Biological contamination of insulin pens in a hospital setting

Herdman, Michelle L.; Larck, Chris; Schliesser, Shelley Hoppe; Jelić, Tomislav

doi:10.2146/ajhp120728

Cited by 25 publications

(22 citation statements)

References 16 publications

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“…Moreover, to fully protect patients and health workers, adequate nurses training is essential to eliminate the risk of transmission of infectious diseases associated with pens misuse. In fact, more than 700 patients in New York hospitals may have been exposed inadvertently to human immunodeficiency virus (HIV), hepatitis B or hepatitis C because of reuse of insulin pens on multiple patients after changing the disposable needle [28]. Patient notification events resulting from multipatient use of insulin pens in U.S. health care settings were recently summarized [29].…”

Section: Discussionmentioning

confidence: 99%

“…Patient notification events resulting from multipatient use of insulin pens in U.S. health care settings were recently summarized [29]. It is unquestionable that each pen is absolutely for personal usage only, and it must be labeled with the name of the patient; in fact, in the final phase of insulin delivery, an aspiration of material occurs: this may contaminate the pen, as shown by several observations, and also in a recent study who demonstrated trace of biological contamination (hemoglobin, squamous epithelial cells, macrophages and RBC) in the pen after use [28]. As recommended by the Institute for Safe Medication Practices, all the study nurses performed a training period before using pens, which also included a hands-on individual testing of devices.…”

Section: Discussionmentioning

confidence: 99%

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A Prospective Study for Introducing Insulin Pens and Safety Needles in a Hospital Setting. The SANITHY Study

Bossi

Veronesi²,

Poerio³

et al. 2016

CDR

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BackgroundTo assess costs and safety of insulin pen devices and safety needles as compared to vial/syringes in hospitalized patients requiring insulin therapy in a General Hospital in Northern Italy.Materials and MethodsIn a prospective 9-month study, consecutive patients admitted to three Hospital Units received insulin therapy through either a traditional disposable syringe method, or pen/safety needles with dual-ended protection, or disposable safety syringes. We compared the median direct (insulin and devices) and indirect (insulin supply at discharge, insulin wastage) costs of a 10-day in-hospital insulin treatment in the 3 study groups, additionally accounting for the costs related to the observed needlestick injury rate. Patients’ safety during in-hospital stay (hypo- and hyperglycemia episodes) and satisfaction were also assessed.ResultsN=360 patients (55% men, mean age 75.6 years, 57% with DM since ≥10 years) were recruited in the study. Insulin pens had higher median direct cost than both traditional syringes (43 vs. 18 €/patient, p<.0001) and safety syringes (21.5 €/patient, p<.0001). However, when also indirect and injuries costs were taken into account, the estimated savings for using pens over traditional syringes were as high as 32 €/patient (45.8 vs. 77.6 €/patient, p-value <.0001). No differences in patients’ safety were observed. 74% and 12% of patients using pens and syringes would like to continue the method at home, respectively (p<0.0001).DiscussionA selective use of individual pre-filled pens/safety needles for patients who are likely to continue insulin therapy at home may strongly reduce hospital diabetes treatment related costs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Prospective Study for Introducing Insulin Pens and Safety Needles in a Hospital Setting. The SANITHY Study

Bossi

Veronesi²,

Poerio³

et al. 2016

CDR

View full text Add to dashboard Cite

show abstract

“…Reports have included technique-related concerns such as improper priming, failure to "tip and roll" suspensions, use of the pen as a multiple-dose vial, incorrect injection method, misinterpretation of fluid on the skin after an injection as delivery of a partial dose, needlestick injury, and the potential for blood-borne pathogen transmission if insulin pens are used intentionally or inadvertently in more than one patient. 11,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] In response to reports of insulin pen misuse in more than one patient, the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) issued communications intended to notify healthcare professionals and the public about the potential for transmission of hepatitis B and C viruses, HIV, and other blood-borne pathogens, with recommendations for mitigating the risk of misuse. 30,31 An expert consensus panel convened by the ASHP Research and Education Foundation identified 10 practical recommendations to enhance insulin-use safety throughout the medication-use process in hospitals.…”

