In part two, our colleague, the “nurse from St. Louis,” shares “factors” that contribute to the problem of improper or lacking disinfection of glucometers–and “recommended actions” and a “conclusion.” HONOReform calls on our many partners and colleagues to make glucometer safety a priority in your institutions; and we remind patients to always ask questions…such as, Was this glucometer just disinfected?
Factors Contributing to the Problem of Improper Cleaning of Meters
After researching this issue, it is apparent that glucometers and other blood testing meters were approved by the FDA for individual home use. Cleaning these meters with alcohol would have been appropriate when used for one individual only at home. However, when these meters are used on multiple people, then disinfecting with agents that kill blood borne pathogens, after each use, is the only safe and appropriate option. See this article for more information. It appears that the manufacturers and sales representatives marketed these devices that were approved by the FDA as being safe and effective for individual home use as being appropriate to use at health fairs and mass health screenings as well.
Because some of the manufacturers and sales representatives contributed to this problem, we are asking them to help rectify these unsafe practices, i.e., of improper use and cleaning/disinfecting of point-of-care blood testing meters, as soon as possible. We believe that these companies should immediately update their websites and printed material and contact all current, past and potential customers via email, regular mail, phone calls and in-person visits. Very specifically they need to inform everyone that any type of point-of-care blood testing equipment needs to be cleaned and disinfected after each use if used for multiple people. Of course, the health care worker must follow all other standard infection control procedures. Furthermore, should the sales representatives find any used penlets (a lancet device that can be used on multiple patients but should not be) in a healthcare setting they should confiscate those devices.
Obviously, we all must remain vigilant regarding proper infection control measures, especially those related to blood borne pathogens. It is imperative that we communicate concerns in order to educate and motivate everyone to put patient safety first. The lives and health of our patients depend on us to practice safely.
We are grateful to the “nurse from St. Louis” for sharing part one of a two-part blog for stressing the absolute importance of always cleaning the glucometer between patients. This week, from her point of view, she introduces the “scope of the problem” and shares some of the important “facts.”
Introduction/ Scope of the Problem
Recently there have been several documented breaches in infection control procedures, resulting in potential exposure to blood borne pathogens in a variety of health care settings throughout the United States. We have already discussed the OSHA reprimand and fine levied upon SSM Health Care in St. Louis, Missouri for not properly disinfecting point-of-care blood testing meters after each patient. In addition, the July 2014 issue of the American Journal of Nursing has an article titled “Infection Prevention Practices in Ambulatory Surgery Centers” which included reports of “blood glucometers not being cleaned between patients” at health care centers in Pennsylvania. Furthermore, Complete Health Care for Women in Ohio was reprimanded by OSHA for violations related to not protecting staff and patients from blood borne pathogens. If these types of breaches occur at large, well-regarded, quality award winning healthcare systems, then they can happen anywhere. read more
Welcome back to the HONOReform blog, aka “Survivor Stories,” for our second full year of publication. We thank everyone who has had a role in making our blog a growing success—contributors and readers and everyone who has suggested to friends that they should check out our blog and pass it on to others.
And we encourage you to please continue to support our efforts.
Here at HONOReform, community-building is a key to emphasizing safe injection practices and doing all we can to educate the public and reeducate providers on the absolute necessity of injection safety.
We are so grateful to Desarae Mueller-Fichepain, whose father’s story was featured last week in the article written by reporter Matthew Hansen. And we are grateful to Mr. Hansen, who we got to know when he joined us to take a tour of one of the four factories operated here in the state by our corporate colleagues BD (Becton, Dickinson and Co.).
These exchanges, advocate to reporter and reporter to readers, are essential ones. Continued education and reeducation on proper injection safety is vital. What happened to Desarae’s dad, Mr. Emil Mueller, should not happen to anyone here in the United States—or, we think, anywhere in the world.
It is our honor to share the article, published in the Thursday, December 11, Omaha World-Herald. We thank Desarae, and all of the HONOReform advocates, for their openness, leadership and support.
Hansen: In massive hepatitis C outbreak in Fremont, the victims’ voices went unheard
Emil had fought off prostate cancer for a decade, battled it in the same steely way that he made it through each shift at Fremont’s Hormel plant. He clocked in at the plant each morning. He picked up his knife. He cleaved the fat off of giant, immovable slabs of ham.
