The improper cleaning of glucometers is one of the top three Immediate Jeopardy (IJ) citations in Florida. And while avoiding an IJ citation is imperative, it’s critically important to resident care that glucometers are cleaned properly to prevent infection from Hepatitis B Virus (HBV).
As part of routine diabetes care, capillary blood is sampled using a finger-stick device. It’s then tested using a handheld blood glucose meter. In settings where multiple patients require assistance with blood glucose monitoring, opportunities for bloodborne pathogen transmission may exist.
Between 2008-2017, the Centers for Disease Control and Prevention (CDC) reports there have been 24 outbreaks of both HBV and HCV in health care settings. This includes 179 outbreak-associated cases with greater than 10,935 persons notified for screening. Of the outbreaks, 18 occurred in long term care centers, with at least 147 outbreak-associated cases of HBV and approximately 1,680 at-risk persons notified for screening. Of the 147 infected, six died from the complications of acute HBV infection. Each outbreak was attributed to glucose monitoring practices that exposed HBV-susceptible persons to blood-contaminated equipment that was previously used on HBV-infected persons.
The CDC has investigated numerous Hepatitis B outbreaks in people with diabetes in assisted living, long term care facilities and nursing centers. Modes of transmission are believed to have occurred from:
- Use of blood glucose meter for more than one resident without cleaning and disinfection between uses
- Failure to consistently wear gloves and perform hand hygiene between fingerstick procedures
- Use of the same fingerstick devices for more than one resident
- Cross-contamination of clean supplies with contaminated blood glucose monitoring equipment used by home health agencies
- Use of the same injection equipment such as a syringe or insulin pen for more than one person
- Failure to maintain separation of clean and contaminated podiatry equipment
- Improper sterilization of contaminated podiatry equipment
- Failure to perform environmental cleaning and disinfection between podiatry patients
Stanford University, School of Medicine, Departments of Pathology and Pediatrics released an article titled “Infection Transmission Associated with Point of Care Testing and the Laboratory’s Role in Risk Reduction” that is good to be used for training of staff.
The CDC’s educational document on Injection Safety and Blood Glucose Meters answers frequently asked questions regarding assisted blood monitoring and insulin administration. One of the important points from this article is that fingerstick devices, or lancing devices, should never be shared. The CDC also recommends that blood glucose meters should not be shared. However, if devices must be shared, they should be cleaned and disinfected after every use, per manufacturer’s instructions. If the manufacturer does not specify how the device should be cleaned and disinfected, then it should not be shared.
One question often heard and on the list of the CDC’s FAQs is how HBV can be transmitted through the meter. If the blood glucose meter never touches the patient, why does it need to be cleaned and disinfected after each use? Infectious agents, such as HBV, can be transmitted through indirect contact transmission, even in the absence of visible blood. Indirect contact transmission is defined as the transfer of an infectious agent (HBV) from one patient to another through a contaminated intermediate object or person. With some blood glucose meters that require pre-loading of the test strip, the device may come into direct or close contact with the patient’s fingerstick wound. If blood is transferred from the patient to the meter, and the meter is not cleaned and disinfected after use, subsequent patients can be exposed to this blood when the meter is used on them.
The FDA recently released guidance for manufacturers regarding appropriate products and procedures for cleaning and disinfecting blood glucose meters. The disinfection solvent you choose should be effective against HIV, Hepatitis C and Hepatitis B virus. The guidance notes that 70% ethanol solutions are not effective against viral bloodborne pathogens, and the use of 10% bleach solutions may lead to physical degradation of your device. It is important to allow wet and dry time per the manufacturer’s guidelines. Device manufacturers are responsible for improved, effective, validated cleaning and disinfection protocols, product labeling, and package instructions.
Educate your center’s clinical team on proper procedures and do audits regularly to ensure proper procedures are being used. Be proactive so your center can not only avoid the spread of HBV, but also any chance of a related Immediate Jeopardy citation.