Safe Blood Glucose Monitoring (BGM)
To prevent the transmission of bloodborne pathogens when assisting patients or residents with BGM, care providers should:
- Always perform hand hygiene and use new gloves before conducting BGM and between each person tested.
- Use a single-use lancet to prick the skin. Restrict use of penlet devices to individuals who do not require assistance with BGM.
- NEVER share fingerstick devices between persons.
- NEVER use insulin pens and other medication cartridges and syringes for more than one person; they are for single-patient use only.
- When possible, assign blood glucose monitors to an individual person. If sharing is necessary, clean and disinfect the monitor after every use according to the manufacturer’s instructions. If the manufacturer does not specify how the device should be cleaned and disinfected, then it should not be shared.
- Dispose of used lancets in an approved sharps container and empty container appropriately.
OSHA Bloodborne Pathogens (BBP) Standard
This federal regulation describes the policies and practices that employers must establish to protect employees who may have contact with blood or other potentially infectious materials while performing their job duties. The Virginia Occupational Safety and Health (VOSH) Program has adopted the federal OSHA standard and has incorporated it by reference into the Virginia Administrative Code (16VAC25-90-1910). The strategies outlined in the OSHA BBP Standard that can reduce the risk of infection on the job include:
- Exposure control plan – document that describes how the employer will address the parts of the Bloodborne Pathogens Standard.
- Engineering controls – systems or mechanical devices that minimize hazards in the workplace, such as sharps disposal containers.
- Work practice controls – practices that reduce the possibility of exposure by changing the way a task is performed, such as appropriate practices for hand hygiene and handling laundry.
- Standard precautions – a set of measures designed to protect staff and patients or residents from exposure to disease that should be applied all the time for all patients and residents. Includes personal protective equipment, or protective wear that serves as a barrier between a person and the blood/body fluids of another person.
- Housekeeping – Facility should have a regular cleaning schedule and procedures for cleaning and disinfecting all areas of the facility as well as a plan to manage blood spills.
- Hepatitis B vaccine – Employers should offer the hepatitis B vaccination series at no cost to all employees covered under the OSHA BBP Standard, within 10 working days of initial assignment, after appropriate training has been completed, unless the worker has previously received the vaccine series, antibody testing has revealed the worker is immune, or the vaccine is contraindicated (not recommended) for medical reasons. The vaccination series must be provided in accordance with the recommendations of the U.S. Public Health Service current at the time of the vaccination. This includes follow-up testing one to two months after the completion of the three-dose vaccination series to test for antibody to hepatitis B surface antigen.
- Occupational exposure follow-up, training, and record keeping – exposures to blood or body fluids should be reported and follow-up care provided. Training in the BBP Standard is required upon hire and annually. A sharps injury log must be maintained and medical records kept for a specified amount of time.
Bloodborne Pathogens General resources
- Fact sheets
- Presentations, posters, and compliance logs
- Bloodborne Pathogens and Blood Glucose Monitoring (Fall 2012) – Powerpoint
- Safe Injection Practices and Safe Blood Glucose Monitoring Practices – (May 2014) – Powerpoint
- Practice Safe Blood Glucose Monitoring (Fall 2011) – Poster
- Blood Glucose Monitoring: Single-Use Devices vs. Penlets (Fall 2011) – Poster
- Monitoring Tool to Ensure Safe Practices with Blood Glucose Monitoring (compliance log – Fall 2011) – Spreadsheet
- Administrative tools
- OSHA Bloodborne Exposure Control Plan (policy template – Fall 2012)
- Blood glucose monitoring protocol (policy template –Fall 2012)
- Administrator’s checklist for safe injection practices and blood glucose monitoring (template –Fall 2012)
- CDC’s Position: Protect Patients Against Preventable Harm from Improper Use of Single-dose/Single-use Vials (May 2012) – restates CDC’s position on the use of single-dose/single-use vials and also seeks to dispel inaccuracies being disseminated to healthcare providers.
- Other resources
- The One & Only Campaign – a public health campaign, led by the Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), to raise awareness among patients and healthcare providers about safe injection practices. The campaign aims to eradicate outbreaks resulting from unsafe injection practices.
