In the early 2000s, the CDC investigated a number of hepatitis B outbreaks in assisted living, long-term care and nursing homes across numerous U.S. states. Investigations completed by the U.S. Centers for Disease Control and Prevention identified several modes of hepatitis B virus transmission.
- Blood glucose meters that were used on multiple residents without being cleaned and disinfected between use
- Staff failure to consistently wear gloves and perform hand hygiene between fingerstick procedures
- Use of the same fingerstick devices on multiple residents
- Clean supplies coming into contact with contaminated blood glucose monitoring equipment being used by home health agencies
Following these outbreaks, the U.S. Food and Drug Administration, the Centers for Medicare & Medicaid Services and the CDC issued mandatory guidelines and recommendations for the use of blood-glucose monitoring equipment in healthcare settings. In particular, the CDC recommended, “Unused supplies and medications taken to a patient’s bedside during finger-stick monitoring or insulin administration should not be used for another patient because of possible inadvertent contamination.”
The CDC recognized that people living with diabetes are at increased risk for hepatitis B through exposure to shared blood glucose meters, fingerstick devices and other diabetes-care equipment such as syringes and insulin pens. The hepatitis B virus is 50 to 100 times more infectious than HIV, is easily transmitted, and can survive outside the body for at least a week. The risk of transmission is so significant that in 2011, the CDC recommended that unvaccinated people with diabetes begin receiving the hepatitis B vaccine.
In a Letter to the Editor, authored by Viroj Wiwanitkit, M.D., and published in the American Journal of Infection Control (June, 2011), Wiwanitkit reported on a non-biased study he conducted that proved glucose test strips stored in vials were responsible for a total contamination rate of 25.7%. These rates were equal whether vial-packaged strips moved from room to room or were dedicated to a single patient room. Wiwanitkit urged manufacturers to distribute single units that could be used in a no-touch procedure.
More recently, independent laboratory analyses funded by Abbott Diabetes Care, identified blood on both the outside and inside of glucose test-strip vials. These analyses confirm that glucose test strips in vials do pose a risk of contamination within healthcare facilities.*
Why assume this risk when it is unnecessary and potentially dangerous? As with all products used in a patient’s room or at their bedside, glucose test strips should come individually wrapped. These findings from the CDC and scientific publications suggest that individually-wrapped test strips may be the best practice to implement in reducing the risk of cross contamination in your long-term care facility.
Luckily there are products available that have been designed to help to minimize your risk. Abbott’s diabetes care unit manufactures glucose test strips that are individually foil-wrapped and therefore able to be used in a no-touch procedure.
Shridhara Alva Karinka, Ph.D., is the director of clinical affairs at Abbott.
* Analysis funded by Abbott Diabetes Care. Fifty-one opened vials of Roche Accu-Chek Comfort Curve test strips being used in two hospitals, fifty-one opened vials of LifeScan SureStepPro test strips from another two hospitals and nine opened vials of Nova StatStrip test strips from a different hospital were obtained and tested for the presence of blood by the luminol test and either the phenolphthalein test or Teichmann test. Each hospital had at least one vial that tested positive for blood. Of the 51 Accu-Chek vials, three (5.9%) tested positive for blood (two tested positive for blood on the exterior surface of the vial; one tested positive on the interior surface). Of the 51 SureStepPro vials, two (3.9%) tested positive for blood on the exterior surface of the vial. Of the nine Nova StatStrip vials, two (22%) tested positive for blood (one tested positive on both the exterior and interior surfaces of the vial; another tested positive on the interior surface). Blood detection analysis was performed in April-June 2013, Nov-Dec. 2013 and Jan-Feb 2014 by Microbe Inotech Laboratories, Inc., St. Louis, MO. Data on file at Microbe Inotech Laboratories. Reports MILB-0024A, MILB-0127A, MILB-0659A, MILB-0660A, and MILB-0834A. Results show blood contamination from five facilities and are provided for informational purposes only. Contamination at other facilities may vary.