Infection transmission risk with shared glucometers, fingerstick devices, and insulin pens

The Centers for Disease Control and Prevention (CDC) has issued several warnings regarding unsafe practices that might result in the transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and other infectious diseases during assisted blood glucose monitoring and insulin administration. Assisted blood glucose monitoring is when a healthcare worker uses a shared glucometer to assist or perform glucose testing, usually for multiple patients with diabetes (as opposed to self-blood glucose monitoring using the patient’s own glucometer). This typically occurs in hospitals or clinics, ambulatory care settings, senior centers, correctional facilities, long-term care settings, health fairs, and schools or camps.

Outbreaks associated with assisted blood glucose monitoring have been identified with increasing regularity in various inpatient and outpatient healthcare settings where blood glucose monitoring equipment is shared. Failure to follow the most basic principles of infection control contributed to most of these outbreaks.

Most frequently, the unsafe practices that have contributed to the transmission of infections include the following:

• Using fingerstick devices, also called lancing devices, for more than one person

• Using a blood glucometer for more than one person without cleaning and disinfecting it after every use

• Failing to change gloves and perform hand hygiene between fingerstick procedures

• Using insulin pens for more than one person risks infection transmission

Fingerstick devices should never be used for more than one person. Although some fingerstick devices have been previously approved and marketed for multi-patient use and require the lancet and disposable components to be changed between each patient, CDC recommends never using these devices for more than one person due to failures to change the disposable components, difficulties with cleaning and disinfection after use, and their link to multiple HBV infection outbreaks. Single-use fingerstick devices are disposable and prevent reuse through an auto-disabling feature.

Whenever possible, blood glucometers should not be shared. If they must be shared, each device should be cleaned and disinfected after every use, per the manufacturer’s instructions. The glucometer must be cleaned before it can be disinfected, which might require the repeated application of an approved cleaning agent following the manufacturer’s recommendations. If the manufacturer does not specify how the device should be cleaned and disinfected, then the glucometer should not be shared. Organizations have the responsibility to verify with the manufacturer that the glucometers are, in fact, approved to be used for multiple patients.

Using insulin pens for more than one patient is an ongoing medication safety risk we have previously discussed in this newsletter and during consultations and live presentations, starting as early as 2008. Since then, ISMP and others have chronicled large-scale, potential exposures to bloodborne pathogens caused by using insulin pens for multiple patients even after changing the needle. Insulin pens should never be used for more than one patient.

Additionally, The Joint Commission (TJC) has found that knowledge gaps among providers and leaders associated with assisted glucose monitoring and insulin administration via a pen have resulted in unsafe practices and subsequent escalation to an Immediate Threat to Health or Safety. TJC has just released an informational video that examines some of the more common mistakes witnessed by surveyors when staff administer insulin via a pen or perform glucose monitoring using a shared glucometer. Additionally, the May 2021 issue of Perspectives details helpful information on compliance with standards related to glucose monitoring and insulin administration (The Joint Commission. Consistent Interpretation. Joint Commission surveyor’s observations of staff competency related to blood glucose monitoring and insulin administration. Perspectives. 2021;41[5]:38-41).