Presentation on theme: "Blood Glucose Monitoring And Bloodborne Pathogens"— Presentation transcript:
1Blood Glucose Monitoring And Bloodborne Pathogens
2Blood Glucose Monitoring (BGM) Monitoring blood glucose levels is done to help guide therapy for persons with diabetesBGM involves:Inserting a test strip into a blood glucose monitorDrawing blood with a fingerstick deviceApplying blood to a test stripAdministering insulin as needed
3Blood Glucose Monitoring (BGM) continued Exposure to bloodborne pathogens can occur during BGM if unsafe practices are usedPossibility for exposure to staff member performing the procedure as well as resident receiving BGMBloodborne pathogens include:Hepatitis B virus (HBV)Hepatitis C virusHuman immunodeficiency virus (HIV)
4Fingerstick DevicesUse a lancet to prick the skin to get drops of blood for testingTwo types of devicesReusable devicesSingle-use devices
5Fingerstick Devices Reusable devices Single-use devices Often resemble a pen (“penlet”)Use not recommended due to problems that have been observed, including:Failure to change disposable piecesFailure to clean and disinfect properlyLinks to multiple HBV outbreaksRisk for occupational needlesticksOnly appropriate for people who do not require assistance with BGMSingle-use devicesDisposablePrevent reuse through an auto-disabling featureAppropriate for settings where assistedmonitoring of blood glucose is performedReusable Fingerstick DeviceSource: CDCPenlets pose a risk for occupational needlesticks.to staff another problem we see with penlets is that staff are more likely to stick themselves than with retractable lancets (b/c they have to remove the lancet after sticking the resident and some of them depending on the design are really dangerous..like a flip top version, you can easily cut you thumb on the lancet when you flip it open to remove the lancet…)Single-Use Fingerstick DeviceSource: CDC
6Fingerstick Devices: Recommended Practices Restrict use of fingerstick devices to individual persons. Never share between persons.Any fingerstick devices designed for reuse on a single person must be clearly labeled with the individual resident’s name and stored in a secure area such as a locked cabinet or medication cart.Select single-use devices that permanentlyretract upon puncture.Dispose of used lancets at the point of usein an approved sharps container.It is imperative to be vigilant and not use a fingerstick device on the wrong resident or to share devices.
7Blood Glucose Monitors Also known as a glucometer.Gives instant feedback on the individual’s blood glucose level.Improper use can cause incorrect readings, such as:Glucometer or strip that’s not at room temperatureOutdated test stripsGlucometer not calibrated for the box of test stripsBlood drop that is too smallDirty or unsanitized glucometerKeeping accurate documentation of blood glucose levels is critical to treatment.Check the batteries often to ensure the glucometer is working correctly.Frequency and timing of monitoring should be dictated by the particular needs and goals of the resident.
8Blood Glucose Monitors continued After testing, apply a Band-Aid and/or sufficient pressure to stop bleeding.When possible, assign blood glucose monitors to an individual person. Do not share.If sharing is necessary, clean and disinfect the monitor after every use, per manufacturer’s instructions.If the manufacturer does not specify how the monitor should be cleaned and disinfected, then it should not be shared.Manufacturer’s cleaning instructions are included in the glucometer’s packaging.Label device with resident’s name and store in a secure place such as a locked cabinet.Source: NIDDK/NIHAll supplies and equipment and medications should be stored in clean areas separate from used supplies and equipment. All individual equipment (glucose meters) should labeled with the resident’s name and stored in a secure place (medication cart, locked cabinet).
9Insulin Administration Insulin pensPen-shaped injector devices for insulinHave an insulin reservoir or cartridge; an individual usually self-injects several doses of insulin before the reservoir is emptyThe needle is changed in the insulin pen before each injectionAssign to individuals and label appropriatelyNever share insulin pens between peopleShould be used only by individuals who are able to administering insulin and change the pen needle independently.Insulin PenSource: CDC
10Insulin Administration Multiple-dose vials of insulinDedicate to a single person – do not “borrow” insulin from another person’s vialAlways puncture the vial with a new needle and a new syringe for each dose of insulinNever reuse needles or syringes.Do not carry insulin (or other medications) or supplies in your pockets.Gather all necessary supplies and make sure an approved sharps container is available.Insulin should be drawn up and disposed of at the care location.Examples: resident’s bedside using medication cart, designated medical care sitePlace used sharps in sharps container immediately.
11Hand Hygiene and Gloves Wear gloves during:Blood glucose monitoringAdministration of insulinAny procedures where contact with blood or body fluids might occurChange gloves:Between resident contactsAfter touching fingerstick wounds or potentially contaminated objects/equipmentBefore touching clean surfacesDiscard gloves in appropriate receptacles
12Hand Hygiene and Gloves continued Perform hand hygiene:Immediately after glove removalBefore inserting invasive devices, regardless of glove useUse soap and water or an alcohol-based hand rubSource: CDCRegardless of glove use, hand hygiene should be performed before inserting invasive devices such as catheters (note this is a WHO hand hygiene recommendation – CDC does not make a distinction about glove use)Remember, there are many other times when hand hygiene should be performed as well!Source: CDC
13Blood Glucose Monitoring Unsafe Practices Using fingerstick devices for more than one personUsing a blood glucose meter for more than one person without cleaning and disinfecting it between uses per manufacturer’s instructionsUsing insulin pens for more than one personFailing to change gloves and perform hand hygiene between fingerstick procedures
14Best PracticesReview resident schedules for persons requiring assistance with blood glucose monitoring and/or insulin administrationReduce # of percutaneous procedures (sticks) to the minimum medically necessaryEnsure adequate staffing is maintained to perform diabetes care activitiesProvide a full hepatitis B vaccination series to all previously unvaccinated staff persons whose activities involve contact with blood or body fluidsLimit the use of insulin pens and reusable fingerstick devices to persons who perform BGM independentlyPart of the OSHA bloodborne pathogen standard to provide a full hepatitis B vaccination series to staff members who may contact blood or other potentially infectious body fluids
15Best Practices continued Establish responsibility for oversight of infection control activities. Provide infection control training to staff with responsibility for fingersticks and injections.Consider the diagnosis of acute viral hepatitis infection in residents who develop jaundice or an illness that includes hepatic dysfunction or elevated aminotransaminase levels (AST, ALT)Report to public health authorities any suspected instances of a newly acquired bloodborne infection (e.g., hepatitis B) in a resident or staff member
16Commit to Best Practices Today! Proper blood glucose monitoring is critical for treatment accuracy and reduces the risk of transmission of bloodborne pathogens and other diseases.Commit to Best Practices Today!