Evaluation of the potential for bloodborne pathogen transmission associated with diabetes care practices in nursing homes and assisted living facilities, Pinellas County.

OBJECTIVES: To evaluate and characterize routine blood glucose monitoring practices in nursing homes and assisted living facilities (ALFs). DESIGN: Cross-sectional, self administered survey and facility site visit. SETTING: Two hundred eighty-nine licensed long-term care facilities in Pinellas County, Florida. PARTICIPANTS: Stratified random sample of 48 long-term care facilities (17% overall sample). MEASUREMENTS: Data on facility characteristics, infection control policies, staff practices, and equipment used for blood glucose monitoring. Differences between facilities in each stratum were compared and evaluated using the Pearson chi-square or Fisher exact test. RESULTS: Fifteen nursing homes and 17 small and 16 large ALFs participated; 53 declined (48% participation rate). Bloodborne pathogen training (P=.02), hepatitis B vaccination (P=.003), and blood glucose monitoring (P<.001) policies were reported less often at ALFs. Staff glove use during blood glucose monitoring was lowest (50%) at small ALFs (P=.02). Reusable fingerstick devices intended for personal use were most often in use at ALFs (P<.001); four of 18 facilities (including 1 nursing home) were inappropriately using them for multiple residents. At 22 facilities (including all nursing homes), multiple residents shared blood glucose meters; only six (27%) reported cleaning them after each use. CONCLUSION: Despite existing recommendations, practices that facilitate bloodborne pathogen transmission during blood glucose monitoring were identified at nursing homes and ALFs. Infection control practices and polices were most often lacking at ALFs. Better training and oversight of blood glucose monitoring in long-term care is needed to prevent transmission of bloodborne pathogens.