Safety

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Congress Asks: Why Can’t Seniors Have Accurate BG Meters?

Trusted versus Unknown

If you had a choice between using a trusted blood glucose meter that you know is accurate and one that you had never used before (and never heard of before) that you don’t know is accurate, which would you pick? 

Most of us would choose the accurate one, for obvious reasons. However, for Medicare beneficiaries who want to use the National Mail Order Program to receive their testing supplies, that’s not often an option.

H.R. 3271 and S. 1914 (both known as the Protecting Access to Diabetes Supplies Acts of 2017) force the Centers for Medicare and Medicaid Services (CMS) to change the way that the Competitive Bidding Program (CBP) is applied to diabetes testing supplies.

DPAC has been speaking in support of H.R. 3271 and S.1914 (Protecting Access to Diabetes Supplies Acts of 2017) for some time now –  just see DPAC’s CEO Christel Marchand Aprigliano’s testimony on the bill in front of the E&C Subcommittee on Health as one example!

Now we have a chance to get new momentum behind the bill.  

The Congressional Diabetes Caucus recently sent a letter to the acting secretary of HHS asking him why Medicare beneficiaries with diabetes are receiving blood glucose meters that aren’t accurate. If H.R. 3271 or S. 1914 becomes law, CMS must do two main things: (1) strengthen the 50% rule, which would lead to Medicare beneficiaries being able to use the accurate blood glucose meter they trust, and (2) strengthen and codify the anti-switching rule, which would change the refill process to give the beneficiary more choice and knowledge from the supplier when they buy a blood glucose meter.

We have Congress’s attention. Now we need to ask them to act!

Keep reading for details or click HERE to send a letter

to your Representative and ask them to cosponsor H.R. 3271!

Currently, Medicare pays for the cheapest blood glucose meters, so the most trusted blood glucose meters on the market are not available to beneficiaries. Additionally, as the Congressional Caucus on Diabetes wrote, a recent study showed that only six of the eighteen blood glucose meters in the study were accurate to DA Standards. Many of the meters offered through the National Mail Order Program are not accurate.

The bills require CMS to make sure that an entity that enters the competitive bidding process has the ability to actually get their products to people with diabetes when the person needs it. The bills also let CMS terminate a contract with a bidding entity if it is unable to get supplies to beneficiaries when they need them. In addition, the bill specifies that an entity furnishing such products to beneficiaries:

  • an entity selling diabetes testing supplies must give the Medicare beneficiary the brand of test strips that they want, and that match the blood glucose meter that they want,
  • the entity may not try to influence or incentivize a beneficiary to switch the brand of either their diabetic test strips or their blood glucose meter, and  
  • the entity must refill prescriptions within fourteen days.

(House Summary) DPAC has blogged about this in detail before, and that blog can be found HERE.

This month, the Congressional Diabetes Caucus took up this issue when they wrote a letter to the acting secretary of HHS, Eric Hargan, asking him why Medicare beneficiaries only had access to certain blood glucose – most of which did not give accurate results! The Caucus asked HHS what steps, if any, CMS and the FDA are taking to ensure seniors with diabetes receive products that work as intended? In its letter, the Caucus wrote:

“Given the importance of blood glucose measurement to manage diabetes, we are concerned about the study implications on patient health and safety. Some stakeholders have even suggested that CMS suspend the National Mail Order Program in light of these and other potential problems that are limiting seniors’ access to quality products. We therefore urge you to take action to implement and enforce product performance standards for diabetes testing supplies. Seniors should be able to rely on the accuracy of the blood glucose testing systems obtained from Medicare. Taxpayer dollars also should not be spent on products that are inaccurate, unsafe, of dubious quality or that are mislabeled or misbranded.”

CMS has until January 29th to give an answer to the Caucus’s questions. You can learn more about the Congressional Diabetes Caucus HERE.

H.R.3271 and S.1914 will let Medicare beneficiaries with diabetes use the blood glucose meter that they and their doctor decide is best for them, and will make sure that no company can try and get a beneficiary to switch brands for no medical reason.

We need to help Medicare beneficiaries with diabetes get quality equipment.

You can send a letter to your Representative asking them to cosponsor H.R.3271 HERE.

Let’s protect our community on Medicare with diabetes!

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Guest Post: Victor Walsh on Competitive Bidding

victor-a-walshDPAC shares stories about access and the issues patients have encountered in getting the diabetes supplies, medications, and services they need. Dr. Victor Walsh, Ph.D and PWD (person with diabetes),  gives his thoughts and comments about the Medicare Competitive Bidding program for diabetes testing supplies by sharing his story.


