Correspondence

Contamination of a Finger-Stick Device

N Engl J Med 1993; 328:969-970April 1, 1993

Article

To the Editor:

Our laboratory recently completed a nutritional study involving 104 college students in which fasting blood glucose levels were obtained with a spring-loaded finger-stick device. The Glucolet Automatic Lancing Device (Figure 1Figure 1Glucolet Automatic Finger-Stick Lancing Device.), marketed by Ames Laboratories/Miles Laboratories (Elkhart, Ind.), was selected for our study on the basis of several factors, including ease of use, comfort, and effectiveness.

In contrast to our expectations, we found an extraordinarily high incidence of contamination of the cap of the device with blood. Such contamination presents a danger of transmission of the hepatitis B virus and possibly of the human immunodeficiency virus1. We found the device contaminated with blood in 30 of 104 finger sticks to measure fasting blood sugar levels, or a contamination rate of 29 percent -- higher than has been reported with a different type of spring-loaded finger-stick device that is equipped with a disposable finger guard2. In most cases, the contaminating blood was found around the surface and opening of the cap.

Contamination was determined by visual inspection without magnification. Therefore, in our laboratory the caps are chemically disinfected between uses by being soaked for 60 minutes in Cidex solution (Surgikos, Arlington, Tex.). Before soaking, however, the caps are scrubbed with detergent to remove excess blood and rinsed in tap water.

Since the pen-type automatic lancing device is frequently used in kits for home monitoring of blood glucose levels, some public health education is in order for diabetic patients and others using the kits. Informal inquiries in our community indicate that kits are often shared with friends, relatives, and the like. Since they replace the disposable lancets, the users are convinced that there is no hazard. They do not perceive the need to sterilize the caps, and chemical disinfection or autoclaving is simply not practical in the home. One solution to the problem would be the introduction of disposable caps for pen-type automatic lancing devices.

Nathan Shier, Ph.D.
John Warren, Ph.D.
Mohammad Torabi, Ph.D.
Robert Hongen, M.D.
Indiana University, Bloomington, IN 47405

2 References

1. 1

   Polish LB, Shapiro CN, Bauer F, et al. Nosocomial transmission of hepatitis B virus associated with the use of a spring-loaded finger-stick device. N Engl J Med 1992;326:721-725
   Full Text | Web of Science | Medline

2. 2

   Douvin C, Simon D, Zinelabidine H, Wirquin V, Perlemuter L, Dhumeaux D. An outbreak of hepatitis B in an endocrinology unit traced to a capillary-blood-sampling device. N Engl J Med 1990;322:57-57
   Full Text | Web of Science | Medline

Author/Editor Response

Miles Inc., manufacturer of the Glucolet, replies:

To the Editor: The letter by Shier et al. is anecdotal with regard to how often the device is shared. That part of the letter is unsubstantiated.

The blood-letting device is for all purposes a needle. The government, the communications media, and multiple organizations continuously remind people not to share needles. Exposure of this idea from these campaigns has reached the saturation point. Our labeling is quite explicit in directing users with precautions about handling the blood-letting device (the needle) and disposing of it safely. We reiterate that the Glucolet device is a personal item, and our labeling emphasizes this fact.

The vast majority of people with diabetes are highly responsible and informed when it comes to the human immunodeficiency virus. The letter by Shier et al. is applicable, if at all, to a tiny segment of the population with diabetes.

J.M. Botero, M.D.
Miles Inc., Elkhart, IN 46515

Citing Articles (3)

Citing Articles

1. 1

   Yee Gyung Kwak, Sang-Oh Lee, Tae Hyong Kim, Eun Ju Choo, Min-Hyok Jeon, Jae-Bum Jun, Kyung-Mi Kim, Jae Sim Jeong, Yang Soo Kim. (2012) The use of multidose vials and fingerstick blood sampling devices in Korean emergency departments and intensive care units. International Journal of Nursing Practice 18:1, 77-83
   CrossRef

2. 2

   J Quale. (1998) Deja vu: nosocomial hepatitis B virus transmission and fingerstick monitoring. The American Journal of Medicine 105:4, 296-301
   CrossRef

3. 3

   H Fruhstorfer, T Müller. (1995) Capillary blood sampling: How much pain is necessary?. Part 1: Comparison of existing finger stick devices. Practical Diabetes International 12:2, 72-74
   CrossRef