Blood Glucose Monitoring: Best Practices and Safety Measures

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 patient 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 • 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 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 patient’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.

7. Blood Glucose Monitors • Also known as a blood glucose meter or 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 • Improper use can cause incorrect readings, such as: • Glucometer or strip that’s not at room temperature • Outdated test strips • Glucometer not calibrated for the box of test strips • Blood drop that is too small • Dirty or unsanitized glucometer • Keeping accurate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.

8. 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 patient’s name and store in a secure place such as a locked cabinet. Source: NIDDK/NIH

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: patient’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 patient 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 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 an insulin pen for more than one person • Failing to change gloves and perform hand hygiene between fingerstick procedures

14. Best Practices • Reduce # of percutaneous procedures (sticks) to the minimum medically necessary • Ensure adequate staffing ismaintained 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

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 patients who develop jaundice or an illness that includes hepatic dysfunction or elevated aminotransaminase levels (AST, ALT). • Reportto public health authorities any suspected instances of a newly acquired bloodborne infection (e.g., hepatitis B) in a patient or staff member.

16. 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!