Every nurse will encounter people with diabetes during his/her nursing carrier. The management of this group of people has increasing emphasis on education in psychological care, there by increasing the role that nursing plays. Improved glycaemic control is strongly linked to reduce morbidity and possible mortality from diabetic complications. To achieve this, the patient has to play the largest part in his/her care. A role the individual is often ill prepared for, and may be unwilling to take on.
ADA (1995) describes diabetes mellitus as a condition in which the glucose in the blood is completely high because the body is no longer able to use its fuel. There are two important reasons for optimizing diabetes control. The first is to eliminate symptoms, and the second is the longer term of aborting the development of diabetic complications. These can be achieved by monitoring the blood glucose levels and it is done by using finger pricking devices to obtain a capillary blood sample. These devices should be disposed off properly to avoid complications and infections.
The Rational Behind This Essay
BMA (1992) defines sharp as anything which can puncture the skin and may be contaminated with blood or other body fluid. Safe disposal of sharps is therefore a responsibility to be taken seriously by people with diabetes to prevent complications.
A record number of healthcare staff has become infected with the hepatitis C virus following needle stick injuries. Statistics showed that six healthcare workers contracted the infection as a result of needle stick injury between July 2003 and June 2004. Two of the incidents were caused by sharps discarded by other staff, and a domestic get infected by a protruding needle from a rubbish bag. Nursing Times (2004)
AMA (2000) pointed out the danger of old practice of breaking needles after use. Robert S.S (2001) discovered that six diabetic patients were described of having needles embedded in their flesh and did not know. Probably, they accidentally broke it or on purpose, which landed on the floor and they stepped on it of which they couldn’t feel it due to their nerve damaged.
Jefferies D.J (1991) discovered that 28 documented cases of HIV sero conversion were found in health workers, which 0.31% followed percutaneous exposure to HIV positive material. This is due to transmission of inoculation accidents.
Jagger J and Perry J (2002) also explained that sharps disposal related injuries accounted 36% (1,335). More than half of these involve nurses, which blood drawing carry the highest risk of transmitting blood borne pathogens. 68% of disposal injuries occurred before the sharps reached the container. It was either the user was fumbling with the used device, or leaving it near a disposal container, or patient bed. Other 32% injuries were previously disposed of devices. These include healthcare workers stuck by sharps as trying to place them in the sharp container.
How Sharps should be Disposed Off
Until recently, various methods of disposal of sharps were suggested to patients including can drinks sealed with tapes, fabric conditional bottles and safe clip devices. Except for the later, all such methods are unacceptable.
Strathcylde diabetic group (1983)
When nurses do blood glucose testing, universal precautions must be followed by using the approved sharp disposal box. The box should be sealed and changed when it is more than 2/3 full. Used lancets should also be disposed off in the box.
Wherever approved, yellow sharp boxes should be used. Community nurses have access to these and can provide them for patients in the absence of approved equipment. For instance, patients can be described on B-D safe clip devices which can enable them to clip their needle hub when they are being discharged from the hospital.
Campbell M (1993)
The BMA (1992) has also drawn up a standard for sharp container which should have specifications such as: the container having a lid and a handle. The sharp containers should remain functional during the entire usage (i.e they should be durable, closable, leak resistant on their sides and bottom, and puncture resistant until their final disposal). It should be disposed off by incineration and must be placed a yellow clinical waste bag containing sharps only. It should not be placed in yellow bags with other waste. This should be labeled with date and site of origin.
Action I Have Taken
I have taken this opportunity and educated my colleagues about proper disposal of sharps. I have given them leaflets of it and pasted posters regarding sharp disposals on the ward. I have also educated them on the universal precautions that must be taken when doing blood glucose testing. Also, I have requested for more sharp containers on the ward to prevent nurses from over filling them which may cause accidents. I have advised my colleagues to encourage bleeding whenever bleeding occurs and the area should be washed under running water, after which they should seek further management.
I educate diabetics that come on the ward to dispose off lancets into sharp containers making sure they press the point firmly into the lancet cover before placing it into the sharp container. They should also keep all their needles and glucose monitoring equipment clean, blood stain free and out of reach of children at all times.
Considering some of the aspects of care required by patients with diabetes and the initial support and advice that can be given by non-specialist nurses, all nurses have a major role to play in diabetic care and sharp disposal. Based on my references, I have learnt to know the importance of proper sharps disposal and the hazards involved if not properly disposed off. It has broadened my knowledge in diabetic care and this has given me the opportuinity to impact my knowledge to my colleagues.