On the morning of January 21, 2014, I went into insulin shock and lost consciousness on the front porch of my home in Santa Cruz, CA. A passerby called 911 and a medic alert team revived me intravenously with glucose and then took me to nearby Dignity Hospital.

Several months later, I contacted the Centers for Medicare and Medicaid Services (CMS) in San Francisco. In my email to David Sayen, the Regional Administrator, I mentioned that this episode could have been prevented, “if I had coverage for more test strips to check my blood glucose.” I also noted that I had a recent second medical emergency, in which I went into insulin shock asleep, but somehow woke up. Unable to call anyone or talk, I crawled into the kitchen and revived myself by licking up apple juice that I had spilled on the floor.

Competitive Bidding Program (CBP)

What is happening to me and other insulin-treated diabetics is an unfolding disaster that has eluded the media and public awareness. In 2011, Medicare launched its Competitive Bidding Program (CBP) as required by the 2003 Medicare Modernization Act (MMA) to reduce costs, prevent waste and streamline acquisition of medical equipment and supplies for Part B beneficiaries.

Under CBP, coverage of test strips is limited to 300 over three months or three per day. Additional strips may be covered provided the treating physician can justify their usage as “medically necessary and reasonable.” The physician must provide the beneficiary’s testing logs to the supplier to confirm a higher frequency in use. The process is unwieldy and prone to error; burying physicians in paper work that detracts from time with patients.

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To learn more about this program, click the image.

Claims and appeals on my behalf have been repeatedly denied resulting in lapses of coverage and mounting out-of-pocket expenses, including for continuous glucose meters, transmitters, sensors and other diabetic equipment that Medicare does not cover. Many seniors simply do not understand how CBP works or are unable to record logs and thus slip through the safety net.

Diabetes is expensive to treat, especially in a patient’s later years when ongoing difficulty to control glucose levels often leads to other serious complications. In 2014, 28% of Medicare’s beneficiaries had been diagnosed with diabetes. Almost one in every three Medicare dollars was spent on their care.

Controlling Fraud And Waste, But At What Cost?

Medicare’s unprecedented growth over the past decade has triggered an epidemic of fraud, abuse and improper claim payments amounting to an estimated $60 billion now. In 2014, improper payment for durable medical equipment and supplies totaled $5.1 billion. This includes big-ticket items like wheelchairs, respirators and oxygen concentrators, as well as blood glucose test strips.

Clearly, there is a compelling need to control fraud and waste, but CBP’s focus on documentation is not the right approach, especially as it relates to cases like mine. It creates real barriers to attaining necessary testing supplies and is dinosaurian in a digital age.

Hypoglycemia and CBP

Furthermore, CMS’s staff does not understand the life-threatening consequences of a diabetic condition called hypoglycemia unawareness—the inability to recognize the onset of rapidly dropping blood glucose levels. Not all diabetics experience it, but older, long-term, insulin-treated diabetics like me are prime candidates.

Hypoglycemia occurs because continual and erratic blood glucoses eventually incapacitate the brain’s glucose-sensing neurons from transmitting symptoms. The brain does not store glucose, but draws it directly from the bloodstream. Rapidly declining glucose levels seriously affect its cognitive, locomotive and visual functions and, if untreated, lead to convulsions, comas, brain damage or death.  

Limiting coverage of diabetics vulnerable to hypoglycemia to three strips a day is not only foolish but irresponsible and dangerous. They must check their blood sugar before and after every meal and always at bedtime; otherwise, they may not wake up. Ask any endocrinologist.

Restricting Access

Another problem is the ongoing difficulty to acquire essential testing supplies. In June, my mail-order supplier CCS Medical withdrew from supplying branded test strips because CMS cut the reimbursement rate by 20%. I never heard from CMS. It took me over a month to find another supplier  that carried One Touch Ultra Blue strips that I use for my blood glucose meter. Service ended abruptly severally weeks later when the mail order company stopped carrying them. There is only one mail order supplier in my area that still carries this brand. As for local pharmacies, only one accepts Medicare beneficiaries whose test strip usage exceeds the local coverage limit of three per day.

Jeopardizing Safety

Such disruptions and delays, along with long wait times for follow-up calls, jeopardize patient safety. I have repeatedly called or emailed CMS staff in San Francisco asking questions about how the mail-order suppliers are monitored, but answers almost always focused on coverage requirements, not supplier service, and now I know why.

