Multicenter Study of Bacterial Pathogens on Reusable, Cleaned ECG Lead Wires: Are Patients at Risk for Nosocomial Bacterial Infections While in the Operating Room?

Poster Presentation: AORN Chicago IL March 2009

Authors: Nancy Albert, PhD, CCNS, CCRN, CNA, FAHA, FCCM, Director, Nursing Research and Innovation-Division of Nursing and Clinical Nurse Specialist – Kaufman Center for Heart Failure Cleveland Clinic; Kelly Hancock, RN, MSN, Cleveland Clinic; Susan Krajewski, RN, MSN, MPA, Oschner Medical Center; Matt Karafa,, PhD, BA, MS, Cleveland Clinic; Karen Rice, RN, MSN, DNS, APRN, ACNS-BC, ANP, Oschner Medical Center; Susan Fowler, PhD, RN, CNRN, FAHA, Atlantic Health; Colleen Nadeau, RN, BSN, Sharp Grossmont Hospital

 

Purpose of Study

Reprocessing of reusable ECG Lead wires can be a source of microorganism that causes infection. Little is known about growth of pathogenic microorganisms on perceived clean ECG lead wires ready for use by incoming patients. The study is to collect and review the growth of pathogenic microorganisms on cleaned ECG lead wires ready for use on incoming patients, ECG lead wires found hanging by the bedside of a cleaned, ready-to-use room or in a box/cabinet where cleaned ECG lead wires are maintained.

 

Method

Samples of cleaned ECG lead wires from operating rooms (OR), critical care (ICU), telemetry (Tele), and emergency care (ED) departments from four large hospitals (2 urban, 2 community) that maintained ECG lead wire cleaning protocols were collected and swabbed. Laboratory personnel wearing mask, gown and gloves followed an approved swabbing protocol. Samples were shipped to a central laboratory within 24 hours to detect the presence of aerobic bacteria and fungus.

Bacterial results, once identified, were grouped by risk of human infection:

  • At Risk: Bacteria that have a higher risk or could cause infection, have high morbidity or mortality
  • Potential Risk: Bacteria species that have potential to cause infection
  • No/Rare Risk: Bacteria species not known to cause infections in humans

In addition, pair wise differences were used to determine differences in departments or facilities.

 

Results

In total, 201 ECG lead wires tested were found to be harboring pathogenic microorganisms (63% of those sampled) and 226 different bacteria (24 bacteria species) were identified. At risk or potential risk bacteria growth was found on 121 ECG lead wires (38% of those sampled).

The top 5 most prevalent bacteria were:

  • Staphylococcus epidermidis: 60 found (30% of sample)
  • Bacillus species: 51 found (25%)
  • Staphylococcus hominis: 38 found (19%)
  • Staphylococcus warneri: 16 found (8%)
  • Staphylococcus haemolyticus: 8 found (4%)

Of these bacteria, Staphylococcus haemolyticus is an at-risk bacteria and Staphylococcus hominis is a potential risk bacteria.

The top 5 most prevalent bacteria, not included above, were:

  • Acinetobacter iwolfii: 7 found (4% of sample)
  • Enterococcus faecium: 3 found (2%)
  • Staphylococcus aureus: 2 found (1%)
  • Enterococcus fawcalis: 2 found (1%)
  • Streptococcus agalactiae: 1 found (.5%)

Nine bacteria documented were resistant strains – resistant to: Amoxicillin, Ampicillin, Erythromycin, Oxacillin, Penicillin, and Tetracycline). Of the staphylococcus and enterococci species identified on the ECG lead wires, four staphylococcus species were resistant to penicillin antibiotics and eight additional (2 staphylococcus aureus and 6 enterococci species) were sensitive to penicillin antibiotics and vancomycin, respectively.

By clinical area, presence of any bacteria and number of bacteria species per ECG lead wires differed. The ED and Tele were found to have more growth and higher number of species than the ICU. The OR was found to have less growth and number of species than the other departments.

By facility type, both urban hospitals exhibited less bacterial growth and fewer bacterial species than both community hospitals.

 

Implications

Cleaned reusable ECG lead wires carry microorganisms that may cause human nosocomial infection. Facilities should study the rate of resistant bacteria on clean ECG lead wires and identify processes and systems to prevent nosocomial infections from reusable ECG lead wires.

 

Summary by M. Ann Anderson, MS, RN
Director of Clinical Support, LifeSync Corporation