Assuring epidemiological safety for healthcare of patients with diabetes mellitus

Healthcare associated infections (HAI) — infections that patients develop during the course of receiving healthcare in hospitals, outpatient department and at home, out of healthcare facilities, and infection resulting from occupational exposure. Patients with diabetes are vulnerable to HAI. Infections increase metabolism problems in patients with diabetes; and vice versa, high blood glucose level increases risk of infections. For assuring epidemiological safety for patients with diabetes infection control must be provided for the following medical practices: insulin injections; blood glucose test; care of diabetes foot; intravascular catheterization and surgery. Any invasive procedures increase the HAI risk. HAI are most commonly transferred through direct and indirect contact with the infection. Some of the main HIA preventive practices: staff cleaning hands with alcohol based sanitizer, single use of medical gloves, single use of insulin needles and syringes. In health facilities only multiple users and multiple blood glucose monitoring devices must be used by health providers. The protocol of glucose blood testing should include detailed disinfection procedures and additional measures to decrease the risk of potentially transmitting disease between patients and between patients and providers. Health providers should have special skills to care of patients with diabetes foot to perform non-traumatic procedures and infections control practices. Proper hand hygiene and gloves use combined with effective aseptic technique before catheter insertion and maintenance protect against severe HAI. Risk of infections significantly decreases when single-dose antibiotic was used before surgery as antimicrobial prophylaxis. To disease risk of infections patients should be recommended to strictly control diabetes during the weeks before elective surgical procedures.

1. Брико Н.И. Госпитальная эпидемиология: реальность и перспективы. // Поликлиника. 2014;6:11-14. [Briko NI. Gospital’naja jepidemiologija: real’nost’ i perspektivy. Poliklinika. 2014;6:11-14. (In Russ.)].

2. Брико Н.И., Лыткина И.Н. Состояние заболеваемости и перспективы вакцинопрофилактики гепатита В в Москве. // Лечащий врач. — 2000. — №10. — С. 3-9. [Briko NI, Lytkina IN. Sostojanie zabolevaemosti i perspektivy vakcinoprofilaktiki gepatita B v Moskve. Lechashhij vrach. 2000;10:3-9. (In Russ.)].

3. Вартапетова Н.В., Карпушкина А.В., Брико Н.И., и др. Профилактика инфекций, связанных с оказанием медицинской помощи в акушерских отделениях / стационарах. – М.: Институт Здоровья Семьи, 2013 – 192 с. [Vartapetova NV, Karpushkina AV, Briko NI, et al. Profilaktika infekcij, svjazannyh s okazaniem medicinskoj pomoshhi v akusherskih otdelenijah / stacionarah. Moscow: Institut Zdorov’ja Sem’i. 2013;192. (In Russ.)]. Доступно по ссылке: http://aids-orel.ru/doc/profilaktika.pdf

4. Ведение больных сахарным диабетом с терминальной хронической почечной недостаточностью на диализе. Методические указания № 2004/38. — Москва, 2004. [Vedenie bol’nyh saharnym diabetom s terminal’noj hronicheskoj pochechnoj nedostatochnost’ju na dialize. Practice guidelines. Moscow 2004;2004/38 (In Russ.)]. Доступно по ссылке: http://www.voed.ru/mp_12.htm.

5. Биккулова Д.Ш. Клинические рекомендации по венозному доступу. // Российский журнал детской гематологии и онкологии. — 2014. — №3. — С. 73-77. [Bikkulova DS. Clinical guidelines for venous access. Rossiyskiy zhurnal detskoy gematologii i onkologii. 2014;3:73-77. (In Russ.)].

6. Галстян Г.Р., Токмакова А.Ю., Егорова Д.Н., и др. Клинические рекомендации по диагностике и лечению синдрома диабетической стопы. // Раны и раневые инфекции. Журнал имени проф. Б.М. Костючёнка. — 2015. — Т. 2. — №3. — С. 63-83. [Galstyan GR, Tokmakova AY, Egorova DN, et al. Clinical Guidelines for Diagnosis and Treatment of Diabetic Foot Syndrome.Wounds and wound infections. The prof. B.M. Kostyuchenok journal. 2015;2(3):63-83. (In Russ.)]. doi: 10.17650/2408-9613-2015-2-3-63-83.

