Diabetic Monitoring with Care

Edition: May 2012 - Vol 20 Number 05
Article#: 3982
Author: Repertoire

When routine procedures become habitual, do caregivers tend to become lax? If so, one small reminder from their distributor sales reps can provide them with a huge service – and help ensure the safety of the patients they care for.

On the face of it, monitoring diabetic patients should not present a risk to long-term-care residents. But, when blood glucose monitoring equipment, such as insulin pens and cartridges, are shared among patients, there is a risk of transmitting viral hepatitis and other bloodborne pathogens, according to the Centers for Disease Control and Prevention (CDC). Madison, Wis.-based Dean Clinic, for example, was forced to test its diabetic patients for hepatitis and HIV after a nurse misused insulin pens while teaching residents to inject insulin and test their blood sugar levels, according to an article in the Milwaukee Journal Sentinel (“Disease Exposure Via Medical Devices A Growing Concern,” August, 2011).

The nurse, who had worked at the clinic for five years, reused insulin pens and lancets on patients during a demonstration on how to use them, notes the article. Although she changed both the needle in the insulin pen and the sharp lancet used to get a drop of blood for testing blood sugar, clinic officials believed that blood may have adhered to the insulin pens or lancet devices. As the CDC points out, incidents such as the Dean Clinic case have become more common in recent years, prompting stronger communication on this issue.

Multiple-use poses risks

In the past 10 or 15 years, the CDC and the Food and Drug Administration (FDA) have pointed out a progressive increase in reports of bloodborne infection transmission – particularly hepatitis B – resulting from the shared use of fingerstick and point-of-care blood testing devices. And while the agencies acknowledge that infections are occurring in a number of health settings, they note that there has been a significant increase in long-term-care settings, prompting them to issue a warning in August 2010 that the use of blood lancets to obtain blood from more than one patient can lead to bloodborne pathogen transmission.

Single-use fingerstick and point-of-care devices may be reused safely by a single patient in a nursing home when the user follows the device labels for cleaning the blood testing device or reusable components in the fingerstick device, as well as changing lancet blades. But, these devices should never be used for more than one patient for the following reasons, according to the CDC:

  • Improper use or device malfunction can lead to the use of contaminated lancet blade on more than one patient.

  • Because it is difficult for caregivers to ensure that all blood has been removed from point-of-care blood testing devices and the reusable portions of fingerstick devices, they can be a source of bloodborne infections if used on multiple patients. Contaminated blood left on devices can result in bloodborne pathogen transmission among users.

  • Failure of caregivers to change their gloves between patients can result in bloodborne pathogen transmission.

In part, the CDC and the FDA attribute the misuse of fingerstick and point-of-care devices to “unclear labeling and ineffective cleaning/disinfection instructions.” Whereas multiple-use fingerstick devices were at one time considered safe for use on more than one patient, in 2010 the FDA recommended a change in the intended use and labeling of fingerstick devices to reduce the risk of bloodborne pathogen transmission (“Guidance for Industry and Food and Drug Administration Staff: Blood Lancet Labeling,” Nov. 29, 2010). Today, the agency recommends that all fingerstick devices – including the reusable portion of reusable fingerstick devices – be labeled for use on single patients only. In addition, the FDA recommends:

  • Labels include instructions that the device should not be used for assisted blood draws by healthcare providers in settings such as long-term-care, assisted living facilities, clinics and health fairs, and should not be shared among more than one person.

  • Labels provide validated instructions for cleaning and disinfecting the reusable portion of the device following every use by the device owner.

Blood glucose meters should also be limited to use by one patient, adds the CDC. If they must be shared, the device should be cleaned and disinfected after every use, per manufacturer instructions. When cleaning and disinfection instructions are not included, the device should not be shared.

Sales reps should consider sharing with their customers the CDC’s recommendations for diabetes care and hand hygiene in long-term-care and other health settings:

• Diabetes care procedures and techniques

  • Medications, such as insulin, should be prepared in a centralized medication area. Multiple-dose vials should be assigned to individual patients and labeled appropriately.

  • Supplies and equipment, such as fingerstick devices and glucometers, should be maintained within individual rooms if possible.

  • Trays and carts used to deliver medications and supplies to individual patients should remain outside patient rooms. Supplies and medications should not be carried in caregivers’ pockets.

  • Unused supplies and medications taken to a patient’s bedside during fingerstick monitoring or insulin administration should not be used for another patient due to possible contamination.

  • Glucometers should be assigned to individual patients and used as directed.

  • Needles, syringes and lancets should not be reused.

  • Capillary blood sampling devices should be restricted for use to individual patients. Single-use lancets that permanently retract upon puncture should be used.

  • Fingerstick devices and lancets should be disposed of at the point of use in approved sharps containers.

  • Unused and used diabetic equipment/supplies should be stored separately.

• Hand hygiene and gloves

    Gloves should be worn during fingerstick glucose monitoring, insulin administration and any other procedures involving potential exposure to blood or body fluids.

  • Gloves should be changed between patient contacts. They should also be changed when they have touched potentially blood-contaminated objects or fingerstick wounds before touching clean surfaces.

  • Gloves should be discarded in appropriate receptacles following every procedure that involves potential exposure to blood or body fluids, including fingerstick blood sampling.

  • Hand hygiene (e.g., hand washing with soap and water or the use of an alcohol-based hand rub) should be performed immediately following glove removal and before touching other medical supplies intended for use on other patients/residents.

In addition, the CDC recommends that all caregivers in long-term-care settings be vaccinated for hepatitis B, particularly when their activities involve contact with blood or body fluids. Facilities should investigate reported cases that represent acquired bloodborne infection and provide infection control training to staff members, particularly those who are responsible for percutaneous procedures.

By keeping their customers informed and educated, sales reps ensure the wellbeing of caregivers and their patients, as well as their continued trust.