Preventing Bloodborne Pathogen Transmission during Assisted Monitoring of Blood Glucose and Insulin Administration in Long Term Care

BACKGROUND:  U.S. Centers for Disease Control and Prevention (CDC) investigated multiple outbreaks of viral hepatitis among residents of long term care (LTC) facilities attributed to breaches in infection control during assisted monitoring of blood glucose (AMBG). Blood glucose monitoring is performed to guide therapy for persons with diabetes. Assisted monitoring occurs when a licensed healthcare worker assists with or performs testing for an individual. If devices are used on more than one resident, there is the potential for bloodborne pathogen transmission. This study aims to educate Infection Preventionists (IPs) at LTC facilities in Maine about U.S. CDC’s recommendations for infection control during diabetes care. Our overall goal is to decrease the number of new hepatitis B virus infections in Maine.

METHODS:  In May 2013, we designed and implemented a Knowledge, Attitudes, and Practices (KAP) survey among IPs at 101 LTC facilities that are members of the Maine Health Care Association. We launched an educational campaign from May to October 2013 on infection control during diabetes care. The campaign comprised of a poster highlighting the importance of single use devices, dissemination of this poster and U.S. CDC’s recommendations, and training of healthcare workers at four professional meetings. In January 2014, we sent a post-survey to the same 101 LTC facilities. Survey analysis was performed using Survey Monkey and SAS version 9.3.

RESULTS:  Twenty-one completed pre-campaign surveys were returned (response rate 21%). Post-campaign survey results will be available by February 2014. Survey respondents worked at their respective facilities for a median of four years. AMBG is performed in all 21 facilities. Devices used for AMBG include glucometers (95.2%), lancets (81.0%), and fingerstick devices (42.9%). Assisted insulin administration is performed in 85.7% of facilities. Devices used for insulin administration include a syringe and multi-use vial of insulin (94.4%), insulin pen (44.4%), and a syringe and single-use vial of insulin (16.7%). All respondents’ facilities have a policy for preventing bloodborne pathogen transmission, although infection control practices related to AMBG and insulin administration are only addressed in 57.1% of policies.

CONCLUSIONS:  AMBG is both a common practice in LTC and potential vector for bloodborne pathogens in the absence of infection control. Educating IPs on U.S. CDC’s recommendations is instrumental in preventing outbreaks of viral hepatitis because of their tenure and supervisory role. Changes in knowledge, attitudes, and practices related to infection control during diabetes care will be evaluated upon receipt of post-campaign surveys in February 2014.