Evidence summary for the management of insulin injection-related sharps waste disposal in patients with diabetes mellitus / 中国实用护理杂志

Objective:To retrieve and summarize the best evidence related to the management of insulin injection-related sharps waste disposal in diabetic patients at home and abroad, so as to provide reference for clinical healthcare professionals.Methods:This was a evidence-based research. Evidence on insulin injection-related sharps waste management in patients with diabetes, including guidelines, expert consensus, evidence summaries, best practice information sheet, recommended practices, clinical decisions and systematic reviews was systematically searched from domestic and international databases and professional websites, and the search time frame was from the establishment of the database to December 2021. Evidence was extracted and summarized following a quality evaluation of the literature that met the criteria.Results:A total of 15 papers were included, summarizing 25 pieces of best evidence on four areas including risk assessment and management of sharps waste associated with insulin injections, education and training, and the use of safe devices and sharps containers.Conclusions:Best evidence on the management of insulin injection-related sharps waste disposal provides evidence to support clinical practice for healthcare professionals to standardized sharps waste disposal practices in patients with diabetes.

Infecciones nosocomiales en unidades de observación de emergencia y su asociación con el hacinamiento y la ventilación / Nosocomial infections in emergency observation units and their association with overcrowding and ventilation

RESUMEN Con el objetivo de medir la frecuencia de las infecciones nosocomiales en las unidades de observación de medicina interna de los servicios de emergencia en dos hospitales de nivel III de Lima, se realizó un estudio de prevalencia de periodo durante cinco días en pacientes admitidos después de las 72 horas de observación y con descarte de infección comunitaria, utilizando datos obtenidos de las historias clínicas. Adicionalmente, se evaluó el hacinamiento y la ventilación de las salas de hospitalización. La frecuencia de las infecciones nosocomiales en los servicios de emergencia fue 8,1%, cuatro veces lo reportado como prevalencia de periodo en el Perú. Los factores de riesgo asociados fueron el tiempo prolongado de estancia y la carencia de ventilación apropiada del ambiente hospitalario. La ventilación inapropiada triplica el riesgo de aparición de infecciones nosocomiales.

ABSTRACT The aim of this study was to measure the frequency of nosocomial infections in the internal medicine observation units of the emergency services in two level III hospitals in Lima. A 5-day prevalence study was carried out on patients admitted after a 72 hours observation period, in whom community-based infections were ruled out. Data was obtained from clinical records. Additionally, overcrowding and ventilation in the hospitalization rooms were evaluated. The frequency of nosocomial infections in the emergency services was found to be 8.1%, four times what was reported as period prevalence in Peru. The associated risk factors were prolonged length of stay and lack of proper ventilation in the hospital environment. Inadequate ventilation triples the risk of nosocomial infections.

Autocuidado de pessoas com diabetes mellitus: reuso e descarte de seringas e agulhas / Autocuidado de personas con diabetes mellitus: reutilizacióny desecho de jeringas y agujas / Self-care of people with mellitus diabetes: reuse and disposal of syringes and needles

RESUMO Objetivo: Analisar a taxa de reuso de seringas e agulhas e identificar as práticas de descarte de perfurocortantes por usuários de insulina. Método: Estudo transversal, realizado com pessoas diagnosticadas com diabetes mellitus tipo II de um Centro de Referência em Diagnóstico e Terapêutica da região Centro-Oeste do Brasil. Foram utilizados dados secundários provenientes de prontuários e fichas de consulta. As diferenças de proporção foram estimadas pelo teste qui-quadrado, considerando-se p<0,05. Resultados: A taxa de reuso de seringas e agulhas foi de 94,9%. Houve alta prevalência do reuso de seringas e agulhas por mulheres, com mais de 60 anos, com tempo de estudo menor do que cinco anos, que possuíam mais de 11 anos de diagnóstico. A maioria dos usuários descartou as agulhas e seringas no lixo domiciliar. Tais dados evidenciam que as práticas de autocuidado realizadas pelas pessoas com DM quanto ao reuso e descarte de perfurocortantes não são seguras e podem favorecer complicações. Conclusão: Apesar das características demográficas e clínicas não terem apresentado associação com o reuso, esforços devem ser direcionados para as práticas de educação em saúde, levando em consideração o contexto da pessoa, a condição socioeconômica, nível de escolaridade e seu papel ativo no seguimento do tratamento.

