A-194 Point of Care Glucose Test Time Interval Data Used as a Proxy Indicator for Glucose Meter Cleaning and Disinfection Adequacy Between Patient Testing Episodes

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Abstract Background At a community hospital within our health system (269 inpatient beds and 46 glucose meters), a condition level finding was cited for blood found on one meter during a routine regulatory survey. Point of Care (POC) test instrument portability is often an essential characteristic in choosing to perform a POC test at the bedside. Glucose meters are in close proximity to patients who are providing fingerstick blood samples for immediate testing. The process of obtaining the blood sample and applying it to the test strip may result in blood inadvertently getting on a caregiver’s gloves and the glucose meter itself. Per the testing protocol, when testing different patients consecutively, the caregiver safely discards the used test strip, changes gloves, and performs the cleaning and disinfecting (C&D) of the glucose meter to ensure the next patient is not exposed to blood from the previous test. The C&D procedure requires a minimum two minutes of drying time. We estimate that consecutive POC glucose tests should have about a three minute gap when the meter gets proper C&D between patients. We sought to determine whether the time interval between tests could be used an indicator of improved C&D compliance during a process improvement project. Methods As a patient safety concern, improved compliance with C&D steps was needed. Various stakeholder groups conducted a three month long campaign of education, training, and surveillance to improve C&D compliance. As a proxy for monitoring the C&D, data on test times from individual glucose meters was downloaded from the POC middleware system. Sample information, patient identifiers, and test results were not obtained. Time intervals between tests were calculated and the number of tests that occurred on the same instrument with short intervals (< 3minutes) were counted. Results Data from the POC middleware system was downloaded from the month prior to and immediately following the project (July and November). In July, there were 733 instances of glucose tests being carried out within three minutes of a previous test on the same instrument, from a total of 6622 tests (11.1%). In November, there were 565 occurrences (out of 6445 tests, or 8.8%), a decrease of 23% from the beginning count, and a drop of 2.3% among all tests. A follow up survey found no instances of blood on meters. Conclusions Using the time between tests interval as a proxy for monitoring glucose meter C&D is straightforward when the data is readily available. In our application of this process, an improvement in the number of short intervals was found, but the number of short intervals was not completely eliminated. This is likely due to occurrences when a test was repeated on the same patient or when training or competency was taking place, circumstances in which C&D not required. To observe patient privacy, our data collection approach could not eliminate these potential confounders of our data.

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