Considerations for Blood Glucose Monitoring and Insulin Administration

Key points

  • Germs can live in blood. Never use fingerstick devices for more than one person.
  • Assign blood glucose meters to a person unless the device is designed for use in professional settings and is cleaned and disinfected after every use.
  • Never use insulin pens for more than one person.

Summary of recommendations

  • Never use fingerstick devices for more than one person.
  • Do not share blood glucose meters. If you must share them in a healthcare or congregate setting, select a device designed for use in professional settings, not an over-the-counter device.
  • Clean and disinfect blood glucose meters after every use, per the manufacturer's instructions.
  • Insulin pens and other medication cartridges and syringes are for single patient use only. Never use them for more than one person.

These recommendations apply in:

  • Hospitals or clinics.
  • Long-term care settings (e.g., nursing homes and assisted living facilities).
  • Senior centers.
  • Health fairs.
  • Correctional facilities.
  • Schools or camps.
  • Any other setting where blood glucose monitoring and insulin administration occurs.

Background

Germs can live in blood.

Blood glucose monitoring guides therapy for persons with diabetes. Blood glucose monitoring and insulin administration can happen in two ways:

  • Self-monitoring and administration, where the individual performs all steps of the testing and insulin administration themselves.
  • Assisted monitoring and administration, where another person assists with or performs testing and insulin administration for an individual.

Terms to know

Fingerstick devices, also called lancing devices, prick the skin to obtain drops of blood for testing. The FDA recommends healthcare providers label all fingerstick devices and only use them on a single patient. There are two types:

  • Reusable fingerstick devices resemble a pen. You can remove and replace the lancet(s), allowing providers to use the device multiple times for an individual patient.
  • Single-use, auto-disabling fingerstick devices are disposable and prevent reuse through an auto-disabling feature. These should be used in settings where you perform assisted blood glucose monitoring.

Blood glucose meters are portable devices that measure blood glucose levels and aid in diabetes self-management. Healthcare providers use these types of devices in a variety of clinical settings. Blood glucose meters can easily become contaminated during use. When used in healthcare or other group settings, germs and infections can spread if preventive measures are not in place.

Insulin pens are pen-shaped injector devices that contain a reservoir for insulin or an insulin cartridge. These devices permit self-injection, but healthcare providers may also use them to administer insulin. Each pen is designed to be safe for just one patient to use multiple times with a new, fresh needle for each injection. Pens must never be used for more than one patient because blood may be present in the pen after use. While you can use insulin pens multiple times, you must take extreme care to prevent reuse of needles.

Recommend practices in healthcare settings

  • Single-use, auto-disabling fingerstick devices should be used in settings where you perform assisted blood glucose monitoring.
  • Restrict use of fingerstick devices to individual persons. They should never be used for more than one person. Select single-use lancets that permanently retract upon puncture. This adds an extra layer of safety for the patient and the provider.
  • Dispose of used lancets at the point of use in an approved sharps container. Never reuse lancets.

  • Whenever possible, assign blood glucose meters to a person and do not share them.
  • Dedicated meters should be cleaned and disinfected per the manufacturer's instructions and, at a minimum, anytime the device is reassigned to a different person. Dedicated meters should be stored in a manner that prevents cross-contamination and inadvertent use for the wrong patient.
  • If blood glucose meters must be shared, the device should be cleaned and disinfected after every use, per the manufacturer's instructions, to prevent the spread of blood and infectious agents. If the manufacturer does not specify how the device should be cleaned and disinfected, it should not be shared.

  • Unused supplies and medications should be maintained in clean areas separate from used supplies and equipment (e.g., glucose meters). Do not carry supplies and medications in pockets.

  • Insulin pens should be assigned to individual persons and labeled appropriately. They should never be used for more than one person.
  • Multi-dose vials of insulin should be dedicated to a single person whenever possible.
    • If the vial must be used for more than one person, it should be stored and prepared in a dedicated medication preparation area outside of the patient care environment and away from potentially contaminated equipment.
    • Medication vials should always be entered with a new needle and new syringe.
    • Dispose of used injection equipment at point of use in an approved sharps container. Never reuse needles or syringes.

  • Wear gloves during blood glucose monitoring and during any other procedure that involves potential exposure to blood or body fluids.
  • Change gloves between patient contacts. Change gloves that have touched potentially blood-contaminated objects or fingerstick wounds before touching clean surfaces. Discard gloves in appropriate receptacles (containers).
  • Perform hand hygiene immediately after removing gloves and before touching other medical supplies intended for use on other persons.

  • Regularly review individual schedules for persons requiring assistance with blood glucose monitoring and/or insulin administration.
  • Provide a full hepatitis B vaccination series to all previously unvaccinated staff persons whose activities involve contact with blood or body fluids.
  • Establish responsibility for oversight of infection control activities. Provide infection control training for staff members who assume responsibilities for fingersticks and injections.
  • Assess adherence to infection control recommendations for blood glucose monitoring and insulin administration. Periodically observe staff who perform or assist with these procedures and track use of supplies.
  • Report any suspected instances of a newly acquired bloodborne infection, such as hepatitis B, in a patient, facility resident, or staff member to public health authorities.
  • Check with state authorities for specific state and federal regulations regarding laboratory testing.

Rationale

If healthcare providers use blood glucose testing or insulin administration devices on more than one patient, equipment and supplies may become contaminated. Unsafe practices during assisted monitoring of blood glucose and insulin administration contribute to the spread of hepatitis B virus, hepatitis C virus, HIV, and other infections.

Unsafe practices include:

  • Using fingerstick devices for more than one person.
  • Using a blood glucose meter for more than one person without cleaning and disinfecting it in between uses.
  • Using insulin pens for more than one person.
  • Failing to change gloves and perform hand hygiene between fingerstick procedures.

Resources

Print
Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)