Learn about the role of environment in disease transmission and how to implement standard and transmission-based precautions to prevent the spread of antibiotic resistant bacteria and other infections in your facility.
3.3 Safe Diabetes Care
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En provenance du cours de The University of North Carolina at Chapel Hill
Infection Prevention in Nursing Homes
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À partir de la leçon
Safe Injection Practices
The goal of this module is to identify how to protect residents and staff using safe injection practices and safe diabetes care. To obtain CE Credit for this module: Take the Quiz and complete the evaluation at the end of the module, you will be directed to your course completion certificate.
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Evelyn CookAssociate Director
North Carolina Statewide Program for Infection Control and Epidemiology (SPICE)
Another means of spreading blood borne pathogens is through unsafe diabetes care.
This under appreciated area of risk has been the mode of transmission for
many hepatitis B outbreaks.
As mentioned earlier, there have been twenty three hepatitis B
virus outbreaks associated with the assisted monitoring of blood glucose.
These accounted for
92 percent of all hepatitis B virus outbreaks in long term care facilities.
The outbreaks have been linked to the infection control breaches shown here.
Including sharing of blood glucose meters without disinfection and cleaning between
uses, use of finger stick devices or insulin pens for multiple people,
and failure to perform hand hygiene or change gloves between procedures.
Sharing glucometers without proper disinfection is the most common breech.
If all health care providers know and practice these three simple rules for
safe injections and safe diabetes care,
the knowledge gap that contributes to outbreaks will be significantly reduced.
If new knowledge is applied to implement safe practices,
great strides could be made in preventing devastating out breaks.
We can do this by designating someone to provide ongoing oversight,
developing written infection control policies,
providing training, conducting quality assurance assessments, and
lastly speak up with if you see someone not following safe injection practices.
You are not only protecting your patients,
you are protecting your colleagues as well.
The One and Only Campaign led by the CDC and
the Safe Injection Practices Coalition was launched in September of 2009
in response to the increasing number of outbreaks relating to unsafe injections.
In an attempt to prevent these unsafe injection practices, the campaign
established the goal to ensure that patients are protected each and
every time they receive a medical injection.
The One and Only Campaign aims to do this by increasing understanding and
implementation of safe injection practices among health care providers and to
empower patients to ask their health care providers about their injection practices.
The free resources that they have developed educate both health care
providers and patients.
Go to oneandonlycampaign.org for more information.
[MUSIC]
Rejects.
>> Show me the technique.
>> Contestants from around the country.
[MUSIC]
One great prize.
This season on The Technique.
>> [MUSIC]
>> [APPLAUSE] >> Hi guys, I'm Rob Marino and
welcome back for the second round of The Technique.
It's been rough for a few contestants.
But we've got some definite front runners in David, Jennifer, and Sara.
Tonight, we'll be focusing on safe blood glucose monitoring, and
insulin administration.
[MUSIC]
>> [APPLAUSE] All of the contestants that made it through
really showed their chops last week.
And tonight we are observing their technique
in providing safe blood glucose monitoring and insulin administration.
And I tell you, I can't wait.
>> Jean, for all the folks at home,
can you remind us what the judges will be looking for in this round?
>> Sure, Rob.
The CDC wants all health care providers to know these simple rules for anyone who
performs or assists with blood glucose monitoring and insulin administration.
There are two types of fingerstick devices, those that are designed for
reuse on a single person, and those that are for single use and disposable.
The simple rule is fingerstick devices should never be used for
more than one person.
Now these are devices that measure blood glucose levels.
Whenever possible, these meters should be assigned to an individual person and
not shared.
Now if they are shared, they must be cleaned and
disinfected between each use, according to the manufacturer's instructions.
Insulin can be administered using an insulin pen designed for
reuse on a single person.
It can also be administered using a needle and
syringe, after drawing it up from an insulin vial.
The simple rule here is, injection equipment like insulin pens, needles, and
syringes, should never be used for more than one person.
Just like with safe injection practices it is always important that we see these
folks perform hand hygiene before putting on gloves and
providing care and again after removing gloves in between residents.
It is also important that they maintain the equipment in a clean way so
that blood contamination does not occur.
>> Great Jean.
Thanks for the recap.
Our contestants sure have a difficult test coming up.
Our first contestant is Sarah.
Before we let her show her technique tonight, let's recap her performance
from round one last week that put her through to the second round.
>> Impeccable performance.
[MUSIC]
Absolutely flawless.
>> A real challenger for the trophy.
>> On the heels of that impeccable performance, it's Sarah.
>> [APPLAUSE]
[MUSIC]
>> Sarah's starting off strong again.
Great hand hygiene and glove use.
[MUSIC]
Hmm.
Interesting choice,
she picked up the reusable lancing device to pierce the resident's finger.
[MUSIC]
Looks like she's finished with the first resident and is moving on to the next one.
[MUSIC]
But wait, she didn't clean the glucose meter and
is planning to reuse the lancing device on the next resident, that is not good.
[MUSIC]
>> Rob, I've seen enough, stop.
Stop.
[SOUND] You have just committed two serious errors here.
By not disinfecting the glucose meter with an EPA approved disinfectant,
and you were about to use the same lancet device on the next resident.
You certainly fallen from the pedestal we put you on.
>> I really had high hopes for you.
But clearly you need some practice on your technique.
>> I'm sorry Sarah.
You do not have, the technique.
>> Those are the highs and lows of this competition, you've got to bring your
A game everyday if you wanna make it through to final judgement.
>> [APPLAUSE] >> That brings us to our next contestant
Jennifer, you all remember her, she barely made it out of the first round with
a split decision from the judges, let's see if she can change her fortune tonight.
Ladies and gentlemen, I give you Jennifer.
