IPs adopt comprehensive policy for glucometers

State inspection prompts rapid action

Infection preventionists at Vanderbilt Medical Center in Nashville have developed a comprehensive glucometer cleaning protocol that other IPs may want to emulate as regulators respond to outbreaks of hepatitis B virus in diabetics and other patients.

Indeed, state and local health departments are becoming more attuned to the issue, as evidenced by their interest in Vanderbilt's program in an otherwise routine inspection last year. During the visit, surveyors raised concerns about potential transmission of blood from one patient to another during blood glucose monitoring, explained Vanderbilt IP Kathie Wilkerson, RN, CIC. Again, there was no report of transmission to any patient via the equipment, but the state inspectors were obviously aware of the numerous reports of HBV outbreaks linked to improper use of glucose monitoring devices.

Glucometers at the hospital are used in areas where bedside blood glucose monitoring is performed, including inpatient units, clinics and emergency rooms, she explains. The meters are shared equipment, while safety lancets are disposable, one-time use devices. Cleaning and documentation of meter cleaning was being done according to policy and manufacturer's guidelines, she says. The policy at the time stated that glucometers were to be cleaned every 24 hours and when visibly soiled, but the state mandated that the hospital begin cleaning them after every use and document the program more thoroughly. And they wanted it done yesterday.

"We had to have a response in place very shortly," Wilkerson says. "I think they came in June and by that September we were up and running.

Training more than 5,000 health care workers was daunting to say the least, but the Vanderbilt team developed several innovations to move the process forward. For example, an on-line tutorial was developed and assigned to direct care-givers with responsibility for bedside glucose testing. Hospital educators assisted in the staff retraining. As a visual aid and learning reinforcement, a pictorial guide was developed and placed in every glucometer case for a step-by-step quick reference. (See cleaning guide.)

"Each of the glucometers comes with a case which contains the solutions that you need to use to test for glucose and a bottle of the strips," Wilkerson explains. "All of this comes in a case so everything is contained and together, and we put the [visual aid] on the inside cover of the case. When you open the case you see exactly what to do. If they need any reminders or help — it's right there."

The project was directed by a task force of key stakeholders that included members of nursing, education, infection control, laboratory, and accreditation and standards. The glucometer manufacturer was contacted for guidance on cleaning products, something that she recommends as a first step for any one undertaking such a program. Nursing leadership and infection prevention monitored compliance with the new policy through direct observation.

Ongoing monitoring of this process has demonstrated continuing compliance, she notes. However, an unexpected finding was the need to replace several glucometers, Wilkerson explains. Increased use of a chlorine-based agent caused clouding of the screen even with wiping the meter with a water dampened cloth as a last step. Several glucometers have been replaced, emphasizing the importance of continued communication with vendors to ensure the best methods and appropriate solutions are being used to clean equipment.