Infection Prevention and Control Violations in Outpatient Care

By on 2:05 PM

Phenelle Segal, RN, CIC, infection prevention and control consultant, continues to observe suboptimal practices in outpatient medical office practices and raises concern about the lack of knowledge and resources.

Recently, when visiting physician practices, she has observed clinical staff removing a glucose monitoring meter/device from drawers in examination rooms, using it on the patient and promptly returning it to the drawer with no disinfection of the device before or after use.

It is a well-known fact that blood glucose monitoring devices, if used on more than one patient (single-use meters are available but most doctor's offices do not use them), must be disinfected according to manufacturer's instructions for use (MFUs) between each patient use. Over the course of several years, more and more scientific-based evidence is revealing the risk of bloodborne pathogen viral illnesses, namely hepatitis B and C, as a result of poor or non-existent disinfecting of these devices. 

The Centers for Medicare & Medicaid Services (CMS) regulates the use of glucose monitoring devices for outpatient settings. This is one of the core observations when surveyors visit ambulatory care practices, including ambulatory surgery centers (ASCs). In 2014, the CDC-HICPAC Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care (pdf) was updated (originally published in 2012) and addresses the handling of these devices.

It is not only CMS that provides pertinent monitoring, but also the Food and Drug Administration (FDA). Recently, a detailed letter was sent to manufacturers of blood glucose monitoring systems listed with the FDA which "outlines recent changes in the review of blood glucose monitoring systems submissions." It warns the manufacturers of "the risk of transmission of disease from shared use of fingerstick (lancing) devices and point of care blood testing devices. The posting of these notifications was in response to recent outbreaks of viral hepatitis among patients where these devices were shared between users."

It is prudent that every outpatient practice using a glucose meter, regardless of the services provided, adhere to strict standards and regulations for disinfection in order to protect the safety and health of all patients who trust they are in reliable hands when visiting a healthcare provider. Medical office practices are responsible for providing education to their staff members. Taking a few extra minutes and spending a few extra dollars to ensure patient safety is worth the investment.

Phenelle Segal is a leading infection prevention consultant who provides infection prevention and control services to outpatient facilities including ambulatory surgery centers and physician practices.

Phenelle Segal, RN, CIC, FAPIC

Phenelle Segal, RN, CIC, FAPIC, is the founder and president of Infection Control Consulting Services LLC (ICCS). Phenelle has more than 30 years' experience providing customized comprehensive infection control and prevention services to healthcare facilities nationwide. Her services focus on assisting hospitals, ambulatory surgery centers, dental office and oral surgery practices, doctor's offices, nursing homes and other organizations with implementing and maintaining an infection control program that: complies with The Joint Commission, AAAHC, Centers for Medicaid and Medicare Services (CMS) and other regulatory agencies; respond to situations of noncompliance; and improve the processes for reducing risk.