7. Коннер К. Сосудистый доступ для гемодиализа. // Нефрология. — 2009. — Т. 13. — №4. — С. 9-17. [Konner K. Vascular access for haemodialysis. Nephrology. 2009;13(4):9-17. (In Russ.)].

8. Шестакова М.В., Майоров А.Ю., Филиппов Ю.И., и др. Федеральные клинические рекомендации по помповой инсулинотерапии и непрерывному мониторированию гликемии у больных сахарным диабетом. ПРОЕКТ // Проблемы Эндокринологии. — 2015. — Т. 61. — №6. — C. 55-78. [Shestakova MV, Mayorov AYu, Philippov YI, et al. Russian national guidelines on insulin pump therapy and continuous glucose monitoring for diabetes mellitus patients. DRAFT. Probl Endokrinol (Mosc). 2015;61(6):55-78. (In Russ.)]. doi: 10.14341/probl201561655-78.

9. Дедов И.И., Шестакова М.В., Галстян Г.Р., и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Под редакцией И.И. Дедова, М.В. Шестаковой (7-й выпуск) // Сахарный диабет. - 2015. - Т. 18. - №1S - C. 1-112. [Dedov II, Shestakova MV, Galstyan GR, et al. Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V. (7th edition). Diabetes mellitus. 2015;18(1S):1-112. (In Russ.)]. doi: 10.14341/dm20151s1-112.

10. Любимова А.В., Зуева Л.П., Голубкова А.А., Техова И.Г. Гигиена рук медицинского персонала. Федеральные клинические рекомендации. — М., 2014. – 31 с. [Ljubimova AV, Zueva LP, Golubkova AA, Tehova IG. Hand hygiene for medical personnel. Federal clinical guidelines. Moscow. 2014;31. (In Russ.)]. Доступно по ссылке: http://nasci.ru/_resources/directory/198/common/2014_6_Gigiena_ruk_new.pdf

11. Шестакова М.В., Шамхалова М.Ш., Ярек-Мартынова И.Р., и др. Клинические рекомендации по диагностике, скринингу, профилактике и лечению хронической болезни почек у больных сахарным диабетом. — М., 2014. [Shestakova MV, Shamhalova MS, Jarek-Martynova IR, et al. Clinical guidelines for chronic kidney disease diagnosis, screening, prophylactics and treatment in diabetes mellitus patients. Moscow; 2014. (In Russ.)]. Доступно по ссылке: http://www.endocrincentr.ru/images/material-images/Rec_HBP%20by%20DM_2015.pdf.

12. Майоров А.Ю., Мельникова О.Г. Национальные рекомендации для медицинских работников по технике инъекций при лечении сахарного диабета. Эндокринологический научный центр. — М., 2012. [Mayorov AYu, Melnikova OG. National guidelines for health care providers on injection technique for diabetes mellitus treatment. Moscow. 2012. (In Russ.)]. Доступно по ссылке: http://www.endocrincentr.ru/rekomend_2012.pdf

13. Пантелеева Л.Г., Абрамова И.М., Шестопалова Т.Н., Белова А.С. Обеззараживание глюкометров в медицинских организациях в целях профилактики инфекций, связанных с оказанием медицинской помощи. // Поликлиника. — 2015. — №5-2. — С. 50-53. [Panteleeva LG, Abramova IM, Shestopalova TN, Belova AS. Obezzarazhivanie gljukometrov v medicinskih organizacijah v celjah profilaktiki infekcij, svjazannyh s okazaniem medicinskoj pomoshhi. Poliklinika. 2015;5-2:50-53. (In Russ.)].