RESUMEN Objetivo: analizar la taza de reutilización de jeringas y agujas e identificar las prácticas de desecho de punzocortantes por usuarios de insulina. Método: estudio transversal, realizado con personas diagnosticadas con diabetes mellitus tipo II de un Centro de Referencia en Diagnóstico y Terapéutica de la región Centro-Oeste de Brasil. Fueron utilizados datos secundarios provenientes de registros médicos y fichas de consulta. Las diferencias de proporción fueron analizadas por la prueba de chi-cuadrado, considerándose p<0,05. Resultados: la taza de reutilización de jeringas y agujas fue de 94,9%. Hubo alta prevalencia de la reutilización de jeringas y agujas por mujeres, con más de 60 años, con tiempo de estudio menor que cinco años, que poseían más de 11 años de diagnóstico. La mayoría de los usuarios descartólas agujas y jeringas en la basura domiciliaria. Tales datos evidencian que las prácticas de autocuidado realizadas por las personas con DM respecto a la reutilización y desecho de punzocortantes no son seguras y pueden favorecer complicaciones. Conclusión: Aunque las características demográficas y clínicas no hayan presentado asociación con la reutilización, esfuerzos deben ser dirigidos para las prácticas de educación en salud, teniendo en cuenta el contexto de la persona, la condición socioeconómica, el nivel de escolaridad y su rol activo en el sector del tratamiento.

ABSTRACT Objective: To analyze the rate of reuse of syringes and needles and identify the practices of disposal of sharps by insulin users. Method: Cross-sectional study conducted with people diagnosed with type II diabetes mellitus at a Reference Center for Diagnosis and Therapy in the Midwest region of Brazil. Secondary data from medical records and consultation forms were used. Differences in proportions were estimated by the chi-square test, considering p < 0.05. Results: The rate of reuse of syringes and needles was 94.9%. There was a high prevalence of reuse of syringes and needles by women, people aged over 60 years, with less than five years of schooling, and more than 11 years of diagnosis. Most users discarded needles and syringes in domestic waste. Thus, self-care practices of people with DM regarding the reuse and disposal of sharps are not safe and may favor complications. Conclusion: Althoughdemographic and clinical characteristics had no association with reuse, efforts should be directed towards health education practices, taking into account the person's context, socioeconomic condition, educational level, and active role in the follow-up treatment.

Perception regarding Bio-medical Waste Management among medical students in a Tertiary Care Hospital

Background: Bio-medical waste is perilous and can be a health hazard. There is considerable role of medical undergraduates, interns and post-graduates in preventing hazardous consequences from mishandling of bio-medical waste. Aims & Objectives: To assess the knowledge, attitude and practice about Bio-medical waste management among medical undergraduates, interns and post-graduate students. Methodology: A cross-sectional study was carried out among 75 participants including MBBS students, interns and post-graduate students (25 from each group) at King George’s Medical University, Lucknow through purposive sampling technique over a period of one month. A structured self-administered questionnaire was used for data collection. Data were analyzed using Chi-square, Fischer-exact, one-way ANOVA and Post Hoc (Tukey) Tests. Results: MBBS students had more knowledge and the better attitude towards BMW management guidelines as compared to interns and post-graduates(p<0.001), while post-graduate students were more aware of the needle-stick injury and were correctly practicing BMW management as compared to MBBS students and interns(p<0.001). Conclusions: Knowledge, attitude and practice regarding BMW management is still inadequate among MBBS students, interns and post-graduates, so repeated training-retraining and supportive supervision regarding the same should be foster. Strict regulations and surprise perusals might be a strong impetus for medical students and other health personnel.

