Failure to Follow Glucometer Disinfection Protocol and Contact Time Requirements
Penalty
Summary
The deficiency involves the facility’s failure to implement its infection prevention and control program and follow manufacturer instructions and facility policy for disinfecting a blood glucose meter (glucometer). The facility’s written Glucometer Cleaning Protocol stated that glucometers were assigned to individual residents, were not to be shared, and were to be cleaned and sanitized after each use. The protocol required use of an approved disinfectant wipe after each use, wiping all surfaces (top, bottom, and sides), following a two-minute contact time, and allowing the glucometer to air-dry before placing it in a clean area away from contamination. Manufacturer instructions similarly required use of an EPA-registered disinfectant or germicidal wipe, adherence to the product label instructions for proper cleaning time, and ensuring the meter was completely dry before testing a resident’s glucose level. The disinfecting wipe instructions specified a two-step process (preclean and then disinfect) and that the surface remain visibly wet for two minutes. During a continuous observation of a finger stick blood sugar (FSBS) procedure, a nurse was seen returning to the medication cart after testing, wiping the glucometer once with an approved disinfecting wipe, discarding the wipe, and immediately placing the still-wet glucometer into a clear plastic storage bag, which was then placed in the medication cart. Timing of the process showed that the disinfectant solution did not remain on the glucometer for the required two-minute contact time, and the glucometer surface was not dry when it was placed in the plastic bag. The nurse reported that her usual process was to wipe the glucometer with a disinfectant wipe, immediately place it into a plastic storage bag, and put the open bag in the medication cart to air-dry, stating she would return later to seal the bag. She explained she did not like to leave glucometers on top of the medication cart because they should be locked inside the cart. Interviews with supervisory staff revealed inconsistent understanding and implementation of the facility’s protocol. The House Mentor for the unit initially stated that glucometers were only cleaned when visibly soiled with blood and that staff were trained to clean glucometers only when visibly soiled because each resident had an individually assigned glucometer; she expressed no concern with the observed nurse’s cleaning and storage method and did not mention the two-minute contact time or the need for air-drying before bagging. When later providing the written protocol, the House Mentor pointed to the section stating glucometers were to be cleaned after every use, not only when visibly soiled. Other leadership staff stated that nurses received education at hire and during annual skills fairs on wiping glucometers so they were visibly wet and allowing appropriate dry time in open air before placing them in plastic bags, and that the observed nurse should have followed this process. It was also noted that the facility did not have a process in place to measure or ensure the two-minute contact time for the disinfectant.
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