Infection Control and The blood Pressure cuff

Infection Control and The blood Pressure cuff

By Shelley Hill RNRole of The Advanced Practice NurseWestern Governors University

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What would Florence nightingale think about this?

Contact Precautions

GownGlovesMaskHair covered No germs getting out of this room .Right?

Think twice

Meet the Vital Machine

A wonderful machine that can be wheeled room to room to check vitals.

AND THATS THE PROBLEM.

Its fast, convenient, and pretty accurate, but it goes ROOM TO ROOM.

What would Florence say?

Oh my, does that machine get used on every patient?

Does the cuff get washed after each usage?

YES, IT DOES.

WELLIM NOT SURE WHO CLEANS IT.

I attribute my success to this I never gave or took any excuse. Florence Nightingale

When a nurse wraps a blood pressure cuff around a Patients arm

Introduces bacteria, possibly MRSABacteria doesnt have to go far to the fingertipsFrom fingertips to face and other parts of the body

The blood pressure cuff

1969 Study identified the blood pressure cuff as a reservoir for bacteria, no other piece of equipment was used more without adequate disinfection (Beard, Mcintyre & Roundtree).2003 Study states that 77% of blood pressure cuffs on trolleys in hospitals were contaminated (83% of cuffs in the ICU ), 45% CARRIED MRSA (McCaughery, 2007). a Study reported in the AARP Bulletin states, 39% of medical personnel didnt know that C.diff could be spread on stethoscopes, blood pressure cuffs and other equipment (Dubay, 2009).

Vectors for the spread of pathogens

Hospital acquired infections

Nearly two million patients in the U.S. gets a hospital acquired infection each year.90,000 of those patients die as a result of their infection.Hospital Acquired Infection kill 5 times as many Americans as AIDS.Annual cost to treat these infections in the U.S. is 30.5 Billion dollars.Average cost of $15,272 per patient.

CDC, 2009

Example: MRSA

NOT GOOD

Resistant to AntibioticsIncreasing rates in 2011 70% of Staph Infections were MRSA (themrsa.com)

18,000 deaths in the U.S. per year (JAMA, 2007)Most serious cases take place in the healthcare setting (CDC, 2007).

MRSA is Lurking in every U.s. hospital,

and poses a serious and sometimes deadly health risk to patients who are unwittingly exposed to these superbugs.We know how to control MRSA, but hospitals are not being consistent in their infection control measures.Hospitals need to make a commitment and invest the resources to protect patients from MRSA. In the long run, it will save money and lives.

Lisa McGiffert, Director of The Consumers Union

Lets talk solutions

Are there EBP Recommendations to curb hospital acquired infections.Propose new policy or enforce present policy. Propose introduction of new products. Evaluate if changes make a difference in hospital acquired infection rates.

Mrsa screening alone?

It is important to identify patients with MRSA.Note: MRSA Screening is controversial. The agent used to decolonize the nasal passageway may make the resistance even worse. MRSA Screening needs more controlled studies.Rapid screening before admission is no more effective than conventional screening and it is more expensive.MRSA CAN be reduced by rigorous application of standard control principles, along with TARGETED screening.

Mark Wilcox, 2008professor of medical microbiologyLeeds Teaching Hospital

Active surveillance

Physicians, hospitals and other healthcare facilities need to work together to identify patients with MRSA and other resistant infections.Record keeping is essential. Once identified, Contact Precautions and Isolation can be used to prevent the spread of the bacteria.Contact precautions with single room isolation or cohorting were associated with a 60% reduction in MRSA acquisition (Marshall, Richards, McBryde, 2013)

What other measures could be taken to prevent the spread of resistant bacteria?

What about blood pressure cuffs?

Make changes to improve or reinforce BP Cuff cleanliness policies

CDc recommendations on equipment usage

In acute care hospitals, long term care and other residential settings, use disposable noncritical patient care equipment (e.g. BLOOD PRESSURE CUFFS) or implement patient-dedicated use of such equipment. If common use of equipment for multiple patients in unavoidable, clean and disinfect such equipment before use on another patient.

