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A301
October 17, 2009 3:00 PM - 4:30 PM Room Room 357 |
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| Potential for Cross-Infection with Multi-Use Electrocardiogram Lead Wires | ||||||||
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John F. Termini, M.D., Jerry L. Epps, M.D., Jeremy Bigge, D.O., Stephen K. Patteson, M.D. Department of Anesthesiology, University of Tennessee, Knoxville, Tennessee |
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Introduction:
This study's purpose was to determine the incidence of pathogen contamination of EKG lead wires. Acquired hospital infection rates increased 36% from 1975 to 1995. With increased antibiotic resistance, sicker patients, and elevated numbers of immunocompromised patients, the threat of nosocomial infections is heightened. ASA guidelines require EKG monitoring. ASA recommendations for cleaning are at the end of the day unless visibly contaminated. However, non-visible contamination of wires may contact broken skin areas, central line sites, nasal or oral surfaces of the next patient. Poor understanding of infection control and pressure for rapid OR turnover might lower vigilant inspection.
Materials:
59 Mueller Hinton (150 X 15 mm style) 5% sheep blood agar plates were used. EKG wires and wire tips were the culture sites.
Methods:
University of Tennessee OR cleaning standards include EKG wire and cord wiping between each case with ammonium chloride solution and suspended on a clip. Additionally, 1/16% bleach is added for known MRSA cases. Rooms were chosen randomly. The distal wire and tips were allowed to drop onto the culture plate. The plates were collected after the last procedure and returned to the Microbiology lab. Catalase activity was assessed in Gram positive cocci and Stauphaurex was performed on all catalase positive organisms. Hemolysis was evaluated on all catalase negative, Gram positive organisms. Alpha hemolytic organisms were plated on Enterococcus agar. The Gram positive rods were identified by Gram staining and colony morphology alone. Indole and oxidase activity were measured in Gram negative organisms along with complete identification.
Results:
Some organisms had different morphologies on the same plate, but were quantified once identification was confirmed. A total of 8 organisms were cultured. Bacillus, Staphylococcus, Corynebacterium, Streptococcus viridans, and Micrococcus were considered environmental contaminates. 17% of the contaminates were pathogenic.[table1]Potential health care acquired pathogens included 7 cases of Acinetobacter baumannii, one Pseudomonas aeruginosa, and one Aspergillus. As additional cases were performed there was a notable increase in wire contamination with same species and new organisms.
Discussion:
The main finding was universal contamination on all 59 plates. Of concern were the occurrences of Acinetobacter in 6 different rooms, one mold colony, one pseudomonas, and one Aspergillus colony. Viruses were not cultured due to cost constraints. ASA guidelines recommend cleaning daily unless visibly contaminated. Even with cleaning, this study had 100% contamination of several samples with escalating organism counts between cases. The costs for disposable wires at this institution is estimated at $100,000/year. As a result, even with the increased expense of a disposable product, the harboring of pathogenic organisms on lead wires with a sicker population, may contribute to nosocomial infections and lead to consideration for disposable wires.
From Proceedings of the 2009 Annual Meeting of the American Society Anesthesiologists. |
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