length enable a “no pinch-up” technique to avoid opposite hand injuries?
- Is the pen needle compatible with a variety of insulin injection pens?
- Does the pen needle provide confirmation (audible, visible, tactile) when attaching to the injection pen?
- Is the injury prevention feature automatically activated without requiring user action upon completion of the injection? Is it manual? Is it intuitive to the user?
- Are the exposed sharps permanently covered after use and prior to disposal? If it has a back end needle, is that covered?
Synergistic benefits
The public health landscape continues to change. Global obesity crises and increases in the consumption of highly processed foods can result in rising chronic diseases, which impact the types of patients organizations see and the care required. With regard to diabetes, organizations also must consider the impact on occupational health and safety. Building safer systems offers synergistic benefits for patients, healthcare professionals, and communities.
The authors work at the International Safety Center. Amber Hogan Mitchell is president and executive director. Ginger B. Parker is vice-president and chief information officer.
American Nurse Journal. 2025; 20(3). Doi: 10.51256/ANJ032514
References
Centers for Disease Control and Prevention. National diabetes statistics report. September 30, 2022. cdc.gov/diabetes/php/data-research/index.html
Hogan Mitchell A, Parker GB. Building programs to reduce sharps injuries from insulin injection. Am Nurse Today. 2017;13(2):13-4.
Hogan Mitchell A, Parker GB. Insulin injection and changing injury trends. Am Nurse J. 2023;18(8):22-3. doi:10.51256/anj082322
International Diabetes Foundation. Facts & figures. idf.org/about-diabetes/diabetes-facts-figures
International Safety Center. 2022 EPINet report for needlesticks and sharp object injuries. internationalsafetycenter.org/exposure-reports
International Safety Center. 2022 EPINet Report for Needlestick and Sharp Object Injuries. 2023. https://internationalsafetycenter.org/wp-content/uploads/2023/06/2022-EPINet-Needlesticks-Sharps-Injuries-Summary-Data.pdf
Occupational Safety and Health Administration. Bloodborne pathogens standard. osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030
The TDICT Project. Sharps with Injury Prevention (SIP) Evaluation Form for Safer Injections. tdict.wpengine.com/wp-content/uploads/2018/11/TDICT-Safety-Injection-Evaluation-Form.pdf
Key words: needlestick, bloodborne pathogens, insulin injection, occupational health