14. Асланов Б.И., Зуева Л.П., Колосовская Е.Н., и др. Принципы организации периоперационной антибиотикопрофилактики в учреждениях здравоохранения. Федеральные клинические рекомендации – М., 2014. – 42 с. [Aslanov BI, Zueva LP, Kolosovskaya EN, et al. Principles of perioperative antibiotic prophylaxis organization in health facilities. Federal clinical guidelines. Moscow. 2014;42. (In Russ.)]. Доступно по ссылке: http://nasci.ru/_resources/directory/198/common/2014_9_PAP_new.pdf

15. Федеральные клинические рекомендации (протоколы) по ведению детей с эндокринными заболеваниями / Под ред. И. И. Дедова и В. А. Петерковой. — М.: Практика, 2014. — 442 с. [Dedov II, Peterkova VF, editors. Federal clinical guidelines (protocols) for endocrine diseases management in children. Moscow: Praktika. 2014;442. (In Russ.)]. Доступно по ссылке:http://www.endocrincentr.ru/images/material-images/deti%202015(1).pdf

16. Siminerio L, Kulkarni K, Meece J, et al. American Association of Diabetes Educators Strategies for Insulin Injection Therapy in Diabetes Self-Management. American Association of Diabetes Educators; 2011. Available on: https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/research/aade_meded.pdf?sfvrsn=2

17. American Diabetes Association. Standards of Medical Care in Diabetes - 2016. Diabetes Care. 2016,29 Suppl 1:S4-S42.

18. Anderson DJ, Podgorny K, Berrios-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627. doi: 10.1086/676022.

19. Bickel A, Gurevits M, Vamos R, et al. Perioperative hyperoxygenation and wound site infection following surgery for acute appendicitis: a randomized, prospective, controlled trial. Arch Surg. 2011;146(4):464-470. doi: 10.1001/archsurg.2011.65.

20. Bond W. Survival of Hepatitis B Virus after Drying and Storage for One Week. The Lancet. 1981;317(8219):550-551. doi: 10.1016/s0140-6736(81)92877-4.

21. Burke JP. Infection control - a problem for patient safety. N Engl J Med. 2003;348(7):651-656. doi: 10.1056/NEJMhpr020557.

22. Centers for Disease Control. Epidemiologic Notes and Reports: Nosocomial Transmission of Hepatitis B Virus Associated with a Spring-Loaded Fingerstick Device-California. MMWR Morb Mortal Wkly Rep. 1990;39(35):610-613.

23. Transmission of hepatitis B virus among persons undergoing blood glucose monitoring in long-term-care facilities—Mississippi, North Carolina, and Los Angeles County, California, 2003-2004. MMWR Morb Mortal Wkly Rep. 2005;54(9):220-223.

24. Centers for Disease Control. Recommended Infection-Control and Safe Injection Practices to Prevent Patient-to-Patient Transmission of Bloodborne Pathogens Report available at: http://www. cdc. gov/hepatitis/Populations. GlucoseMonitoring. htm. 2009.

25. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. doi: 10.2146/ajhp120568.

26. Cocoman A, Murray J. Intramuscular injections - To swab or not to swab. World of Irish Nursing. 2007;15(8):26-27.

27. Hicks D, Burmiston S, Basi M, et al. The first UK injection technique recommendations. 2nd ed. Diabetes Care in the UK. London. 2010.

28. Dronge AS, Perkal MF, Kancir S, et al. Long-term glycemic control and postoperative infectious complications. Arch Surg. 2006;141(4):375-380; discussion 380. doi: 10.1001/archsurg.141.4.375.

29. FIT4Safety (2012) Injection Safety in UK and Ireland; Safety of Sharps in Diabetes Recommendations 1st Edn. FIT4Safety, UK. Available on: http://www.fit4diabetes.com/united-kingdom/fit-safety-recommendations/

30. Fleming DR, Jacober SJ, Vandenberg MA, et al. The Safety of Injecting Insulin Through Clothing. Diabetes Care. 1997;20(3):244-247. doi: 10.2337/diacare.20.3.244.