CDC, 2007

Society for healthcare epidemiology of America Recommendations for equipment

Dedicate the use of noncritical patient-care equipment to a single patient (or cohort of patients infected or colonized with the same pathogen), avoid sharing between patients. If use of common equipment or items is unavoidable, then adequately clean and disinfect them before use for another patient.

Muto, 2003

Staff Education & reinforcement

For Equipment

Disposable when possibleDedicated to patientClean and disinfect all equipment before removing from this room.

In-service Lessons Posters Infection Control Rounds Positive Reinforcement

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#1 Infection control measure

Still is good old hand washing.

#2 Keeping equipment clean

Wiping down with disinfectants

#3 Washing the BP cuffs

Product called, Cuff Care Systems

Washing Machine for blood pressure cuffs.

http://www.cuffcare.com/The_Facts_About_Wiping.html.

#4 Using barriers

Using a disposable sleeve on the patients arm.

It protects the patient by not letting the blood pressure cuff touch the patients skin.

http://www.eleemedical.com/barriers.htm

#5 Single Patient disposable cuffs

By staying with patient, this cuff prevents cross contamination

http://www.welchallyn.com/wafor/hospitals/prevent_infect/default.htm

# 6 Antimicrobial treatedreusable cuffs

Prevents fungal and bacteria growth on BP CUFF

UltraCheck by CAS Medical Systems

Do these ideas and products work?

In Denmark, MRSA peeked in the 1960s at 33%. After a strict MRSA control transmission policy, the rate dropped to less than 1%. This was maintained for 25 years. (Muto, 2003)The VA healthcare System in Pittsburgh had a 70% reduction of infections in the surgical unit, and an 82% reduction of MRSA after two years of a staff-owned prevention program that included active surveillance, hand hygiene, strict contact precautions. (Richmond, 2007)University of Pittsburgh had a 90% reduced MRSA rate in there ICU units. They used a program using screening tests, and gowns. They spent $35,000 and saved over $800,000 in infection costs. (McCaughery, 2006)A U.S. study, published in the American Journal of Infection Control, showed a 53% drop in rates of C.difficile infection when disposable BP (blood pressure) cuffs were used (Alexander, 2013).

YES!

Preventing Hospital Acquired Infections

Does there need to be more studies done on the relationship of bp cuffs and cross contamination?

YES!

This is a good start

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Could this be the answer?

Is this The future?

Ultra Violet Light

http://www.xenex.com/how-uv-disinfection-light-works/

What would Florence say?

The very first requirement in a hospital is that it should do the sick no harm.

-Florence Nightingale

Desired outcome

Decreased Hospital Acquired InfectionsRisk mitigation Keep hospitals in business.Ultimate GOAL?Going to the hospital, and not getting something worse than what you went in for!

References

Alexander. ,May 2013. American Journal of Infection Control. Vol 37 #5.Beard, Mcintryre, Roundtree. 1969. The Sphygmomanometers as a reservoir of Pathogen bacteria. The Medical Journal of Australia. Retrieved from www.gehealthcare.com.CDC. 2007. Guideline for isolation Precautions. Retrieved from www.cdc.gov.CDC. 2009. Retrieved from www.cdc.gov.Dubay. 2009. AARP Bulletin Today. JAMA. 2007. as cited by the CDC in MRSA in Healthcare Settings.Marshall, Richards, McBryde.2013. Do Active Surveillance & Contact Precautions Reduce MRSA. PUB Med.gov.

References (continued)

McCaughery. (14 Nov 2006). To Catch a Deadly Germ. New York Times.McCaughery. Betsy. 2007. New Research & Compelling Economic Data in Support of Infection Prevention. Committee to Reduce Infection Deaths.McGiffert. 2007. Consumers Union Urges Hospitals to Adopt Aggressive New Aprroaches to Stop the Spread of Deadly Antibiotic-Resistant Infections. Infection Control Today.Muto, Jernigan,Ostrowshy, Richet, Jarvis, Boyce. 2003. SHEA guidelines for preventing nosocomial transmission of MRSA. Retrieved from www.ncbi.nim.nih.gov.Richmond, Ira. 2007. Best-Practice Protocols: Reducing harm from MRSA. Nursing Management.Wilcox, Mark. 2008. Screening for MRSA. BMJ. Retrieved from www.ncbi.nim.nih.gov.