Blood Glucose MonitoringAnd Bloodborne Pathogens

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

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)

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

Fingerstick Devices• Reusable 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 DeviceSource: CDC

Single-Use Fingerstick DeviceSource: CDC

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 permanentlyretract upon puncture.

• Dispose of used lancets at the point of use in an approved sharps container.

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such as:• Glucometer or strip that’s not at room temperature• Outdated test strips• Glucometer not calibrated for the box of test strips• Blood drop that is too small• Dirty or unsanitized glucometer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.

Blood Glucose Monitorscontinued

• 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

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 PenSource: CDC

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.

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

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 Source: CDC

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

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

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

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!