Patterns of needle disposal among insulin using patients with Diabetes Mellitus: An audit

Gowri P

Consultant Diabetologist, Kauvery Hospital, Cantonment, Trichy

Background

Oral Antidiabetic Drugs (OADs) remain the mainstay in the treatment of Type 2 Diabetes Mellitus (T2DM).

Insulin therapy becomes inevitable as the disease progresses.

Roughly 4 of 10 patients with T2DM in India  are using insulin alone or in combination with OADs at any given point of time.

Where are they disposing the syringes and needles?

Burden of the Problem

  • Sharp disposal is strictly regulated in hospital settings, BUT this is not the case in the community.
  • At home insulin usage- No guidelines
    1. Needle Stick Injuries
    2. Transmission of Blood Borne Infections (BBI)
    3. Environmental Pollution

Literature Review

  • Studies done in different countries showed that proportion of various kinds of sharps thrown into the household bin varied from 46.9% to 67.6%.
  • Studies done in developed countries have also showed improper sharp disposal practices among diabetes patients to be as high as 8090%
  • Only in less than 10% of cases specific containers were used to dispose insulin injection waste.

Guidelines

1.Place all needles in a sharps disposal container immediately after use.

2.Sharps disposal containers should be kept out of reach of children and pets.

3.When sharps disposal container is about three-quarters (3/4) full – DISCARD

4. DO NOT reuse sharps disposal containers by accessing through these services:

Drop Box or Supervised Collection Sites

Household Hazardous Waste Collection Sites

Mail-Back Programs

Residential Special Waste Pick-Up Services

Audit Design

  • Aim-to assess the prevalence of safe disposal of insulin needles among diabetic patients.
  • Method- data collected from diabetic individuals coming to our OPD from Aug 15th to Sep 15th.
  • This was a cross-sectional study using convenience sampling technique.

Audit Design- continued

  • Safe sharps disposal – discarding used insulin needles in designated sharps or puncture-resistant containers;
  • Other sharps disposal methods – Unsafe.
  • A semi structured questionnaire was designed which our OPD Staff filled after discussing with them.
    • Type of Diabetes
    • Duration of Insulin Use
    • Education on Syringe Disposal

Results

Gender

Count

%
Male 186 54%
Female 158 46%
Over All 344

Type of DM

Count

%
Type 1 DM 24 7%
Type 2 DM 320 93%
Over All 344
Syringe-Disposal-1
Syringe-Disposal-2

Results: Safe & Unsafe

Disposal

Count

%
Safe Disposal 48 14%
Unsafe Disposal 296 86%
Over All 344
Safe Disposal

Type of DM

Count

%
Type 1 DM 18/24 75%
Type 2 DM 30/320 9%
Over All 48/344 14%
Syringe-Disposal-3
Syringe-Disposal-5

Duration of Insulin & Type of DM

Dur of Insulin

Count

%
< 1 Year 23 48%
1 – 5 Year 14 29%
> 5 Year 11 23%
Over All 48

Education on Needle Disposal

Count

%
Received Education 213 62%
Not Aware Whether Education Given 131 38%
Over All 344
Syringe-Disposal-6
Syringe-Disposal-7

Patterns of Insulin Disposal

  • Drainage
  • Kitchebn Waste
  • Unused Well/Lake
  • Burn and Dispose
  • Bury in the Ground
  • Flush in the Toilet

Conclusion

  • SAFE SHARP DISPOSAL practice was VERY LOW in our sample. (14%)
  • Safe insulin disposal practice wanes off as duration of insulin usage increases.
  • Type 1 Diabetic children are following safe disposal advice than adults
  • One third of the patients are not aware about the education received.

Recommendations

  1. Education on safe disposal
  2. Pictorial display
  3. Annual comprehensive check-up – reassess insulin technique and disposal practice
  4. Request To the pharmacy- Plastic container for sale

Education before Audit

Syringe-Disposal-8
Syringe-Disposal-9
Syringe-Disposal-10
Syringe-Disposal-11
Dhasaratharaman

T Dhasaratharaman

MSc Statistics

References

  1. Mohan V, et al. Current status of management, control, complications and psychosocial aspects of patients with diabetes in India: Results from the Diab Care India 2011 Study. Indian J Endocrinol Metab. 2014;18:3708.
  2. Bithika M. Thompson, et al. Unsafe sharps disposal among insulin-using patients with Diabetes Mellitus: An emerging global crisis. J Diabetes Sci Technol. 2022;16(6):13761380.
  3. The insulin sharps disposal study: Evaluation of a structured patient education initiative in an urban community health centre in India Family Med Prim Care. 2020 Dec; 9(12): 61646170.

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