Infection Transmission Associated with Point of Care Testing and the Laboratory's Role in Risk Reduction

Lack of knowledge and confusion exists regarding safe and appropriate use of blood glucose monitoring equipment. Increasing numbers of diabetics, and exponential growth in blood glucose monitoring presents increased opportunities for infection transmission between patients. Diabetics have increased exposure to blood and blood borne pathogens from frequent blood glucose monitoring. Risk factors have been identified in infectious outbreaks and by analysis of testing practice. Point of care blood glucose meters are frequently contaminated by blood. Bacterial and viral organisms survive on surfaces and in dried blood. Instrumentation is shared between patients, and is heavily utilized in institutional settings, so that serial testing is performed on multiple patients within a short timeframe. Hand hygiene, glove changes and meter disinfection between testing events has been found to be inconsistent. Time pressure for meter usage competes with proper cleaning and disinfection procedures. Meter storage areas are frequently contaminated by blood. Multi-use lancets, improperly used for serial patient blood sampling, are a source for infection transmission. Test strips in vials, frequently contaminated by bacterial organisms, present potential hazard. The responsibility of the clinical laboratory is to insure successful implementation of practices that insure patient safety. Risk reduction strategies include single-use auto-disabling skin puncture devices for blood sampling; hand hygiene and glove change for every testing event; effective meter cleaning and disinfection for every testing event; meter use restriction to a single patient; safe practices for glucose meter storage; infection control practices to reduce contamination of blood glucose test strips or changes in test strip packaging and test strip dispensing.