WISE recommendations to ensure the safety of injections in diabetes.
OBJECTIVE
Injections and fingersticks administered to patients with diabetes in health care settings present a risk of blood exposure to the injector as well as other workers in potential contact with sharps. Such exposures could lead to transmission of bloodborne pathogens such as hepatitis and HIV. A recent EU Directive requires that where such risks have been identified, processes and devices must be put in place to reduce or eliminate the risk. The aim of this paper is to provide formal guidelines on the application of this Directive to diabetes care settings. These evidence-based recommendations were written and vetted by a large group of international safety experts.


METHODS
A systematic literature search was conducted for all peer-reviewed studies and publications which bear on sharps safety in diabetes. Initially a group of experts reviewed this literature and drafted the recommendations. These were then presented for review, debate and revision to 57 experts from 14 countries at the WISE workshop in October, 2011. After the WISE meeting, the revised Recommendations were circulated electronically to attendees on three occasions, each time in a new iteration with revisions.


RESULTS
Each recommendation was graded by the weight it should have in daily practice and by its degree of support in the medical literature. The topics covered include Risks of Sharps Injury and Muco-cutaneous Exposure, The EU Directive, Device Implications, Injection Technique Implications, Education and Training (Creating a "Safety Culture"), Value, Awareness and Responsibility.


CONCLUSIONS
These safety recommendations provide practical guidance and fill an important gap in diabetes management. If followed, they should help ensure safe, effective and largely injury-free injections and fingersticks. They will serve as the roadmap for applying the new EU Directive to diabetes care.
European Medical Association, BD, POB 13, Erembodegem-Dorp 86, B-9320 Erembodegem-Aalst, Belgium. kenneth_strauss@Europe.bd.com
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D003920:Diabetes Mellitus; D019317:Evidence-Based Medicine; D017408:Guidelines as Topic; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006509:Hepatitis B / Q000517:prevention & control* / Q000635:transmission; D006526:Hepatitis C / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D007267:Injections; D016602:Needlestick Injuries / Q000150:complications / Q000517:prevention & control*; D017751:Safety Management