Day after day. Year after year. No excuses. No complaining. That’s how Emil worked. That’s how he lived.
And then, in 2000 or 2001, Emil began to see the new oncologist in town, a doctor by the name of Tahir Ali Javed. He’s a nice guy, he told his daughter, Desarae.
But within months, Emil began to change. The color started to fade from his cheeks. His grit faded, too.
If you are a regular member to this blog you will have heard me say these things before, so I apologize for the repetition, but it appears I may not be saying it loud enough. So I am thankful to have the support of fellow patient safety advocates, healthcare workers who understand the broken system as well as a series of talented reporters to help articulate the point.
Our healthcare system is broken, let me say that again, it is broken and not the way the majority of Americans might think after reading that statement. It isn’t about the Affordable Care Act, in fact, just the opposite. It is underneath the polished floors and inside the magnificent facilities. It is behind the scenes, what happens when most people are not watching.
Once a year, HONOReform reaches out to our loyal supporters to ask for their continued support of our mission. We include below the text of a letter we are sending this week to many of our previous donors. In advance, we are grateful for the generous support, and we ask you to please consider forwarding this request to people in your network.
Thanks to you and our other helpful supporters and donors, our work at HONOReform continues to evolve. We never waver from our core mission and message, the absolute importance of protecting the medical injection process for Americans. Our goal is to do all we can to prevent outbreaks caused by lack of adherence to medical injection fundamentals.
In the last couple years, however, we have explored additional injection safety issues that can cause harm to patients—misuse of insulin pens, reuse of single-dose medical vials, and drug diversion, among others. There have been many very good advances, and there is a lot of work ahead of us.
I value our work at HONOReform…and my roles as board president, presenter and spokesperson. I believe we make a difference, and that we contribute to public health and wellness. But, I have to say, I really felt the impact of our work when my son Curtis, as part of his medical training, reported that our work was highlighted during his training. When he called to tell me about it, I asked “Did you whisper to your neighbor, ‘That’s my mom?’” “No,” he replied. “I just yelled it out for everyone to hear!”
I am, clearly, a proud mother. This pride extends to the services that we provide here at HONOReform. I thank you for your recognition of our work—and your support and your generosity. Together, we reeducate healthcare providers and educate the public on the importance of proper medical injection technique.
I encourage you to please continue to help support our work. Go to www.HONOReform.org to donate to our vital mission. If you have any questions, please contact our executive director, Steve Langan (steve@HONOReform.org; 402.659.6343).
Our many thanks.
Thanksgiving time is family time. We delight in family gatherings with lots of good food and great conversations. We at HONOReform wish you a wonderful Thanksgiving!
Sometimes life’s events mar even Thanksgiving, usually one of the happiest family times of the year. And when those life events are completely preventable, the disappointment is even greater.
Vicky is the daughter-in-law of one of the victims of the Nebraska Hepatitis C Outbreak of 2002. She explained the unrest that the outbreak caused in her family that Thanksgiving. Here is their story in Vicky’s words:
“Shortly after we learned that Dad tested positive for Hepatitis C, Mom called to say that they would not be coming to Thanksgiving at our house. I was shocked. Although Dad was fighting cancer, he was fairly active for an 80+ year old; he got out of the house regularly for errands and coffee with his friends. And above all, Mom and Dad loved spending time with the family, and the precious grandchildren were to be at the dinner.
When I pressed Mom for a reason, she was evasive, but finally she gave their reason: they didn’t want to risk transmitting the virus to any of the family. They were worried that by taking food off the same platters, perhaps an accidental reuse of forks or spoons would transmit the virus. Maybe even by being in the same room, the virus would be transmitted.”
Their concern was not uncommon among the community that autumn. The Nebraska Hepatitis C outbreak of 2002 was uncovered shortly before Thanksgiving. Public health officials determined that nurses at the Fremont Cancer Clinic reused syringes to access a large saline bag that was used for port flushes on many patients throughout the day. Because a patient with known Hepatitis C was treated at the clinic, the saline bag was contaminated with his blood, and therefore with Hepatitis C. Nebraska Health and Human Services notified the exposed patients, urging them to be tested for Hepatitis C, Hepatitis B and HIV. Of all the people who were tested, 99 were diagnosed with Hepatitis C, composing the largest outbreak of Hepatitis C from a single source in US history.
