Ministry Reinforces Use Of Accepted Good Practice
Ministry Reinforces The Use Of Accepted Good Practice
DIABETES New Zealand and the Ministry of Health are reminding health professionals of the current accepted good practice for taking blood samples with finger pricking devices.
Advice was issued by Diabetes New Zealand two years ago and was widely reported. However, it appears from a recent survey conducted by the Ministry of Health that the advice, aimed at minimising the risk of transmission of infection, is not always being followed.
Finger pricking devices are used by individuals such as people with diabetes to test their own blood sugar levels. They are also used in doctors' surgeries, clinics, marae healthcare services and some laboratories to collect small blood samples from a number of clients. The devices commonly resemble a ballpoint pen and contain a sharp, spring loaded lancet which momentarily pierces the skin.
Dr Bob Boyd, the Ministry's Chief Advisor, Safety and Regulation said that the commonly accepted practice is for patients using their own devices to keep the same lancet loaded in the device for several tests and then safely dispose of it, replacing it with a new sharp sterile lancet.
When health professionals use finger pricking devices for testing more than one patient, commonly accepted good practice is to either use a separate disposable sharp lancet for every client, or to use a spring-loaded device from which all parts which come into contact with the client's skin are detachable and are disposed of each time. Only some brands of the spring-loaded finger prickers are suitable for use on more than one person. It is not good practice to substitute an individual patient device for this purpose.
Dr Boyd said that Diabetes New Zealand have done a great job trying to raise the standards of health professional practice, and there has been some publicity in the past. However, a recent survey of hospitals suggests the advice has not been implemented.
"It is disappointing to find that despite the previous publicity and despite our heightened awareness of possible blood-borne illnesses, some health professionals are not following good practice advice."
"The development and refinement of medical technology, allied with increased awareness about the risks of transmission of disease through shared equipment, has seen the development of equipment designed specifically for safe use on more than one person. In this case it is no longer appropriate to re-use the equipment and depend on attempted disinfection between cases, when there are safer devices readily available.
"Health professionals must ensure they keep up to date on currently accepted good practice methods, and that they are using the appropriate equipment for the situation. If they are in any doubt about the equipment they are using they should throw it out and replace it with modern equipment."
Dr Boyd said that the same advice applied to the home, where several family members may be tempted to use the same finger-pricking device for monitoring their blood sugars. Everyone should have their own device. Don't share needles and don't take unnecessary risks.
There is a documented, but extremely small risk of transmitting hepatitis B from someone who is a carrier of the disease by the use of single finger pricking devices on more than one person. While the Ministry is not aware of anyone in New Zealand having contracted hepatitis B in this way, it has occurred overseas.
Over the past ten years there have been four episodes reported worldwide of Hepatitis B infection being transmitted through use of individual-use devices on more than one person. Three of those episodes were in America and one in Europe. In each of these cases only the lancet had been replaced and it was reported that the nurse had not changed gloves between tests.
Dr Boyd said ensuring the quality and safety of health care required individual commitment and systemic action.
"All of us working in the health sector have to ensure quality is built into everything we do in our professional lives, and that we build quality improvement into our systems."
Dr Boyd said the forthcoming Health and Disability Services (Safety) Bill would provide a regulatory framework for safety and quality assurance. Other initiatives such as the Health Professionals Competency Assurance Bill were also designed to ensure the quality and safety of health services.
For more information contact:
Selina Gentry, Ministry of Health Media Advisor, ph: 04-496-2483 or 025-277-5411 Internet address: http://www.moh.govt.nz/media.html
Margaret Jamieson, Diabetes New Zealand President, ph 025 623 7598
Questions and Answers ? Finger Pricking Devices
What is Currently Accepted Good Practice Current Accepted Good Practice involves the efficient and effective use of available resources to achieve quality outcomes for the patient (ref: Infection Control Standard NZS 8142:2000 ).
In terms of the practice regarding finger-pricking devices, health professionals are advised that it is preferable to use a single use totally disposable device when testing more than one person and to dispose of it safely after use. Alternatively they should use a device in which all parts which come in contact with the client's skin and which may become contaminated with blood are disposable and are replaced between cases to reduce the risk of transmission of infectious disease. Both lancet and plastic tip should be disposed of safely after use.
Individuals monitoring their own blood sugar levels should use their own device and not share them with others.
Has the accepted practice changed? Yes. During the last publicity about this issue in 1998 the spokesman for the General Practitioner's Association was reported as saying that he would continue using the device designed for individual patient use to carry out monitoring in his surgery and depend on washing the plastic parts which may have got contaminated between tests. Most practitioners today, given the ready availability of the safer disposable equipment and the wider awareness of possible risk would no longer find that acceptable.
