Protecting patients with diabetes

As diabetes prevalence continues to rise, there has been an increased focus on identifying ways to improve the long-term care and health of Americans living with the disease. This includes the development of strategies and tools to improve diabetes care in nursing facilities, where nearly one-third of elderly residents have the disease.^[i],[ii]

Diabetes is a tricky disease to manage in the best of circumstances, and there’s no denying that the long-term care (LTC) environment adds a host of very real, additional challenges. Diabetes and nutrition management, insulin delivery and assisted monitoring of blood-glucose (AMBG) all require significant staff time and add costs to patient care.

Diabetes must frequently be managed within the context of serious comorbidities such as COPD, congestive heart failure, stroke and infection, which can create conflicting dietary and therapeutic needs. Additionally, diabetes tools and technologies used within multiresident environments are frequently contaminated with blood and blood-borne pathogens, raising the potential for infection transmission.^[iii]

Fortunately, guidelines, practices and technologies exist that can help facilities overcome these challenges to more efficiently and effectively care for their residents with diabetes.

Safer blood glucose monitoring

The United States has demonstrated great progress over the past several years in making healthcare facilities cleaner, safer places for both patients and healthcare workers. This includes reducing the spread of bacteria and blood-borne pathogens from one patient to another. In the case of AMBG, however, there remains significant room for improvement.

Studies show that AMBG still results in exposure to blood and blood-borne pathogens among people with diabetes. The pathogens most likely to be transmitted through contact with blood are hepatitis B virus (HBV), which can survive for up to a week on contaminated surfaces, hepatitis C virus (HCV) and human immunodeficiency virus (HIV).

Sharing of blood glucose monitoring equipment in assisted living facilities resulted in at least 16 outbreaks of HBV infection in the United States between 2004 and 2011. Facility-borne contamination has resulted in dire consequences: patient illness (and in some cases death), antibiotic-resistant microbe strains, increased costs and facility compliance citations.^[iv]

In response to increasing HBV outbreaks—as well as evidence of increasing transmission rates for other infectious diseases related to AMBG—both the Centers for Disease Control & Prevention (CDC) and the U.S. Food and Drug Administration (FDA) have issued infection control guidelines and requirements for professionals who provide blood glucose monitoring assistance to patients.

Key components of these requirements include:

• Restricting use of fingerstick devices and insulin pens to one patient
• Assigning a blood glucose meter for each patient; in cases where this is not possible, thoroughly cleaning and disinfecting meters between patient testing
• Storing meters in a safe, noncontaminated space and clearly labeling them
• Ensuring consistency with hand hygiene and glove changes between patients

Glucose test strips stored in multiuse vials represent another, significant contamination-transmission risk that continually surprises professionals. Recent studies have demonstrated bacterial contamination of test strips from multiuse vials. The narrow test-strip vial opening can require repeated, manual touching to grab strips, resulting in both nonvisible viral and bacterial contamination as well as visible blood on vial interiors and exteriors in a hospital environment.

In March 2015, the Pennsylvania Department of Human Services responded to a fatal HBV outbreak in LTC facilities by issuing a letter requesting that among other precautions, each resident is assigned his or her own diabetic testing supplies, including test strips. Individually foil-wrapped test strip packaging may help to address this issue. A new data analysis and breakdown by type of test-strip package (individual or multiuse vial) reveals the surprising finding that only 7 percent of strips became contaminated when packed individually versus 45 percent of strips packed in multiuse vials, with a high statistical significance (p < .001). The organisms identified on the individual foil-wrapped strips were nonpathogenic.[v]

Safety and economy

Technology and practice innovations now make it both easier and more cost-effective to provide the safest care possible for patients with diabetes. Individually wrapped strips—per the example above—may reduce contamination while also preventing facilities from having to dedicate entire test-strip vials to individual residents, which can lead to strip waste. Most importantly, the costs for not implementing safer practices have proven to be much higher in terms of patient health and safety.

Shridhara Alva, PhD, is Director, Clinical Affairs and Research and Development at Abbott Diabetes Care. He has published more than 30 scientific papers related to diabetes and biosensing technology and has been involved in the development of electrochemical sensors for diabetes monitoring and disease management. He has also supported the development and launch of several diabetes solutions.

References

1. Dybicz SB, Thompson S, Molotsky S, Stuart B. Prevalence of diabetes and the burden of comorbid conditions among elderly nursing home residents. American Journal of Geriatric Pharmacotherapy 2011;9(4):212-23.
2. American Medical Directors Association. Diabetes management in the long-term care setting: Clinical practice guideline. Columbia, MD: American Medical Directors Association, 2011.
3. Geaghan S. Infection transmission associated with point of care testing and the laboratory’s role in risk reduction. eJIFCC – The electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine 2013;25(2):58-63.
4. Thompson N, et al. Evaluation of the Potential for Bloodborne Pathogen Transmission Associated with Diabetes Care Practice in Nursing Homes and Assisted Living Facilities, Pinellas County. Journal of the American Geriatric Society, 2010.
5. Perez-Ayala M, Oliver P, Rodriguez Cantalejo F. Prevalence of Bacterial Contamination of glucose test strips in individual single-use packets versus multi-use vials. Journal of Diabetes Science and Technology 2013;7(4):854-62.

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