H. Gandhi, MD; S. Sharma, DO; D. Gilski, APN; R. Beveridge, RN BSN; D. Kantoris, RN BSN; N. Davis, PhD; P. Patel, DO FACC Division of Cardiology, Advocate Lutheran General Hospital, Park Ridge, Illinois
Nosocomial infections are a major risk to patients, visitors and employees. They contribute to health-care costs, morbidity and mortality, and the increase in multidrug resistant bacteria. Traditional ECG (TECG) leads wires have the potential to harbor organisms, leading to serious infections. In the critical care environment, false and nuisance alarms, associated with TECG, pose a safety risk to patients and burden the nursing staff by taking them away from the bedside. Monitoring and alarm systems must be enhanced to match the acuity level of hospitalized patients. In this study TECG monitoring and 12 lead ECG recording was compared to a Wireless ECG system (WECG) made by LifeSync®. TECG lead wires were investigated as a reservoir for pathogens that are resistant to antibiotic. In addition both systems were evaluated for bedside alarm accuracy and consistency of 12-lead ECG recordings.
50 TECG lead wires were randomly selected from the medical and cardiac intensive care units and cultured prior to patient use, after being disinfected (using standard protocol). The snaps at the end of the lead wires were dipped in a sterile cup broth for 15 seconds and cultured using a sterile container containing trypic sory broth (TSB). The culture was then incubated for 12-24 hours and placed in two separate petri dishes, one containing blood agar and the other MacConkey medium. These samples were monitored for the next 48 hours and organism growth was recorded.
47 medical and cardiac intensive care unit patients were monitored for alarm accuracy over a 24-hour period. Each patient was monitored for first 12 hours by using either traditional ECG monitoring or lead wire systems followed by the other system for the next 12 hours. True and false alarms were analyzed for both systems using Chi-square test.
47 medical and cardiac intensive care patients were evaluated for consistency in 12 lead ECG recordings. Three 12 lead ECG were recorded from each patient using both the traditional and disposable systems.
Total of 50 cultures were done and 6 cultures had no growth. Total of 70 microorganisms isolated from 44 cultures (Figure 1)
513 alarm events occurred in the TECG system, of which 73% (n=374) were due to true patient alarm conditions and 27% (n=139) were due to motions artifact or other cause of artifact such as poor connections, poor skin preparation or other cause of electrical noise. (Figure 2)
400 alarm events occurred with the WECG system, of which 83% (332) were true and 17% (n=68) were false alarms due to motion artifact or other factors as described above. It was statistically significant difference in false alarm between two systems (p<0.001) with odd ratio 1.8 (1.3-2.5). (Figure 2)
Consistency of 12 lead ECG demonstrated that the TECG system had 4 patients with lead misplacement, while there were no lead placement issues noted by the WECG system. This difference was not statistically significant (p=0.11 Chi-square test).
Nosocomial infections pose tremendous health hazards to critically ill patients and hospital staff. ECG lead wires are reservoir source of multi-drug resistant organisms in the intensive care unit setting. Failure to effectively decontaminate ECG wire may result in invasive infection by multi-drug resistant organisms. Disposable ECG lead wire may reduce the risk of transmission of hospital infections and improve patient safety. Disposable ECG Lead wire (Lifesync® Lead Wire and Wireless system) provide more alarm accuracy and less incidence of false alarm resulting from motion artifact or other cause of artifact compare with traditional ECG wire system. Consistent lead placement for accurate 12-lead ECG recording was confirmed.
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The authors wish to thank Marguerite Griboiannis, SM (ASCP), MPA, CIC of Advocate Lutheran General Hospital Infection Control Department for her assistance in this study.