31. Gandhi GY, Nuttall GA, Abel MD, et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med. 2007;146(4):233-243. doi: 10.7326/0003-4819-146-4-200702200-00002.

32. Gittens G, Bunnell T. Skin disinfection and its efficacy before administering injections. Nurs Stand. 2009;23(39):42-44. doi: 10.7748/ns2009.06.23.39.42.c7039.

33. Goetz AM, Wagener MM, Miller JM, Muder RR. Risk of Infection Due to Central Venous Catheters: Effect of Site of Placement and Catheter Type. Infection Control and Hospital Epidemiology. 1998;19(11):842-845. doi: 10.2307/30141562.

34. Golden SH, Peart-Vigilance C, Kao WH, Brancati FL. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care. 1999;22(9):1408-1414. doi: 10.2337/diacare.22.9.1408.

35. Griffin FA. Reducing surgical complications. Jt Comm J Qual Patient Saf. 2007;33(11):660-665.

36. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20(4):250-278; quiz 279-280. doi: 10.1086/501620.

37. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-e193. doi: 10.1093/cid/cir257.

38. Hawn MT, Houston TK, Campagna EJ, et al. The attributable risk of smoking on surgical complications. Ann Surg. 2011;254(6):914-920. doi: 10.1097/SLA.0b013e31822d7f81.

39. Heinemann L, Krinelke L. Insulin infusion set: the Achilles heel of continuous subcutaneous insulin infusion. J Diabetes Sci Technol. 2012;6(4):954-964. doi: 10.1177/193229681200600429.

40. Hellinger WC, Grant RL, Hernke DA, et al. Glucose meters and opportunities for in-hospital transmission of infection: Quantitative assessment and management with and without patient assignment. Am J Infect Control. 2011;39(9):752-756. doi: 10.1016/j.ajic.2010.12.019.

41. Hind D, Calvert N, McWilliams R, et al. Ultrasonic locating devices for central venous cannulation: metaanalysis. BMJ. 2003;327(7411):361. doi: 10.1136/bmj.327.7411.361.

42. Jaar BG, Hermann JA, Furth SL, et al. Septicemia in diabetic hemodialysis patients: Comparison of incidence, risk factors, and mortality with nondiabetic hemodialysis patients. Am J Kidney Dis. 2000;35(2):282-292. doi: 10.1016/s0272-6386(00)70338-6.

43. Jacobi J, Bircher N, Krinsley J, et al. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Crit Care Med. 2012;40(12):3251-3276. doi: 10.1097/CCM.0b013e3182653269.

44. Johnson PD, Martin R, Burrell LJ, et al. Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust. 2005;183(10):509-514.

45. Kac G, Podglajen I, Gueneret M, et al. Microbiological evaluation of two hand hygiene procedures achieved by healthcare workers during routine patient care: a randomized study. J Hosp Infect. 2005;60(1):32-39. doi: 10.1016/j.jhin.2004.10.014.

46. Nelson RG, Tuttle KR. The new KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and CKD. Blood Purif. 2007;25(1):112-114. doi: 10.1159/000096407.

47. Khawaja RA, Sikandar R, Qureshi R, Jareno RJM. Routine Skin Preparation with 70% Isopropyl Alcohol Swab: Is it Necessary before an Injection? Quasi Study. JLUMHS. 2013;12(02):109.

48. Koh DB, Gowardman JR, Rickard CM, et al. Prospective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters. Crit Care Med. 2008;36(2):397-402. doi: 10.1097/CCM.0b013e318161f74b.

49. Koivisto V, Felig P. Is Skin Preparation Necessary before Insulin Injection? Lancet. 1978;311(8073):1072-1073. doi: 10.1016/s0140-6736(78)90916-9.

50. Korniewicz D, El-Masri M, Broyles J. To determine the effects of gloves stress, type of material (vinyl, nitrile, copolymer, latex) and manufacturer on the barrier effectiveness of medical examination gloves. American Journal of Infection Control. 2002;30:133-138. doi: 10.1067/mic.2002.119512.