Development of a Safe Syringe Disposal System Moving towards Automated Syringe Data Collection / 대한의료정보학회지

OBJECTIVES: An automatic needle destroyer (ANDY) was developed to prevent needlestick injuries, and usability tests were conducted in several hospitals. The addition of extra features to the ANDY is in progress, such as data collection and automatic identification of used syringes. Thus, this report describes how the ANDY can be used to track the data of used syringes. METHODS: The motor torque required for barrel separation differs according to syringe diameters. By monitoring the electric current which is consumed for the motor torque, the type of syringe can be identified. Twelve prototypes were produced, and five usability tests were conducted in hospitals. RESULTS: After use, a syringe is inserted into the proposed device, and the needle portion is then cut and separated from the syringe body (barrel) and discarded. The needles are collected in a sharps container for hygienic disposal, and the barrel is dropped into a general medical waste container. CONCLUSIONS: The ANDY can be used to track the syringe used for each patient. The barcode can be read while the syringe rotates in the main body of the ANDY with a built-in omnidirectional scanner. Collection of information during syringe disposal can facilitate stock management. This system could also be extended to other types of consumable medical devices, although it would still be a challenge to differentiate each medical device.

Assessment of Awareness About Various Dental Waste Management Practices Among Dental Students and Practicing Clinicians

Abstract Objective: To evaluate the knowledge of students and dental practitioners about dental and biomedical waste disposal and to impart emphasis on important aspects such as eco-friendly waste management. Material and Methods: This questionnaire-based study involved 186 participants which comprised of 5 domains, namely laws regarding biomedical waste, steps of waste management, categories of dental waste, general hazards of improper waste disposal and certain material/process specific questions Results: Assessment of the first domain showed that only 58.4% of participants were able to correctly identify the Pollution Control Board of India as the regulatory body for the transport of medical waste. The second domain assessment revealed that 55.9% of subjects were adequately aware of the knowledge handling hospital waste. Assessment of the third domain displayed that the majority of the respondents (91.9%) knew categories of dental waste generated. Evaluation of fourth domain exhibited that 89.8% students agreed that biomedical waste management (BWM) must be made a practical exercise in dental schools to reduce "Know-Do gap" between undergraduates and postgraduates and the last domain demonstrated that only 32.3% of the participants knew the environmentally friendly technique to convert organic waste into commercially useful byproducts Conclusion: It was found that postgraduates had a better awareness of the proper methods to dispose of healthcare waste when compared to students and interns. However, the overall level of awareness was less than adequate. The need for special training in BWM in the clinical set up was highlighted through this study.

Resíduos gerados em domicílios de indivíduos com diabetes mellitus usuários de insulina / Waste generated in households of individuals with diabetes mellitus who take insulin / Residuos generados en domicilios de individuos con diabetes mellitus usuarios de insulina