First, beneficiaries are required under law to order supplies and equipment from either a CBP mail-order supplier or local pharmacy contracted by Medicare. The contracts differ in one critical respect: Pharmacies are not part of CBP and thus have the option to bill beneficiaries, while the small number of mail-order suppliers must accept as full payment the amount approved by Medicare for each item. Reimbursements are substantially less than Medicare’s fees for services, but the trade-off is that the mail-order suppliers gain a monopoly on a burgeoning market of millions of new Medicare customers.

Second, the law exempts CBP from any safety monitoring or oversight restrictions. Given the low, volatile profit margin, this has prompted mail-order suppliers to reduce overhead. The new rate of reimbursement for glucose test strips is only $6.65 per vial of fifty. As a result, mail-order channels have limited the availability of branded test strips needed by diabetics. The outcome has been a disaster for them and probably other Part B beneficiaries.   

In April 2016, the American Diabetes Association (ADA) published a report in its journal Diabetes Care that is highly critical of CBP’s impact on the safety of insulin-treated diabetics and to access to testing supplies. In the program’s nine pilot test markets, the proportion of insulin-treated diabetics that switched from full to partial or no testing supplies increased by 58% compared to a 14% decrease in non-test sites.

The report found that death and hospitalization rates of diabetics in those markets were nearly twice those of Medicare’s other insulin-dependent beneficiaries. Despite the report’s recommendation to suspend the program immediately, it was expanded to the entire nation in July 2013.

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You can act now to tell Congress this must stop by clicking this link.

Programs to reduce costs, though necessary, should never be pursued if they risk patient safety. CMS has never explained how or if it assessed the risk to diabetic recipients before launching CBP and how this program is “reasonable and necessary” in accordance with the Social Security Act of 1965 that it is charged to uphold and administer.

Living with a chronic, incurable disease can be overwhelming and life-threatening. It demands rigorous adherence to a daily regimen and vigilant self-monitoring. This is my responsibility, but it is Medicare’s responsibility to provide the essential tools to manage it.  For me this means CBP should not invalidate my right to manage my health as prescribed by my endocrinologist. In this capacity, CBP has failed miserably and must be repealed by the next Congress in order to prevent further loss of human life.


Diagnosed 54 years ago as a type 1 diabetic, Dr. Victor A. Walsh, Ph.D, is a retired California State Parks historian.  Now a Medicare Part B beneficiary, he is concerned about coverage and management issues involving diabetic testing supplies. His historical and literary essays have appeared in the Christian Science Monitor, Rosebud, California History, Journal of the West, Travel Thru History, San Antonio Express-News, Irish America, Literary Traveler, among other publications.

Lancet Poke The FDA! ACT by June 1, 2016!

In a clinical setting, cross-contamination through lancet re-use and sharing of lancing devices is a serious issue. Hepatitis B outbreaks in long-term healthcare facilities are still happening despite infection protocol policies. Other blood-borne viruses can be transmitted through lancet re-use. These transmissions can and should be prevented. The best clinical option is disposable single-use lancets that automatically shield the sharp.

But what about when you’re at home and you’re the only one using the lancet?

Different story.

And if we don’t speak up by June 1, 2016, we risk greater regulation of home use lancets.

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FDA Docket on the Reclassification of Blood Lancets

There is a FDA docket that is currently open for public comment on lancet regulation and the patient voice needs to be heard. Increasing the regulation of individual use lancets may impact access and cost without evidence of a need for increased oversight.

From the docket:

FDA is proposing to reclassify the following three subsets of blood lancets from class I (general controls) exempt from premarket review to class II (special controls) and subject to premarket review: (1) Single use only blood lancets with an integral sharps injury prevention feature, (2) single use only blood lancets without an integral sharps injury prevention feature, and (3) multiple use blood lancets for single patient use only. FDA believes that general controls by themselves are insufficient to provide reasonable assurance of safety and effectiveness for these devices, and that there is sufficient information to establish special controls to provide such assurance.

And:

FDA further believes that blood lancets for use on multiple patients should be reclassified into class III because multiple patient use blood lancets present a potential unreasonable risk of illness or injury and insufficient information exists for FDA to determine that special controls would provide reasonable assurance of safety and effectiveness of the device.

Regulation and labeling should combine to clearly define the distinction between devices for home use and clinical use. There is evidence that other items, including testing supplies, are potential paths for the transmission of infections including test strips and their containers.