51. Kost GJ, Tran NK, Louie RF, et al. Assessing the performance of handheld glucose testing for critical care. Diabetes Technol Ther. 2008;10(6):445-451. doi: 10.1089/dia.2008.0049.

52. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006;6:130. doi: 10.1186/1471-2334-6-130.

53. Kwon S, Thompson R, Dellinger P, et al. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg. 2013;257(1):8-14. doi: 10.1097/SLA.0b013e31827b6bbc.

54. Larson EL, Eke PI, Wilder MP, Laughon BE. Quantity of Soap as a Variable in Handwashing. Infection Control & Hospital Epidemiology. 1987;8(09):371-375. doi: 10.1017/S0195941700067436.

55. Lazar HL, McDonnell M, Chipkin SR, et al. The Society of Thoracic Surgeons Practice Guideline Series: Blood Glucose Management During Adult Cardiac Surgery. The Annals of Thoracic Surgery. 2009;87(2):663-669. doi: 10.1016/j.athoracsur.2008.11.011.

56. Mahoney JJ, Lim CG. Effect of Disinfectants on Glucose Monitors. J Diabetes Sci Technol. 2012;6(1):81-85. doi: 10.1177/193229681200600111.

57. Meeks DW, Lally KP, Carrick MM, et al. Compliance with guidelines to prevent surgical site infections: As simple as 1-2-3? Am J Surg. 2011;201(1):76-83. doi: 10.1016/j.amjsurg.2009.07.050.

58. Meyhoff CS, Wetterslev J, Jorgensen LN, et al. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA. 2009;302(14):1543-1550. doi: 10.1001/jama.2009.1452.

59. Møller AM, Pedersen T, Villebro N, Munksgaard A. Effect of smoking on early complications after elective orthopaedic surgery. J Bone Joint Surg Br. 2003;85(2):178-181. doi: 10.1302/0301-620x.85b2.13717.

60. National Kidney Foundation. III. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2000. Am J Kidney Dis. 2001;37(1 Suppl 1):S137-S181.

61. Nelson RL, Glenny AM, Song F. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev. 2009(1):CD001181. doi: 10.1002/14651858.CD001181.pub3.

62. Nichols JH. Blood glucose testing in the hospital: error sources and risk management. J Diabetes Sci Technol. 2011;5(1):173-177. doi: 10.1177/193229681100500124.

63. Noskin GA, Stosor V, Cooper I, Peterson LR. Recovery of vancomycin-resistant enterococci on fingertips and environmental surfaces. Infect Control Hosp Epidemiol. 1995;16(10):577-581. doi: 10.2307/30141097.

64. Nurse Practice Committee Guidelines on the Administration of Intramuscular and Sub-Cutaneous Injections. Issue Date: August 2014. Available on: http://www.olchc.ie/Healthcare-Professionals/Nursing-Practice-Guidelines/Administration-of-Intramuscular-and-Sub-Cutaneous-Injections-pdf.

65. Olsen MA, Nepple JJ, Riew KD, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am. 2008;90(1):62-69. doi: 10.2106/JBJS.F.01515.

66. Olsen RJ, Lynch P, Coyle MB, et al. EXamination gloves as barriers to hand contamination in clinical practice. JAMA. 1993;270(3):350-353. doi: 10.1001/jama.1993.03510030074037.

67. Partanen TM, Rissanen A. Insulin injection practices. Pract Diabetes Int. 2000;17(8):252-254. doi: 10.1002/pdi.91.

68. Picheansathian W. A systematic review on the effectiveness of alcohol-based solutions for hand hygiene. Int J Nurs Pract. 2004;10(1):3-9. doi: 10.1111/j.1440-172X.2003.00457.x.

69. Pietsch H. Hand antiseptics: rubs versus scrubs, alcoholic solutions versus alcoholic gels. J Hosp Infect. 2001;48 Suppl A:S33-36.

