1. Blood Glucose Monitoring And Bloodborne Pathogens

2. Blood Glucose Monitoring (BGM)
Monitoring blood glucose levels is done to help guide therapy for persons with diabetes
BGM involves:
Inserting a test strip into a blood glucose monitor
Drawing blood with a fingerstick device
Applying blood to a test strip
Administering insulin as needed

3. Blood Glucose Monitoring (BGM) continued
Exposure to bloodborne pathogens can occur during BGM if unsafe practices are used
Possibility for exposure to staff member performing the procedure as well as resident receiving BGM
Bloodborne pathogens include:
Hepatitis B virus (HBV)
Hepatitis C virus
Human immunodeficiency virus (HIV)

4. Fingerstick Devices
Use a lancet to prick the skin to get drops of blood for testing
Two types of devices
Reusable devices
Single-use devices

5. Fingerstick 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 pieces
Failure to clean and disinfect properly
Links to multiple HBV outbreaks
Risk for occupational needlesticks
Only appropriate for people who do not require assistance with BGM
Single-use devices
Disposable
Prevent reuse through an auto-disabling feature
Appropriate for settings where assisted
monitoring of blood glucose is performed
Reusable Fingerstick Device
Source: CDC
Penlets 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 Device
Source: CDC

6. Fingerstick 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 permanently
retract upon puncture.
Dispose of used lancets at the point of use
in an approved sharps container.
It is imperative to be vigilant and not use a fingerstick device on the wrong resident or to share devices.

7. Blood 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 temperature
Outdated test strips
Glucometer not calibrated for the box of test strips
Blood drop that is too small
Dirty or unsanitized glucometer
Keeping 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.

8. Blood 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/NIH
All 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).

9. Insulin Administration
Insulin pens
Pen-shaped injector devices for insulin
Have an insulin reservoir or cartridge; an individual usually self-injects several doses of insulin before the reservoir is empty
The needle is changed in the insulin pen before each injection
Assign to individuals and label appropriately
Never share insulin pens between people
Should be used only by individuals who are able to administering insulin and change the pen needle independently.
Insulin Pen
Source: CDC

10. Insulin Administration
Multiple-dose vials of insulin
Dedicate to a single person – do not “borrow” insulin from another person’s vial
Always puncture the vial with a new needle and a new syringe for each dose of insulin
Never 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 site
Place used sharps in sharps container immediately.

11. Hand Hygiene and Gloves
Wear gloves during:
Blood glucose monitoring
Administration of insulin
Any procedures where contact with blood or body fluids might occur
Change gloves:
Between resident contacts
After touching fingerstick wounds or potentially contaminated objects/equipment
Before touching clean surfaces
Discard gloves in appropriate receptacles

12. Hand Hygiene and Gloves continued
Perform hand hygiene:
Immediately after glove removal
Before inserting invasive devices, regardless of glove use
Use soap and water or an alcohol-based hand rub
Source: CDC
Regardless 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

13. Blood Glucose Monitoring Unsafe Practices
Using fingerstick devices for more than one person
Using a blood glucose meter for more than one person without cleaning and disinfecting it between uses per manufacturer’s instructions
Using insulin pens for more than one person
Failing to change gloves and perform hand hygiene between fingerstick procedures

14. Best Practices
Review resident schedules for persons requiring assistance with blood glucose monitoring and/or insulin administration
Reduce # of percutaneous procedures (sticks) to the minimum medically necessary
Ensure adequate staffing is maintained to perform diabetes care activities
Provide a full hepatitis B vaccination series to all previously unvaccinated staff persons whose activities involve contact with blood or body fluids
Limit the use of insulin pens and reusable fingerstick devices to persons who perform BGM independently
Part 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

15. Best 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

16. Commit 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!