Because so many people in the community was affected by the outbreak, and because fear and ignorance about the disease was so rampant, it is likely that the conversation between Vicky and her in-laws was repeated in many households that Thanksgiving. Of course, viral hepatitis can ONLY be spread through blood-to-blood transmission, such as through unsafe injections. But at that time the community needed much education about this fact; the need for education about viral hepatitis continues to this day throughout the country.
Vicky went on to share:
“When I strongly assured Mom that the virus was not transmitted through the air or through saliva and that it could only be transmitted through blood, she was still reluctant. She said that even though that may be true, they didn’t want anyone to be uncomfortable by their presence. She thought it would be a jollier time for everyone else if they stayed home.
I told her no, it would not be a jolly time without you; all the family would all miss you too much. Iasked her to call her family physician and talk to him about the situation. After more argument, she finally agreed and said she would call back.
She did call back a week later and said that her family physician assured them it was safe for Dad to attend the family gathering and that they would be coming to Thanksgiving. But she was still worried for the others – worried that they would be uncomfortable with their presence. I offered to call each adult family member and assure them that they would not be at risk for contracting Hepatitis C from Dad at Thanksgiving dinner. She was very relieved by this and thanked me profusely.
We had a wonderful Thanksgiving gathering that year, perhaps made even more dear by our heightened concern and love for our dear Dad. We sat at the table a long time, reminiscing and telling family stories. It was a wonderful day, and my only regret was Mom and Dad’s worry, that nearly kept them from sharing that warm, loving family time with us.”
Vicky’s family had a lovely Thanksgiving that year, but not everyone who contracts disease through unsafe injections is so fortunate. Some will be too sick from their illness, others will let fear and worry keep them away from holiday gatherings. And all because of an illness which is completely preventable!
At your family gathering this year, do yourself and everyone else a favor. Share with your loved ones this advice from the One and Only Campaign:
In order to ensure that you are receiving safe injections, ask your healthcare providers the following questions before you receive an injection:
1. Will there be a new needle, new syringe, and a new vial for this procedure or injection?
2. Can you tell me how you prevent the spread of infections in your facility?
3. What steps are you taking to keep me safe?
Usually in this space we share stories from patients who have survived an unsafe injection. Today we are sharing the survival story of a physician who stopped colleagues from performing unsafe injections during her residency.
Here is Susan’s story
My story of improper injections is from my residency. I was in my third year of family practice residency in Minnesota and I was starting a procedures rotation. The attending physician and nurses were preparing for procedures that day – mainly mole removals and simple skin techniques. I noticed that after the first procedure the nurses took the needle off of the syringe and put a new needle on it in order to use the same syringe of anesthetic for the second patient.
I told them, “You can’t do that.”
They explained that because the attending physician was not drawing back it was actually safe to use the same syringe with a different needle.
I told them that it was NOT the case and then we put the needle and syringe into the sharps container. After class that day I spoke with the program director and several others at the residency. By the next week when I was back on that rotation the procedure had changed. I noticed that there was some conversation between the attending physician and the nurses about how that change had come about.
I was just shocked and appalled at the time. Residency is very stressful. In addition to the stress of learning so many things, I didn’t think I would have to be stressed about watching healthcare providers to make sure they were using proper injection technique. Its just very important to always keep your eyes open because this could happen anywhere.
Kudos to our colleagues, including leadership of National Viral Hepatitis Roundtable (NVHR), for dedicated work on advancing the Viral Hepatitis Action Plan. An update from the recent meeting is included below.
On Tuesday, 10/14/14, the cross-government working group supporting and monitoring the implementation of the updated Viral Hepatitis Action Plan—the Viral Hepatitis Implementation Group or “VHIG”—met in Washington, DC to share updates on 2014 accomplishments and plans for the coming year. Some of the highlights included:
• Promising preliminary data from HRSA’s Bureau of Primary Health Care showing a significant increase in the number of hepatitis C tests conducted in health centers across the U.S. in 2013 and similar promising increases in HCV testing numbers from the Indian Health Service (IHS). read more