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Running head: BLOOD GLUCOSE AND HAND HYGIENE

Blood Glucose Levels Relating to Hand Washing Verses Using Hand Sanitizer
Aubry Hire
Ferris State University

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Blood Glucose Levels Relating to Hand Washing Verses Using Hand Sanitizer
When a patient has the need to monitor blood sugar levels it is essential that the readings
are as accurate as they can be. The most accurate way to test blood glucose levels is to send a
blood sample to the lab for testing, but if a patient needs constant feedback on blood glucose
levels this is not always practical. Thanks to todays technology we can now check blood
glucose levels using a handheld blood glucose meter; these are very quick and cost effective for
most patients, but there are many different things that can skew the results of the handheld blood
glucose test, and it is very important for nurses to perform the procedure so that the results will
be as accurate as possible. The Office of In Vitro Diagnostics and Radiological Health has some
tips for using blood glucose monitors to avoid getting incorrect results and they are listed on the
U.S. Food and Drug Administration (FDA) website (2013). One of the false high results from
the list of recommendations is that the sample site is contaminated with sugar to fix this problem
it is suggested to always clean and dry test site before sampling (FDA, 2013). This paper will
look at the different ways that can be used to clean the patient sample site, most commonly is the
finger.
Blood glucose levels are needed to monitor the levels of glucose (sugar) in the blood.
Blood glucose levels can there for be referred to as a blood sugar. The most common disease in
which people need to check their blood glucose levels is diabetes. Diabetes is a group of
diseases that is associated with the bodys inability to produce and or use insulin. This results in
high blood sugar levels. 8.3% of the United States have some form of diabetes, therefore it is
important for all patients to be able to accurately know what their blood sugar levels are. There
are two types of diabetes, type 1 and type 2. Type 1 diabetes is when the body does not produce
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insulin. Type 2 diabetes is when the body cannot use insulin properly. It can make insulin, but
there is a resistance to the insulin.
The most common way to preform hand hygiene before testing blood glucose levels is to
wash the hands with soap and water. The Centers for Disease Control and Prevention (CDC,
2013) has guidelines for hand washing:
Wet your hands with clean, running water (warm or cold) and apply soap.
Rub your hands together to make a lather and scrub them well; be sure to scrub the backs
of your hands, between your fingers, and under your nails.
Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the "Happy
Birthday" song from beginning to end twice.
Rinse your hands well under running water.
Dry your hands using a clean towel or air dry them.
This is the correct and proper way to wash hands to eliminate potential harmful microbes that
may be living on the skin. This is a tried and true method, that has withstood the rigors of much
testing. To get accurate blood glucose levels, it is imperative that the device is getting a clean
blood sample, one that is free from any extraneous glucose that could give a false result. This is
why hand washing is so popular, it is an effective way to remove anything that could interfere
with the results of the test.
Glucose monitors come with instructions on how to use the meter to get the best results
possible. It appears that the monitors prefer to have the patients preform traditional hand
washing. OneTouch, a brand of blood glucose monitors, has on its website, Before you test
your blood sugar, wash your hands and forearm (if applicable) thoroughly with warm, soapy
water. Rinse and Dry. (OneTouch, 2013). ACCU-CHEK, a different brand of blood
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glucose monitor, says to, Wash and dry your handsusing warm water may help the blood
flow. (ACCU-CHEK, 2013).
There are many reliable sources on the internet that have generalized instructions on how
to use blood glucose monitors. The Mayo Clinic, a medical practice and medical research group,
website (2012) recommends, Wash your hands with soap and warm water. Dry them well.
The American Diabetes Association, a leader in the world of diabetes, says that a patient should
wash hands before inserting a strip into the meter (2013). Hand washing is a proven way to get
rid of bacteria living on the skin.
Fundamentals of Nursing The Art and Science of Nursing Care, a nursing textbook, states
on obtaining a capillary blood sample for glucose testing, Have patient wash hands with soap
and warm water and dry thoroughly. Alternately, cleanse the skin with an alcohol swab. Allow
skin to dry completely. (Taylor, Lollis, LeMone, & Lynn, 2011, p.1216). This is one of the few
sources that even list using an alcohol swab as an alternate method to traditional hand washing.
Alcohol swabs are commonly used in nursing homes, and in hospitals, when the patients need to
be monitored frequently. The use of an alcohol swab can make the task of obtaining a blood
glucose level easier for the nurse.
In the health care setting it is at times appropriate to use an alcohol based hand sanitizer,
instead of a traditional hand washing. This brings about the question if it is appropriate to use an
alcohol based hand sanitizer before testing blood glucose levels. The proper way to use a hand
sanitizer is to Apply the product to the palm of one hand. Rub your hands together. Rub the
product over all surfaces of your hands and fingers until your hands are dry. (CDC, 2013).
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Hand sanitizers are a quick way to preform hand hygiene, but it is still effective and safe to use,
if properly applied.
There was a recent study done that explored this question. Test subjects were asked to
wash their hands with soap and water. The first finger was then used as the control finger. The
second finger had an alcohol based hand sanitizer applied to it. The third finger had Coca-Cola
applied to it. Blood sugars were taken on the three fingers. The forth finger had Coca-Cola
applied to it and then the subjects were asked to sanitize their hands normally. A blood sugar
was then taken from the forth finger. The first, second, and forth fingers were all statistically
similar. The third finger with just the Coca-Cola had a skewed result. After preforming this test,
a second test was performed. It tested the effectiveness of the alcohol based hand sanitizer based
on the surface area that it covered and the dilution of the outside substance. The study concluded
that in some situations it would be acceptable to use an alcohol based hand sanitizer in place of a
traditional hand washing, but in some instances it would not be acceptable (Mahoney, Ellison,
Glaeser & Price, 2011, p.1444-1448).
The CDC warns us that if the hands are noticeably dirty, hand sanitizers are not as
effective as traditional hand washing (CDC, 2013). This statement gives us parameters in which
it would be acceptable to use hand sanitizer as a safe and effective alternative to traditional hand
washing.
The research fits well with in the practice that nurses already use. The only variable
would be whether hand sanitizer is an acceptable replacement for traditional hand washing, at all
times. It seems that it can be an alternative, but only in certain situations. The hand sanitizer
will not affect the glucose readings on the blood glucose monitor, but if there is a foreign
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substance on the hands before the application of hand sanitizer that may affect the results that
you receive. The research and the practical setting concur, making testing blood glucose
monitors an evidenced based practice.