FDA has presented no evidence supporting the upregulation and associated cost increases for individual use lancets.[separator style_type=”shadow” top_margin=”10″ bottom_margin=”40″ sep_color=”” icon=”” width=”” class=”” id=””]

Why are FDA Lancet Docket Comments Important?

FDA is listening to the public through a formal comment process. Every comment matters. The more FDA comments FDA receives from the diabetes community, the more the needs and concerns of the diabetes community will be heard. Other interests will lobby for their views. We must speak up for our own. Our health is more at stake. After all, people with diabetes will experience more in-clinic lancet assisted testing than anyone else.

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Citing detailed cases of infection through cross-contamination involving lancets in clinical care settings over the past three decades, they suggest stricter rules.

ACT NOW and Comment by June 1, 2016

Commenting is easy and fast. Here’s what you need to do:

  1. Copy the text in the shaded area below.
  2. Go here and paste it into the comment box.
  3. Fill out your information. You’re commenting as an individual so UNCHECK the box that says:
  4. Click continue. Select “individual consumer” in the drop down.
  5. Review, check the confirmation box, and submit your comments.
  6. You even get a receipt to confirm your comments were posted.
  7. Share this post with your family and friends in the diabetes community and ask them to comment on this docket. Every voice matters.

 

STEP BY STEP DETAILS

DPAC Copy & Paste Comments to Lancet Draft Guidance

Please Feel Free to Add Your Personal Comments

Thanks to FDA for keeping patients safe from hospital acquired infection.

Section VII “Summary of Data Upon Which the Reclassification Is Based,” details cases of infection transmission. These involve hundreds of patients around the world over three decades. In many situations, human error facilitated infection transmission.

As well as the cases cited in this FDA guidance, other evidence points to additional cases of disease transmission.  In diabetes, notably glucose meters and other materials can transmit infection. FDA has rasied concern over clinical use meters. CDC has detailed that test strip containers are one such other means of passing infection from one patient to another. FDA should consider the total risk, not piecemeal responces.

ALL of the evidence presented in the docket is of transmission in professional care facilities. It is clear that healthcare facilities are where FDA should address the problem of lancets infection transmission. Don’t fix what isn’t broken. The draft presents no evidence to support the proposed up-regulation of personal lancet devices.

I appreciate FDA efforts to protect people in the clinical setting. That is a setting where we, as patients, have no way of knowing if we are getting fresh blades and disinfected devices. In some cases, we may not even be conscious to ask.

FDA’s 2013 draft meter guidance is instructive to this docket. While the final guidance is not yet out, the draft made a clear distinction between the setting of professional use and individual over the counter home use. Separating devices based on these environments is a logical precedent to follow with lancets.

FDA should be addressing documented problems. All of the evidence FDA presents is in clinical settings. Therefore, FDA should be using guidance and labeling to address the clinical setting where we need protection and device design that can minimize human factors that contribute to risk.

Section VII shows that multiple patient devices in-clinic use are a particular risk. The proposed up-regulation to class III of such devices is an indication of FDA’s appreciation of that risk. FDA should be clear how unique device identifiers will usefully implement with replaceable blade devices and how both components will be tracked.

I support FDA taking reasonable regulatory precautions and labeling steps to guide health care providers to use single patient, one-time use, disposable devices. Specifically, those that have blade protection as outlined in section V part B. Multi-patient devices should discourage through regulatory and labeling measures. FDA should address the real risk of transmission and create a clear delineation that safe, single-use, disposable lancets are the best practice.

Labeling is a tool FDA can use to differentiate between use devices intended for home use and professional settings.

Devices for a single patient, over the counter, with replaceable blades, should carry a black box label NOT FOR CLINICAL USE. One time use disposable lancets, with blade protection as outlined in section V part B, should be labeled APPROVED FOR CLINICAL USE.

Price is a driver of purchasing behavior. Third party purchasers, other than the caregiver and patient, may assume that any FDA-approved device is safe in all settings. Clear labeling, as suggested above, will create an economic liability for clinical purchasing agents and insurance payers who require anything for clinical use but lancet devices explicitly approved for clinical use.

Price driven purchasing is a documented source of safety disruption related to blood testing. The Journal Diabetes Care recently detailed the disruption of testing supplies as a source of increased hospitalization and mortality in diabetes patients served by Medicare. I fear a similar economic driven disruption will occur with lancet access driving use of less expensive devices not intended for clinical settings. FDA labels can protect patients with labels.