Section: Facilitating the Safe Use Of Insulin Pens In Hospitalsmentioning

confidence: 99%

Facilitating the safe use of insulin pens in hospitals through a mentored quality-improvement program

Lutz

Haines

Lesch

et al. 2016

American Journal of Health-System Pharmacy

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“…Conversely, whether insulin pen devices should replace traditional vial and syringe in hospitalized patients is still a controversial subject [3]. Together with patients’ satisfaction [4, 5], economic evaluation [4–6] and safety issues related to the potential risk of biological contaminations for both nurses and patients [5–7], nurses’ satisfaction constitutes a key perspective for the management of hospitalized patients with diabetes requiring insulin injections. However, information on this topic is scarce, with the only data coming from the US, where 70 % of nurses considered insulin pens an “improvement” over conventional vial and syringe method 11 months after their introduction in two floors of one hospital [8].…”

Section: Introductionmentioning

confidence: 99%

Determinants of nurse satisfaction using insulin pen devices with safety needles: an exploratory factor analysis

Veronesi

Poerio

Braus

et al. 2015

Clin Diabetes Endocrinol

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BackgroundA paucity of data exists to examine nurses’ satisfaction with the use of insulin pens with safety needles in hospitalized patients with diabetes. We investigated major determinants of nurses’ preference of the method of insulin administration in the context of a General Hospital in Northern Italy.MethodsConsecutive patients admitted to three hospital units of different care intensity requiring insulin received insulin therapy through either the vial/syringe method (October to December 2012) or pen/safety needles with dual-ended protection method (January to March 2013). Before the implementation of insulin pens, floor nurses received a specific training program for proper insulin pen injection technique including individual testing of the devices (pen/safety needles). At the end of the study, nurses completed the Nursing Satisfaction Survey Questionnaire. Cronbach’s alpha was used to determine the internal consistency and reliability of the questionnaire. Major determinants of satisfaction were investigated through an exploratory factor analysis. The association between each retained factor and time spent to teach patients how to self-inject insulin with pen devices was also investigated.ResultsFifty-three out of 60 nurses (mean age ± SD 36.2 ± 8.5 years, 85 % women, 57 % with 10+ years of working experience) returned the questionnaire. Internal consistency of the questionnaire was satisfactory (Cronbach’s alpha > 0.9). Three months after their introduction, about 92 % of nurses considered pen devices an “improvement” over the vial/syringe method. Two factors explained 85 % of nurses’ satisfaction, one related to convenience and ease of use, and the other to satisfaction/time spent for dose preparation and administration. The latter factor was inversely correlated with time spent on patients’ training tasks.ConclusionsNurses’ satisfaction with pen devices was higher than previously reported, possibly reinforced by safety needles with dual-ended protection. Perceived workload was a major determinant of nurse satisfaction using pen devices with safety needles. To facilitate the introduction of insulin pens in the hospital setting, it should be specifically addressed during training programs in the switch-over period.

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Biological contamination of insulin pens in a hospital setting

Abstract: Examination of 125 insulin pens used in hospitals revealed hemoglobin in 1 pen and at least one cell in another 6 pens. The nine detected cells consisted of four squamous epithelial cells, four macrophages, and one RBC.

Cited by 25 publications

References 16 publications

A Prospective Study for Introducing Insulin Pens and Safety Needles in a Hospital Setting. The SANITHY Study

A Prospective Study for Introducing Insulin Pens and Safety Needles in a Hospital Setting. The SANITHY Study

Facilitating the safe use of insulin pens in hospitals through a mentored quality-improvement program

Determinants of nurse satisfaction using insulin pen devices with safety needles: an exploratory factor analysis

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