Living
with Dementia
Posted: December 26, 2006
Published
November 2006 by Dale K Hursh, MD of Lancaster General
MS PowerPoint Presentation
The
New F-Tag 315
Posted: December 18, 2006
Published
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Adobe PDF Document
The
Newly Revised F-Tag 315 and Surveyor Guidance for Urinary
Incontinence in Long Term Care
Posted: December 18, 2006
Published
November 2006, Theodore M. Johnson, II, MD, MPH, CMD, and Joseph G.
Ouslander, MD, CMD. JAMDA.
Adobe PDF Document
Hepatitis
Outbreaks Linked To Use of Glucometers and Fingerstick
Glucose Measurements
Date: March 24, 2005
Pertinence: All LTC Facilities
Importance: High, Level 1
(Level 1 – Threat Likelihood Assessment = possible to be present.
Jeopardy Assessment = Potential for serious outcomes. Level 1 items
should prompt review of information immediately and facilities should
review current processes and education needs.)
Description: Below is a link from the CDC describing
3 nursing home outbreaks of hepatitis B. Please review the article.
It gives the details and helpful descriptions of what went wrong at
these facilities. Recommended practices are included in this link.
Link: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5409a2.htm
Summary: Three outbreaks of hepatitis B, including
fatal cases were recently investigated by the CDC. These cases occurred
in either nursing facilities or assisted living facilities. In all cases,
spread of hepatitis B virus was clearly linked to use of glucometers,
fingerstick equipment including lancets and spring loaded devices, and
failure of staff to maintain proper infection control precautions. In
particular, staff failures included:
-
not cleaning the glucometer machines and/or spring loaded devices after EACH patient use.
-
not using new lancets for each patient
-
not changing gloves after testing each patient
-
not using gloves at all
-
not investigating or reporting hepatitis B cases promptly
Suggestions:
- Review your fingerstick glucose testing processes carefully, making sure the machines and equipment are cleaned after each patient use.
- Reinforce handwashing and glove use.
- Make sure staff change gloves between patients
- Never re-use a lancet.
- Review necessity of frequency of fingerstick measurements with physician staff.
- Develop policies that reduce excessive use of fingerstick measurements, yet which optimize glucose control within the context of the patient’s condition and prognosis.
- Promptly investigate and report all acute cases of hepatitis B. UPIA can provide general guidance to your facility in such situations.
- Foster methods for reporting infection control/patient safety concerns to facility leaders. Importantly, allow methods for anonymous reporting.
Comments: These cases are
particularly distressing and highlight the importance of maintaining standard
precautions in all situations. They also highlight the need for ongoing
surveillance of infections in the LTC setting. This list of suggestions
is not all-inclusive and each facility should individually review their
processes carefully, taking actions consistent with established infection
control practices.
David A. Nace, MD, MPH
Director, Long Term Care
University of Pittsburgh Institute on Aging
naceda@msx.upmc.edu
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