A way for FDA to decrease the clinical diabetes-related cross contamination, clearly detailed in the proposal, is to promote innovations in self-care to help people with diabetes to stay out of the hospital. An article in JAMA estimates ninety-seven thousand Americans each year go to the emergency room for insulin-related hypoglycemia. Far more than the number impacted by the evidence presented in this proposed regulation. FDA upgrading the post-market surveillance of the accuracy of meters may help mitigate those ER visit and limit potential cross-contamination opportunities.

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[content_box title=”FDA Proposes New Rules for All Lancets” backgroundcolor=”” icon=”fa-bank” iconcolor=”#ff675c” circlecolor=”” circlebordercolor=”#dae100″ iconflip=”” iconrotate=”” iconspin=”no” image=”” image_width=”35″ image_height=”35″ link=”https://www.federalregister.gov/articles/2016/03/03/2016-04578/general-and-plastic-surgery-devices-reclassification-of-blood-lancets”]Home and hospital use lancets would be subject to new regulations to limit infection transmission.[/content_box]
[content_box title=”Infection Transmission is a Real Risk” backgroundcolor=”” icon=”fa-h-square” iconcolor=”#ff675c” circlecolor=”” circlebordercolor=”#dae100″ iconflip=”” iconrotate=”” iconspin=”no” image=”” image_width=”35″ image_height=”35″ link=”http://diabetespac.org/lancet”]FDA’s draft outlines cases of patients harmed by cross-contamination in hospitals and care facilities.[/content_box]
[content_box title=”ACT NOW Comment on Draft Rules” backgroundcolor=”” icon=”fa-comments-o” iconcolor=”#ff675c” circlecolor=”” circlebordercolor=”#dae100″ iconflip=”” iconrotate=”” iconspin=”no” image=”” image_width=”35″ image_height=”35″ link=”http://diabetespac.org/lancet#lancetcomment”]FDA wants to hear public comment. DPAC has draft comments you can copy and paste into FDA portal.[/content_box]
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Of Test Strips, Bidding, and Harm

ACT NOW: Find the Truth About Medicare Test Supply Bidding.

Test strips are the foundation of good diabetes self-care. People with diabetes, particularly those who use insulin, need to test frequently to manage their blood glucose and make care adjustments, particularly with the insulin. As simple as it sounds test strips are vital to avoiding dangerous low blood sugars from insulin.

Insulin can be a dangerous drug. An article in the Journal of the American Medical Association estimates that ninety-seven thousand of Americans a year go to the emergency room due to low blood sugars caused by insulin.(1) The journal goes on to says most of those insulin ER visits are seniors, Medicare’s people. Further the article says that one in three of the ER visits the person is hospitalized. When insulin is dangerous, it is expensive.
jama cost nap

 

The ninety-seven thousand mentioned cited in that article is MORE than the government estimate of Americans who go to the ER for stimulants including methamphetamines.(2) It is shocking that insulin beats Breaking Bad as a reason Americans go to the ER.

However, the comparison does help put good self-management in perspective. Clearly a goal is the safe use of insulin that helps keep Americas well, particularly seniors. Quality of life and cost are both better if we can prevent the need for emergency room visits and avoiding unnecessary hospital admissions expenses to Medicare.

 

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We all have heard of medical trials. Trials, because they can impact the participant’s health, have strict rules. Some of those rules came about as the result of studies that were unethically done on people without their permission or knowledge.(3) It seems logical that if someone were going to introduce new means of accessing something as critical to maintaining health as test strips that they would follow the trails safety rules.

Unfortunately, that was not the case.

Medicare changed the rules for how beneficiaries get test strips. Medicare tested it in 2011 in nine pilot cities around the country. But they didn’t treat it as a trial or follow safe protocols. Maybe because they judged the rules don’t apply to them as a government agency. Medicare said it was a huge success, they saved money and there were few complaints and no disruption.

An article in Diabetes Care, the Journal of  American Diabetes Association,  looked carefully at Medicare’s data. It showed that in the nine pilot cities(4) there was a disruption of patients access to test strips. How and how many strips people with diabetes acquired shifted. In some cases, people on insulin stopped receiving testing supplies. The researchers found an increase in hospitalizations, higher cost, and more mortality in people with diabetes using insulin in the test cities.

I don’t know who is right, Medicare, who says there was no harm and extended the program nationwide or the researchers who found statistically significant increase in mortality, hospitalization, and costs in Medicare’s data. I am not a scientist, a statistician or a bioethicist. I do want to know if people on Medicare are safe.