What are the finger-pricking devices used for? These devices are used to collect a drop of blood for sampling. Most commonly they are used by people with diabetes to monitor their own blood glucose. However, they are also used in hospital clinics, when only a small amount of blood is needed to carry out the analysis. They are also used by a variety of people from individuals to health professionals in hospitals, GP surgeries, marae health services, clinics, laboratories, and rest homes.
Most finger-pricking devices resemble a ball point pen and contain a sharp, spring loaded lancet which momentarily pierces the skin.
There are two types of finger-pricking devices produced by a variety of manufacturers. There are finger-pricking devices for individual use by people such as people with diabetes who use it to collect a drop of blood to monitor their glucose level. These devices for individual use have a disposable lancet. And there are finger-pricking devices intended for use on more than one person. These have both a disposable lancet and disposable plastic tip surrounding the lancet, so that all parts, which come into contact with the patient's skin, can be discarded to minimise the risk of transmission of disease. Both lancet and plastic tip should be safely disposed of after use.
Why is Diabetes New Zealand and the Ministry of Health issuing another reminder to health professionals about this device? Earlier this month (November) the Ministry of Health was advised that Hutt Valley Health had used a finger-pricking device designed to be used by an individual patient on eight children, contrary to the instructions which accompanied the device. The lancet had been replaced after each use, but the plastic tip which comes into contact with the skin was not. The Ministry sent a questionnaire to hospitals to find out whether similar practices were occurring in other hospitals. The survey indicated that the use of that brand of individual use finger-pricking device on more than one patient was widespread, despite publicity two years ago from Diabetes New Zealand about accepted good practice.
How long has this been happening in New Zealand and how many people are affected? It is difficult to determine how long the practice of using individual finger-pricking devices on more than one person has been occurring in New Zealand or how many people may be affected. However, we do know that finger-pricking devices have been available in New Zealand for at least 10 years. Devices intended for use on more than one person were introduced sometime later, as people became more aware of the risk of transmission of disease through using individual finger-pricking devices on more than one person.
What is the risk of potential transmission of viral disease from a finger-pricking device? Finger-pricking devices are safe when individuals are using their own device. A risk of cross-infection can only occur when the blood of an infected patient remains on the device and contaminates the sharp lancet as it pierces the skin of the next patient. This risk can be eliminated by disposing of all parts in contact with the patient's skin between tests or by using totally disposable equipment. It is no longer necessary to depend on cleaning or disinfection of the device, because the safer disposable equipment is readily available.
Advice to date suggests the risk of transmitting any infectious disease is extremely low and any risk, albeit a very small one, would relate only to Hepatitis B.
What is Hepatitis B (HBV) Hepatitis B is a blood borne viral infection that causes inflammation of the liver. People who live on the western side of the Pacific Ocean have relatively high rates of infection and is particularly common in Maori, Pacific Island and Asian people, especially young men aged between 15-40 years. This infection can be passed from person to person through blood contamination. An estimated 1 to 2 percent of the New Zealand population are HBV carriers
What are the symptoms of HBV? · your eyes or skin may turn yellow · you may lose your appetite · you may have nausea, vomiting, fever, stomach or joint pain · you may feel extremely tired and not be able to work for weeks or months.
How can you test for HBV? You can have a blood sample tested for the presence of HBV antibodies (which represent previous infection) and for the presence of HBV (indicating current infection or carrier state)
How is HBV treated? Hepatitis B can be prevented through immunisation or prophylactic immunoglobulin injections.
New Zealand has had a universal vaccination programme for hepatitis B since 1988. Most children over the age of 12 will be protected through immunisation. Some people who are carriers of the infection can benefit from treatment with alpha interferon.
Has anyone in New Zealand contracted Hepatitis B from use of individual finger-pricking devices on more than one person? The Ministry is not aware of anyone in New Zealand having contracted hepatitis B from use of an individual finger pricking device on more than one person.
Have there been any problems overseas? Over the past 10 years worldwide, there have been four episodes reported where Hepatitis B was thought to have been transmitted through use of individual finger pricking devices on more than one person. In each case only the lancet had been replaced.
If I have had a finger-pricking device used on me, which was not for my own individual use, what should I do? The Ministry is advised that the risk of infection through use of individual finger-pricking devices on more than one person is extremely low. The Ministry is not recommending that people who have had blood tests carried out in this way should be recalled for viral blood testing. However, if people are concerned they should contact their doctor and discuss whether a blood test is appropriate for them.
Where Can the Finger-Pricking Devices be Purchased? Finger-pricking devices can be purchased from medical wholesalers, pharmacies and Diabetes New Zealand's National Supply Scheme Office, PO Box 54, OAMARU; phone (03) 434 8110; e-mail: firstname.lastname@example.org.