Resíduos de Serviços de Saúde (RSS) podem causar danos à saúde e ao ambiente se não houver um gerenciamento seguro e adequado. No Brasil, os serviços de saúde devem seguir as recomendações técnicas e legais definidas pela Agência Nacional de Vigilância Sanitária e Conselho Nacional do Meio Ambiente. Porém, não há definição técnica e legal sobre o manejo de resíduos gerados nos domicílios, e que sejam do tipo dos RSS. Considerando o elevado número de pessoas com Diabetes Mellitus (DM) no Brasil, e que, dentre esses indivíduos, 20% a 25% são usuários de insulina, em tratamento ambulatorial e domiciliar, faz-se necessária a existência de um sistema organizado para o manejo desse tipo de resíduo no domicílio. Este projeto visou conhecer a realidade do manejo de resíduos perfurocortantes e de origem química e biológica em domicílios de pessoas com DM, usuários de insulina. Esta pesquisa, de caráter descritivo e exploratório, foi desenvolvida com 26 usuários de insulina do Núcleo de Saúde da Família I de Ribeirão Preto (SP). O método para a coleta de dados foi a entrevista com perguntas semiestruturadas. Os dados coletados foram compilados em um banco de dados do Programa Excel e categorizados em tabelas e gráficos, procedendo-se à análise estatística descritiva. Esta investigação foi realizada após a aprovação do CEP do CSE-Cuiabá da FMRP/USP. Os resultados obtidos revelaram que a faixa etária predominante dos usuários de insulina era de 61 até mais de 80 anos para 76,8% dos sujeitos, com apenas 1 sujeito (3,8%) na faixa etária de 11 a 20 anos. O tempo de diagnóstico variou de 10 a 29 anos para 61,5% dos usuários de insulina. Dos sujeitos deste estudo, 73,9% referiram que o tempo de uso da insulina variou entre 0 e 9 anos e de 10 a 29 anos para 23% dos indivíduos. A aplicação da insulina no próprio domicílio foi referida por 88,5% dos sujeitos. Em relação ao monitoramento da glicemia capilar no domicílio, 80,8% dos pacientes afirmaram realizar o teste regularmente. A reutilização de seringas e agulhas foi referida por 69,6% da população estudada. Quanto ao acondicionamento, os sujeitos afirmaram acondicionar as seringas e agulhas (65,2%) e lancetas (52,2%) em garrafas plásticas. Porém, os usuários de insulina referiram acondicionar as fitas reagentes (47,8%) e os frascos de insulina (82,7%) junto com os resíduos comuns. No que se refere ao descarte dos RSS gerados com aplicação da insulina e com o teste de glicemia capilar, a maioria dos entrevistados informou realizar o descarte de seringas e agulhas (57,8%) e lancetas (53,8%) em garrafas plásticas, encaminhando, posteriormente, para algum serviço de saúde. No entanto, o descarte das fitas reagentes (61,6%) e frascos de insulina (76,9%) são destinados para a coleta pública, juntamente com os resíduos comuns do domicílio. Em relação às orientações recebidas para o manejo e descarte desses resíduos, 61,5% dos sujeitos afirmaram ter recebido algum tipo de orientação de algum serviço de saúde. O estudo revela que há uma inadequação do manejo e descarte dos resíduos oriundos do tratamento e monitoramento do DM no domicílio de usuários de insulina. Aponta, também, para a necessidade de ampliar as ações educativas em saúde com vistas à geração de resíduos perfurocortantes e de origem química e biológica nos domicílios de usuários de insulina, no sentido de minimizar riscos de exposição a esses agentes ambientais.

Medical Waste (MW) can be hazardous to human health and to the environment if there is no safe and proper waste management. In Brazil, health services should follow the legal and technical recommendations established by the National Agency for Sanitary Surveillance and the National Council on the Environment. However, there are no legal and technical definitions about the management of waste generated in households, which are of MW kind. Considering the high number of people with diabetes mellitus (DM) in Brazil, and that, among these individuals, 20 to 25% are insulin users in outpatient treatment and home care, it is necessary to have an organized system for managing this type of waste at home. This project aimed to know the reality of the management of sharp, chemical and biological waste in households of people with DM who take insulin. This descriptive and exploratory research was developed with 26 insulin users of the Center for Family Health I, in Ribeirão Preto, in state of São Paulo, Brazil. Data collection was carried out using semi-structured interview. Collected data were compiled into a database of the Excel Program and categorized into tables and graphs, and then descriptive statistical analysis was performed. The research was carried out after approval of the Research Ethics Committee of the Health Teaching Center (CSE) Cuiabá, of the FMRP/USP (the Medical School of the University of São Paulo in Ribeirão Preto). Results revealed that the predominant age group of the insulin users was 61 to over 80 years for 76.8% of subjects, with only one subject (3.8%) aged 11 to 20 years. The time of diagnosis ranged from 10 to 29 years for 61.5% of the participants. From the total of subjects studied, 73.9% reported that the time of use of insulin ranged between 0 and 9 years and 10 to 29 years for 23% of the individuals. Insulin injection in the household was reported by 88.5% of the subjects. Regarding the monitoring of capillary blood glucose at home, 80.8% of the patients reported performing the test regularly. The reuse of syringes and needles was reported by 69.6% of the population. Concerning the storage, the subjects reported storing syringes and needles (65.2%) and lancets (52.2%) in plastic bottles. However, users of insulin reported disposing reagent strips (47.8%) and vials of insulin (82.7%) with ordinary waste. Concerning the disposal of MW generated with the injection of insulin and capillary blood glucose testing, most respondents reported disposing syringes and needles (57.8%) and lancets (53.8%) in plastic bottles, and later sending to some health service. However, the disposal of reagent strips (61.6%) and vials of insulin (76.9%) are forwarded to public collection, along with common household waste. In relation to the guidance received for the handling and disposal of such waste, 61.5% of the subjects reported having received some guidance from health services. The study reveals that there is inadequate handling and disposal of waste from treatment and monitoring of DM in the households of insulin users. It also points out the need to expand health education actions concerning the production of sharp, chemical and biological waste in households of insulin users to minimize risks of exposure to these environmental agents.