Congress is paying the bills. They authorized this experiment. They should find out what the truth is and tell us is Medicare program safe? ACT NOW to ask Congress to get to the truth.

Links and resources on CMS Bidding.

(1) Geller AI, Shehab N, Lovegrove MC, et al. National Estimates of Insulin-Related Hypoglycemia and Errors Leading to Emergency Department Visits and Hospitalizations. JAMA Intern Med. 2014;174(5):678-686. doi:10.1001/jamainternmed.2014.136. https://archinte.jamanetwork.com/article.aspx?articleid=1835360
(2) National Institute on Drug Abuse. Drug-Related Hospital Emergency Room Visits Retrieved from http://www.drugabuse.gov/publications/drugfacts/drug-related-hospital-emergency-room-visits
(3) https://en.wikipedia.org/wiki/Belmont_Report
(4) Test sites included Charlotte-Gastonia-Concord (North Carolina and South Carolina); Cincinnati-Middletown(Ohio, Kentucky and Indiana); Cleveland-Elyria-Mentor (Ohio); Dallas-Fort Worth-Arlington (Texas); Kansas City(Missouri and Kansas); Miami-Fort Lauderdale-Pompano Beach (Florida); Orlando (Florida); Pittsburgh(Pennsylvania); and Riverside-San Bernardino-Ontario (California)

 

Replay: Ask An Expert: Risk of Virus Transmission in Healthcare Settings Due To Diabetes Supplies

DPAC Ask An Expert: Dr. Pamela Allweiss MD, MPH- Risk of Virus Transmission in Healthcare Settings Due to Diabetes Supplies

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Dr. Pamela Allweiss, MD, MPH, Medical Officer for the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC) joined DPAC in January to discuss the risks of virus transmission in healthcare settings (hospitals, clinics, and long-term care facilities) in the United States.

Healthcare-associated infections (HAI) are a serious threat to even the healthiest patients; people with diabetes are at higher risk than the general population. Did you know that there have been recent outbreaks of Hepatitis B in healthcare settings because of improper infection protocol and diabetes supplies?

During this presentation, you will learn more about why this is happening in our healthcare system, listen to questions posed at the live event, and discover how you can mitigate these risks and ways to engage your state policymakers to enforce infection control protocols.

Listen to this free online presentation here. 

Keep Care Settings Infection Free

ACT NOW: Write State Officials to Keep Care Settings Infection Free

Assisted blood glucose monitoring in long-term care facilities, clinic, and hospitals is sadly a primary source of blood-borne virus disease transmission. Between 1990 and 2008, there were 18 hepatitis B virus infection outbreaks in the United States that were associated with the improper use of blood glucose monitoring equipment. 147 people acquired hepatitis B. Six of those patients died.

Unfortunately, preventable outbreaks are still occurring due to breaches in infection control policies. Recently an outbreak of Hepatitis B was attributed to improper assisted blood glucose monitoring in Pennsylvania.

Each state has its own public health processes. Ask your Governor and state legislators to make sure your state public health offices are following CDC guidelines for infection control and enforcing the policies created to safeguard patients and healthcare personnel.

CDC recommended practices for preventing blood-borne pathogen transmission during glucose monitoring in healthcare settings include:

– Lancet/fingerstick devices should never be used for more than one person. (Single disposable lancet devices are recommended for assisted blood glucose monitoring.) The shared use or re-use of these devices is one of the common root causes of exposure and infection when multiple persons require blood glucose monitoring assistance.
– Whenever possible, blood glucose meters should not be shared.  If they must be shared, the device should be cleaned and disinfected after every use, per manufacturer’s instructions.  If the manufacturer does not specify how the device should be cleaned and disinfected then it should not be shared.
– Insulin pens and other medication cartridges and syringes are for single-patient-use only and should never be used for more than one person.
– Hand hygiene protocols must be consistently followed: gloves must be worn during assisted blood glucose monitoring and must be changed between patient contacts or touching a contaminated surface/open finger-stick wound, hand washing with soap and water or hands rubbed thoroughly with an alcohol-based hand rub must be completed immediately after removing gloves and before touching medical supplies intended for use by another person.
– Provide a full HBV vaccination series to all previously unvaccinated staff persons who may come in contact with blood during activities and to patients with diabetes.

Please make sure that the public health departments in our state are diligent in making sure these and other safety steps outlined by CDC are implemented, practiced, and enforced. These infections are preventable with your help.

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