- CDC sharps safety website
- CDC injection safety website
- CDC website on infection prevention during blood glucose monitoring and insulin administration
- CDC FAQs regarding assisted blood glucose monitoring and insulin administration
- Safe In Common – a nonprofit organization of healthcare professionals and advocates that strives to raise awareness and save lives of workers at risk for needlestick injuries.
- Ambulatory surgical centers
- Assisted living facilities and nursing homes
- Multiple Outbreaks of Hepatitis B Virus Infection Related to Assisted Monitoring of Blood Glucose Among Residents of Assisted Living Facilities, Virginia, 2009-2011
- Patel AS, White-Comstock MB, Woolard D, Perz JF. Infection Control Practices in Assisted Living Facilities: A Response to Hepatitis B Virus Infection Outbreaks. Infect Control Hosp Epidemiol 2009;30:209-214.
- Other resources
- OSHA Bloodborne Pathogens Standard for Assisted Living Facilities – in-service/presentation that can be used to fulfill requirement for training on the OSHA Bloodborne Pathogens Standard. Facilities that implement this in-service should add how employees should seek counseling and follow-up care if an occupational exposure occurs. (This training can be customized to other care settings) (May 2014)
- OSHA Bloodborne Pathogens Standard for Assisted Living Facilities (policy template – Summer 2011)
- Blood glucose monitoring protocol (policy template – Fall 2012)
- Administrator’s checklist for safe injection practices and blood glucose monitoring (template – Fall 2012)
- BBP FAQ for Assisted Living Facilities and Nursing Homes
- Safe Injection Practices FAQ for Assisted Living Facilities and Nursing Homes
- Practice Safe Blood Glucose Monitoring (poster – Summer 2011)
- Blood Glucose Monitoring: Single-Use Devices vs. Penlets (poster – Summer 2011)
- Three Simple Rules for Assisted Glucose Monitoring and Insulin Administration for Safe Diabetes Care (educational flyer – September 2014)
- Centers for Medicare and Medicaid Services (CMS) Regulatory Update: Blood Glucose Monitoring (August 2010)
- Virginia Department of Social Services Regulatory Update: Blood Glucose Monitoring (February 2011)
Other Healthcare Resources
- Guidance on Isolation Precautions for Hospital Visitors
- Siegel JD, Rhinehart E, Jackson M, Chiarello L, et al. The Healthcare Infection Control Practices Advisory Committee (HICPAC). 2007 Guideline for Isolations Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.
- Hand hygiene web page
- Tools for protecting healthcare personnel (CDC website)
- Sequence for Donning and Removing Personal Protective Equipment (updated 7/5/17)
- Resources for Long-Term Care Settings
- VDH Blue & Yellow Toolkits (updated 7/5/17)
Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard – federal regulation that states what employers must do to protect workers who may be occupationally exposed to blood or other potentially infectious materials.
NHSN Healthcare Safety Personnel Module – click on the appropriate healthcare setting and select the “Surveillance for Healthcare Personnel Exposure” link to access the training, protocols, forms, analysis resources, and other support materials that can be used to help healthcare facilities track information about occupational exposures to blood and body fluids and their management.
The One & Only Campaign - a public health campaign, led by the Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), to raise awareness among patients and healthcare providers about safe injection practices. The campaign aims to eradicate outbreaks resulting from unsafe injection practices.
BBP Fact Sheets for Long-Term Care Settings (updated 7/5/17)
For additional prevention materials on safe injection practices and blood glucose monitoring such as posters, policy templates, or sample in-services for healthcare or residential facilities, please see Safe Injection Practices
For more information about hepatitis in healthcare settings, see the CDC hepatitis website.
For more information about HIV in healthcare settings, see the CDC HIV website.
Thompson ND, Perz JF, Moorman AC, and Holmberg SD. Nonhospital Health Care-Associated Hepatitis B and C Virus Transmission: United States, 1998-2008. Annals of Internal Medicine. 2009;150:33-39.
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