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References
ACCU-CHEK. (2013, October 31). How to test blood sugar. In ACCU-CHEK. Retrieved
November 21, 2013, from https://www.accu-chek.com/us/glucose-monitoring/how-to-
check.html
American Diabetes Association. (2013, July 19). Checking your blood glucose. In Living with
diabetes. Retrieved November 21, 2013, from http://www.diabetes.org/living-with-
diabetes/treatment-and-care/blood-glucose-control/checking-your-blood-glucose.html
Centers for Disease Control and Prevention. (2013, January 11). What if I dont have soap and
clean, running water?. In Handwashing: Clean Hands Save Lives. Retrieved November
22, 2013
Centers for Disease Control and Prevention. (2013, January 11). What is the right way to wash
your hands?. In Handwashing: Clean Hands Save Lives. Retrieved November 22, 2013,
from http://www.cdc.gov/handwashing/
Mahoney, J. J., Ellison, J. M., Glaeser, D., & Price, D. (2011, November). The effect of an
instant hand sanitizer on blood glucose monitoring results [Electronic version]. Journal of
Diabetes Science and Technology, 5(6), 1444-1448.
Mayo Clinic. (2012, January 24). Blood sugar testing: Why, when and how. In Diabetes.
Retrieved November 22, 2013, from http://www.mayoclinic.com/health/blood-
sugar/DA00007/NSECTIONGROUP=2
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OneTouch. (2013, November 18). How do I check my blood sugar with the OneTouch
Ultra2 meter?. In OneTouch. Retrieved November 21, 2013, from
http://www.onetouch.com/support/products/check-blood-sugar-ultra2?page=4&type=text
Taylor, C. R., Lillis, C., LaMone, P., & Lynn, P. (2011). Fundamentals of nursing the art and
science of nursing care (7th ed., p. 75). Philiadelphia, PA: Wolters Kluwer
Health:Lippincott Williams & Wilkins.
U.S. Food and Drug Administration. (2013, March 21). Common problems with the use of
glucose meters at the point of care. In U.S. Food and Drug Administration. Retrieved
November 21, 2013, from
http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/TipsandArticlesonDeviceS
afety/ucm109449.htm