En caso de que no haya una gestión segura y adecuada, los Residuos de los Servicios de Salud (RSS) pueden causar daños a la salud y al medio ambiente. En Brasil, los servicios de salud deben seguir las recomendaciones legales y técnicas establecidas por la Agencia Nacional de Vigilancia Sanitaria y el Consejo Nacional del Medio Ambiente. Sin embargo, no existe una definición técnica y legal sobre el manejo de los residuos, del tipo de los RSS, generados en los hogares. Teniendo en cuenta el elevado número de personas con Diabetes Mellitus (DM) en Brasil y que, entre ellas, el 20% a 25% son usuarios de insulina, en tratamiento ambulatorio y atención domiciliaria, es necesario que haya un sistema organizado para la gestión de este tipo de residuo en el hogar. Este proyecto tuvo como objetivo conocer la realidad de la gestión de los residuos punzocortantes y de origen químico y biológico en los domicilios de las personas con DM, usuarios de insulina. Esta investigación, de enfoque descriptivo y exploratorio, fue desarrollada con 26 usuarios de insulina del Núcleo de Salud de la Familia I de Ribeirão Preto, estado de São Paulo. Para la recolecta de datos fue utilizada la entrevista semiestructurada. Los datos fueron compilados en una base de datos del Programa Excel y categorizados en tablas y gráficos, con análisis estadístico descriptivo. La investigación fue realizada después de la aprobación del Comité de Ética en Investigación (CPE) del Centro de Salud Escuela (CSE), Cuiabá, de la Facultad de Medicina de Ribeirão Preto de la Universidad de São Paulo (FMRP/USP). Los resultados revelaron que el grupo de edad predominante de los usuarios de insulina era entre 61 a más de 80 años, representando 76,8% de los sujetos y con solo un sujeto (3,8%) con edad entre 11 y 20 años. El tiempo de diagnóstico varió de 10 a 29 años para el 61,5% de los usuarios de insulina. De los sujetos del estudio, el 73,9% informó que el tiempo de uso de insulina varió entre 0 y 9 años y de 10 a 29 años para el 23% de las personas. La aplicación de la insulina en el hogar fue reportado por el 88,5% de los sujetos. En cuanto al monitoreo de la glucemia capilar en el hogar, el 80,8% de los pacientes afirmó realizar el test con regularidad. La reutilización de jeringas y agujas fue reportada por el 69,6% de la población estudiada. En cuanto al acondicionamiento, de los sujetos afirmaron acondicionar las jeringas y agujas (65,2%) y lancetas (52,2%) en botellas de plástico. Sin embargo, los usuarios de insulina refirieron colocar las tiras reactivas (47,8%) y los frascos de insulina (82,7%) junto con la basura común. En cuanto al descarte de RSS generados con la aplicación de la insulina y el test de glucemia capilar, la mayoría de los encuestados informó realizar la eliminación de jeringas y agujas (57,8%) y lancetas (53,8%) en botellas de plástico, encaminándolos, posteriormente, a algún servicio de salud. No obstante, la eliminación de las tiras reactivas (61,6%) y de los frascos de insulina (76,9%) son destinados a la recolección pública, junto con la basura doméstica común. Con relación a la orientación recibida para el manejo y eliminación de esos residuos, el 61,5% de los sujetos declararon haber recibido algún tipo de orientación de los servicios de salud. El estudio revela que, el manejo y desecho de los residuos de tratamiento y monitoreo de la DM en el hogar de los usuarios de la insulina, es inadecuado. Señala, también, la necesidad de ampliar las acciones de educativas con relación a la generación de residuos punzocortantes y de origen químico y biológico en los hogares de usuarios de la insulina, para reducir al mínimo los riesgos de exposición a estos agentes ambientales.

