Today, healthcare-associated infections (HAIs) continue to have an impact on both reimbursement for healthcare providers (HCPs) and the way in which HCPs are held accountable for patient care. In spite of efforts to decrease the number of HAIs in acute care settings, an estimated 4.5 million patients are exposed to HAIs and 2.5 million patients develop HAIs in the US each year.1 Annually, this results in 90,000 deaths and over $5.7 billion dollars of additional healthcare costs.2 HAIs are a major concern to infection control practitioners in acute care and outpatient settings. Adequate nurse staffing, compliance with proper hand hygiene, environmental factors associated with medical equipment, and improved surveillance of HAIs are strategies being used to improve patient care outcomes and reduce the incidence of HAIs. The purpose of this paper is to discuss infection control practices for the environment, provide evidence about electrocardiogram (ECG) lead wires and monitoring device systems (wireless versus nonwireless), and discuss innovative technologies that may reduce crosscontamination between monitored patients.
Prevention of HAIs in acute care facilities has been complex. Several studies3,4 have been conducted to demonstrate that the surfaces of medical equipment as well as surfaces in the general hospital environment can be associated with methicillin-resistant Staphylococcus aureus (MRSA) or other antibiotic-resistant pathogens. Malik et al.5 evaluated the efficacy of cleaning systems in the hospital by visual assessment, standardized microbiologic audits, and environmental monitoring. Microbiologic benchmarking was applied and demonstrated that although visual assessments were satisfactory, use of a rapid microbiologic audit system provided a better indicator for evaluating the cleanliness of equipment and surfaces. Others6 have suggested that design improvements in single beds, electronic records, and room layouts or using enhanced technological equipment (monitoring devices, standardization of equipment) would provide improved patient-centered safety, effectiveness, and efficiency, leading to quality patient care. Moreover, Sexton et al.7 have suggested that more effective methods of cleaning and decontaminating surfaces and equipment are imperative to eradicate MRSA and other HAIs.
Infection Control and Electrocardiogram Monitoring
An early study conducted by Soklaski8 demonstrated that crosscontamination occurred from patient to patient via a 12-lead electrocardiogram bulb, resulting in an outbreak of Serratia marcescens in a group of post-operative cardiac surgery patients. When disposable ECG leads were introduced, the issue was resolved. This report provides scientific evidence that the use of disposable equipment has a direct impact on reducing cross-contamination of pathogens from patient to patient when use of reusable equipment is ceased. Falk9 described a vancomycin-resistant enterococci (VRE) outbreak in a burn unit when a contaminated ECG lead wire was used in a number of patients. Once the ECG lead wire was decontaminated or replaced, VRE was eradicated. More recently, Brookmeyer demonstrated that 77% of reusable ECG lead wires were contaminated for multidrug-resistant bacterial pathogens (MRSA, VRE) and could be a source of HAIs in hospitalized patients.10 The clinical outcomes associated with non-disposable ECG lead wires demonstrate that crosscontamination can occur between or among patients.
- Centers for Disease Control and Prevention, Guidelines for hand hygiene in health-care setting (No. RR-16), Atlanta: CDC, 2002;444.
- Burke J, Infection control: a problem for patient safety, N Engl J Med, 2003;348(7):651├óÔé¼ÔÇ£6.
- Melzer M, Bain L, Drabu YJ, Rapid screening for MRSA: Preventing infections from cannulas reduces MRSA, BMJ, 2008;336(7653): 1085├óÔé¼ÔÇ£6.
- Alfa MJ, Dueck C, Olson N, et al., UV-visible marker confirms that environmental persistence of Clostridium difficile spores in toilets of patients with C. difficile-associated diarrhea is associated with lack of compliance with cleaning protocol, BMC Infect Dis, 2008;8:64.
- Malik RE, Cooper RA, Griffith CJ, Use of audit tools to evaluate the efficacy of cleaning systems in hospitals, Am J Infect Control, 2003;31(3):181├óÔé¼ÔÇ£7.
- Henriksen K, Isaacson S, Sadler BL, Zimring CM, The role of the physical environment in crossing the quality chasm, Jt Comm J Qual Patient Saf, 2007;33(Suppl 11.):68├óÔé¼ÔÇ£80.
- Sexton T, Clarke P, O™Neill E, et al., Environmental reservoirs of methicillin-resistant Staphylococcus aureus in isolation rooms: correlation with patient isolates and implications for hospital hygiene, J Hosp Infect, 2006;62(2):187├óÔé¼ÔÇ£94.
- Sokalski SJ, Jewell MA, Asmus-Shillington AC, et al., An outbreak of Serratia marcescens in 14 adult cardiac surgical patients associated with 12-lead electrocardiogram bulbs, Arch Intern Med, 1992;152(4):41├óÔé¼ÔÇ£4.
- Falk PS, Winnike J,Woodmansee C, et al., Outbreak of vancomycin-resistant enterococci in a burn unit, Infect Contro Hosp Epidemiol, 2000;21:575├óÔé¼ÔÇ£82.
- Jancin B, Antibiotic resistant pathogens fouind on 77% of ECG lead wires, Cardiol News, 2004;2:14.
- Furtado D, Poster presentation: American Association of Critical Care Nurses National Teaching Institute, May 2008. Health-care associated infection in hospitals. (2008) U.S. Government Accountability Office March: #GAO-08-283.
- Bush LM, Disposable items help prevent healthcare-acquired infections, Infection Control Today, 2005;6.
- Zahn C, Miller MR, Excess length of stay, charges and mortality attributable to medical injuries during hospitalization, JAMA, 2003;290:1917├óÔé¼ÔÇ£19.