>> [APPLAUSE] >> I tell you good
aseptic technique again.
See how smoothly her gloves go on.
>> Much better than some of the earlier ones today.
>> Awesome.
[MUSIC]
>> Looks like the judges really want to test Jennifer today after her last
performance.
They've given her an insulin pen.
This will require real attention to detail.
[MUSIC]
>> Really moving through these steps.
[MUSIC]
Using two talents at once, that's brilliant.
[MUSIC]
>> She's doing a great job Selecting a single use lancet.
[MUSIC]
>> Very nicely done there.
[MUSIC]
She's checking the blood sugar.
[MUSIC]
This is so nice to watch when it's done right.
[MUSIC]
She's properly disposing of the lancet, in a puncture proof container I might add.
And disinfecting the meter.
[MUSIC]
Now she's getting ready to inject the resident.
[MUSIC]
>> Very nice.
>> Mm-hm.
[MUSIC]
>> Great job.
>> Mm-hm.
Feel it.
Feel it.
>> [MUSIC]
>> Okay, here she goes.
[MUSIC]
Love.
And the resident didn't even move.
>> Huh-uh.
Did not.
>> When it's done right, it's wonderful.
>> It's like music.
[MUSIC]
>> Oh this is beautiful.
>> Yes we could have charged admission.
[LAUGH]
[MUSIC]
>> Yes.
Great job.
She recognized the insulin pen and
correctly labeled it with the residence name.
And she obviously knew that the insulin pen cannot be shared
between residents, beautiful.
Absolutely beautiful.
Great job.
>> So strong.
>> I have no words but excellent.
>> So very strong.
Oh, right here.
>> I am so very happy that you've recovered from last week.
Can you tell me why you chose to label the insulin pen?
>> Sure.
I always think, be aware, don't share.
Just like with other injection equipment, insulin pens are meant for
use on a single person only and should never be used for
more than one person even if the needle is changed.
Insulin pens should be clearly labeled with the residents name or other
identifying information to ensure that the correct pen is used on the correct person.
>> Jennifer, brilliant performance.
You're moving on to final judgement.
>> [APPLAUSE]
>> [MUSIC]
[APPLAUSE] >> Great job, Jennifer.
Well, we're down to one final contestant before final judgement.
>> [APPLAUSE] >> Last week,
David demonstrated tremendous skill with his ability to perform safe injections.
Can he keep the momentum going?
Will he be able to make final judgement?
David, take it away.
>> [APPLAUSE] >> Interesting,
David is beginning by cleaning the glucose meter.
[MUSIC]
>> And now he is washing his hands.
[MUSIC]
>> Great job.
>> And putting on a clean pair of gloves.
A solid start.
[MUSIC]
>> Wow. I like the fact that he's using
the single-use finger sticks.
It's good stuff.
[MUSIC]
>> Alright, he's done with the first resident.
He's disinfecting glucose meter, again.
He's removed his gloves and is performing hand hygiene.
>> David, please you can stop right there, thank you.
>> Boy, you look good tonight.
>> Minerva [LAUGH] >> I mean his performance.
[APPLAUSE] >> David I really
like the fact that you took the time to disinfect the meter before you started,
can you tell me why you did that?
>> Oh, I wasn't the last person to use the meter so
I can't be certain that it was clean before now.
I cleaned it because the meter may be contaminated with blood,
even if it is invisible to the eye, and I don't want a resident to get hepatitis or
some other germ.
>> Since you seem to have a firm grasp on this.
>> Firm, so firm.
>> What would be the best practice for facilities regarding glucose meters.
Well, my facility back home assigns each resident their own meter to use while
they're residents there.
I think that's the best practice since it reduces the chance of
a meter being shared.
Now, if a facility can't assign each resident a meter,
it needs to be cleaned between each resident with a compatible EPA-approved
hospital disinfectant with a TB or HIV,
hepatitis B kill claim, with a one to ten Deluded Bleach solution.
Or according to manufacturer's recommendations.
>> Okay, great.
I have heard enough.
In fact, I need you to stop talking cuz I'm afraid you're gonna take my job
[LAUGH] But let's just say you are on to final judgment, David.
[MUSIC]
>> All right we're down to our final contestants.
Jennifer from Charleston and David from Chapel Hill.
It's the battle of north versus south Carolina.
It's time for the judges to decide who the McKnight trophy winner is and
who goes home empty handed.
Let's tune in to the judges' deliberation.
>> That David is really something special.
Maybe his expert knowledge and a really great technique.
>> Minerva, you bring up some valid points but I believe your obvious crush
is getting on the way of your unbiased judgement.
Jennifer, she had a really strong performance.
No, make that impeccable.
So I'm torn here.
>> You know no doubt they both performed well,
but honestly I cannot overlook Jennifer's labeling error last round.
Sorry.
[MUSIC]
>> Rob, I think we're ready to crown the winner here.
[MUSIC]
>> Jennifer, David, you've both shown safe injection techniques and
proper glucometer care are alive and well in both of your nursing homes.
And for that, we congratulate your skills and knowledge.
But tonight, there can only be one person who truly represents perfection.
The one who has the technique.
[MUSIC]
Jennifer!
>> [APPLAUSE] >> You do not have the technique.
David is our winner.
>> Oh!
>> Yes!
>> [APPLAUSE] >> David, congratulations.
Is there anything you'd like to say to the audience?
>> Grandma, this
trophy's for you.
[APPLAUSE] >> Woo!
>> Well, it looks like grandma
is about to be the star of her nursing home these days,
while David may get the celebrity treatment from Minerva.
Tune in next season as we continue to inject our way into your heart.
[APPLAUSE] >> Just kidding.
I didn't mean to say it that way.
Thanks for joining us on The Technique.
Have a great night.
>> [MUSIC]
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