70. American Society of Anesthesiologists Task Force on Central Venous A, Rupp SM, Apfelbaum JL, et al. Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2012;116(3):539-573. doi: 10.1097/ALN.0b013e31823c9569.

71. Qamar M, Gillani SW, Sulaiman SAS. The Skin Preparation Knowledge, Attitudes and Practices among the Healthcare Professionals in Compliance with the World Health Organization (WHO) Guidelines. J Clin Diagn Res. 2012;6(6):1041-1046.

72. Rotter ML. Hand washing and hand disinfection. In: Mayhall CG, editor. Hospital epidemiology and infection control. Vol 2. Lippincott Williams Wilkins. 1999;1727-1746.

73. Saxena AK, Panhotra BR, Sundaram DS, et al. Tunneled catheters’ outcome optimization among diabetics on dialysis through antibiotic-lock placement. Kidney Int. 2006;70(9):1629-1635. doi: 10.1038/sj.ki.5001776.

74. Schweickert WD, Herlitz J, Pohlman AS, et al. A randomized, controlled trial evaluating postinsertion neck ultrasound in peripherally inserted central catheter procedures. Crit Care Med. 2009;37(4):1217-1221. doi: 10.1097/CCM.0b013e31819cee7f.

75. Sessler DI. Complications and treatment of mild hypothermia. Anesthesiology. 2001;95(2):531-543. doi: 10.1097/00000542-200108000-00040.

76. Anderson DJ, Podgorny K, Berrios-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627. doi: 10.1086/676022.

77. Strauss K, Gols HD, Hannet I, et al. A pan-European epidemiologic study of insulin injection technique in patients with diabetes. Pract Diabet Int. 2002;19(3):71-76. doi: 10.1002/pdi.314.

78. Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008;70:3-10. doi: 10.1016/s0195-6701(08)60017-1.

79. Swenson BR, Hedrick TL, Metzger R, et al. Effects of preoperative skin preparation on postoperative wound infection rates: a prospective study of 3 skin preparation protocols. Infect Control Hosp Epidemiol. 2009;30(10):964-971. doi: 10.1086/605926.

80. Tanner J, Woodings D, Moncaster K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2006(3):CD004122. doi: 10.1002/14651858.CD004122.pub3.

81. Tenorio AR, Badri SM, Sahgal NB, et al. Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant enterococcus species by health care workers after patient care. Clin Infect Dis. 2001;32(5):826-829. doi: 10.1086/319214.

82. Timsit JF, Schwebel C, Bouadma L, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA. 2009;301(12):1231-1241. doi: 10.1001/jama.2009.376.

83. Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(1):16-38. doi: 10.1210/jc.2011-2098.

84. Umpierrez GE, Smiley D, Jacobs S, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care. 2011;34(2):256-261. doi: 10.2337/dc10-1407.

85. AIUM Practice Parameter for the Use of Ultrasound to Guide Vascular Access Procedures. American Institute of Ultrasound in Medicine; 2012. Available on: http://www.aium.org/resources/guidelines/usgva.pdf.

86. Vegas AA, Jodra VM, Garcia ML. Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization. Eur J Epidemiol. 1993;9(5):504-510.

87. Koivisto V, Felig P. Is Skin Preparation Necessary before Insulin Injection? Lancet. 1978;311(8073):1072-1073. doi: 10.1016/s0140-6736(78)90916-9.

88. Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. 2015;2:CD004985. doi: 10.1002/14651858.CD004985.pub5.

89. World Health Organization. WHO Best Practices for Injections and Related Procedures Toolkit. 2010.

90. Wilkerson K, Hodge EM. Glucometer Cleaning: A Process Improvement Following a State Survey. Am J Infect Contr. 2011;39(5):E165.

91. Williams IT, Perz JF, Bell BP. Viral hepatitis transmission in ambulatory health care settings. Clin Infect Dis. 2004;38(11):1592-1598. doi: 10.1086/420935.