Diagnóstico del sistema de manejo de desechos sólidos generados en el Hospital “Dr. Julio Criollo Rivas” / Evaluation of the solid waste management program of the Dr. Julio Criollo Rivas Hospital

Los Desechos Sólidos Hospitalarios (DSH), contienen agentes patógenos o infecto-contagiosos, que representan un riesgo potencial para el personal que labora en las instituciones de salud, los pacientes y público en general. En consecuencia, el presente estudio tiene por finalidad diagnosticar la situación actual del manejo de los desechos sólidos generados en el Hospital “Dr. Julio Criollo Rivas”, en Ciudad Bolívar - estado Bolívar, durante el último semestre del año 2007, a través de una investigación descriptiva prospectiva, mediante encuestas al personal de enfermería y saneamiento ambiental, visitas aleatorias en los diferentes turnos de trabajo, además de la tabulación sistemática y registro fotográfico; así como la aplicación de listas de verificación para determinar el nivel de eficiencia que presenta el centro hospitalario acerca del manejo de estos desechos. Se determinó que todas las áreas del Hospital generan los cinco tipo de desechos según la normativa legal vigente (A, B, C, D y E), establecida en el Decreto 2.218 “Normas para la Clasificación y Manejo de Desechos en Establecimientos de Salud”, del cual sólo se cumple 29,17%. Sin embargo, 49,06% del personal de enfermería y 45,83%, del personal de saneamiento ambiental, poseen un nivel de conocimiento “Aceptable” acerca del manejo de los DSH. No obstante, la situación actual acerca de la manipulación de los mismos es “Deficiente”, por ello, se deduce la necesidad de plantear e implementar un orden de procedimientos para el manejo de los DSH factible desde el punto de vista sanitario, económico y operativo, y así lograr cumplir con la normativa legal vigente y disminuir el riesgo de enfermedades infectocontagiosas, accidentes laborales y contaminación ambiental.

Hospital solid waste (HSW) contains pathogenic or infecteious agents, representing a potential hazard for healthcare workers, patients and the general public. The present study examined current waste management policies and practices at the “Dr. Julio Criollo Rivas” Hospital, Bolívar City, Bolívar state, during the last semester of 2007, using a descriptive and prospective design that included surveys of nursing and housekeeping personnel, random visits during different work shifts, systematic tabulation, photographic recording and use of checklists to determine the hospital’s efficiency level regarding handling of wastes. Five types of hospital waste were identified (A, B, C, D and E, according to the current legal norm, Decree 2.218 “Rules for classification and handling of waste handling from health establishments”), butonly 29,17% of these rules were being complied with. However, 49,06% and 45,83% of nursing and housekeeping personnel, respectively, exhibited an “acceptable” level of knowledge regarding HSW handling. Nevertheless, the actual practices with HSW handling were rated as “deficient”. Consequently, there is a need to propose and implement HSW policies and procedures that are feasible from health, economic and operational standpoints, so that there is compliance with the law, and environmental and occupational risks are reduced.

Study on the weights coefficient of the comprehensive evaluation indexes in medical waste management using the analytic hierarchy process / 中华疾病控制杂志

Objective To determinate the weights coefficient of the comprehensive evaluation indexes in medical waste management objectively and scientifically.Methods The analytic hierarchy process was used to define the weight coefficients in 9 synthetic evaluation indexes.Results The biggest weight coefficient(0.311 7)was handling medical waste standardly,the consistent ratio(CR)being 0.005 5