Toward safe environment: injection device disposal among diabetic patients attending tertiary care academic clinic in Middle Delta, Egypt

In Egypt, there are 8.9 million adult diabetics using almost 16 million insulin injection devices daily. Unsafe disposal of these sharps will result in many environmental and public health hazards. This study aimed at evaluating knowledge and practice of diabetic patients toward safe disposal of insulin injection devices. Cross-sectional study and health education sessions were carried out at diabetic outpatient clinic of the Internal Medicine Department, Tanta University Hospitals in Middle Delta, Egypt, during a period of 2 months (November through December 2019). The study enrolled diabetics who were > 12 years age, using insulin therapy for > 1 year, and females that do not have gestational diabetes. By using systematic random sampling, 450 patients were selected from diabetic patients attending the clinic during the period of the study. Patients' knowledge and practice of insulin injection device disposal were assessed and evaluated using predesigned questionnaire. Verbal health education message and printed pamphlet were given to illustrate safe disposal. Out of the selected samples, 429 completed the questionnaires. Out of those participants, 85.5% had poor knowledge and only 13.5% had good practice. A total of 86.5% dispose at household collection bin, 65.3% reuse syringe, and 63.21% throw it at the nearest garbage bin when takes the injection outside home. Binary logistic regression revealed that female sex (adjusted odds ratio [AOR], 2.37; 95% confidence (CI), 1.13-4.94; p = 0.022), rural residence (AOR, 3.05; 95% CI, 1.62-5.72; p = 0.001) and low income (AOR = 2.11; 95% CI, 1.06-4.18; p = 0.033) were the main predicting sociodemographic factors for poor practice. Meanwhile, syringe usage (AOR = 2.81; 95% CI, 1.31-6.03; p = 0.008), twice daily schedule (AOR = 2.82; 95% CI, 1.51-5.26; p = 0.001), patient himself as injection provider (AOR = 2.268; 95% CI, 1.18-4.36; p = 0.014), and unawareness of how to dispose sharps safely (AOR = 7.33; 95% CI, 3.58-14.99; p < 0.001) were the predicting factors of bad practice related to patient and treatment characteristic. Vast majority of studied diabetic patients do not use or dispose insulin injection devices safely. As the problem is nationwide, an integrated nationwide program is needed including a structured health education module for diabetic patients and a system for collection of home insulin sharps from those patients and disposing them safely.

Automated summary

This study evaluated the knowledge and practice of diabetic patients in Egypt towards safe disposal of insulin injection devices. Findings showed that the majority of patients had poor knowledge and unsafe practices. Factors such as female sex, rural residence, low income, syringe reuse, and inadequate awareness of safe disposal methods were identified as predictors of bad practice. An integrated nationwide program with structured health education and sharps collection system is needed to address this issue.