Improper Hand Hygiene, Glucometer Cleaning, and Lancet Disposal During Blood Glucose Monitoring
Penalty
Summary
Surveyors identified a deficiency in the facility’s infection prevention and control program related to blood glucose monitoring and sharps disposal for two residents. During observation of a blood glucose check for Resident #11, an LVN prepared materials, entered the room, performed the test, and then exited to the medication cart. The LVN removed his gloves by folding them inward while the used lancet remained inside the balled-up gloves, and then discarded the gloves and lancet in the regular trash. He did not disinfect the glucometer or perform hand hygiene after completing the blood sugar check. When questioned, he stated that because lancets retract, he threw them in the trash. In a separate observation involving Resident #10, an RN who reported this was her first nursing job gathered supplies for a blood glucose check without sanitizing them before entering the resident’s room. Once inside, she picked up a urinal holder from the floor by the rim and handed it to the resident, then accepted it back and placed it on the bedside table. She did not perform hand hygiene or change gloves after handling the urinal holder and proceeded to check the resident’s blood sugar using the same gloves. After completing the procedure, she wrapped the used lancet in her gloves and discarded them in the trash, and then went to another resident’s room without cleaning or sanitizing the glucometer or the area on the medication cart used for the procedure. Interviews with the ADON, DON, and Administrator confirmed that facility policy required lancets to be treated as sharps and disposed of in sharps containers, and that these practices were considered infection control issues. The ADON stated lancets were to be discarded in sharps containers because they did not always retract and could be harmful to housekeeping and other staff. The DON stated that used lancets needed to be disposed of in sharps containers and that staff should know they were considered sharps. The LVN reported he had only received basic glucometer training, could not recall being checked off on blood glucose testing, and could not recall recent in-services on infection control or hand hygiene. The RN stated she had not been trained on infection control at the facility, relied mainly on nursing school knowledge, and acknowledged she should have changed gloves and that lancets were supposed to be discarded in sharps containers. Facility policies on infection control and blood glucose monitoring required hand hygiene before and after resident contact, proper sharps disposal in puncture-resistant sharps containers, and cleaning of the glucometer before and after each use.
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