Patient safety and outcomes, nurse productivity and lower hospital costs are driving efforts in hospitals to implement LifeSync® Wireless ECG System with LeadWear.

Mary Hodgerney is the Nurse Manager of the Cardiac Cath Lab, Electrophysiology Lab, and Cardiac Short Stay units, at UMass Memorial Medical Center. She holds a Masters Degree from the University of Massachusetts School of Nursing and is a Certified Acute Care Nurse Practitioner. Mary was formal lecturer for over 20 years for the Frontiers in Critical Care Nursing Symposium.

 

Could you describe for us the LifeSync System and its design specifically to increase hospital productivity and patient safety and how your facility implemented the LifeSync System?

We went with the LifeSync System for two reasons: one, because it was a wireless option for our patients and we run an ambulatory unit so that patients are frequently up and walking around. And two, this system allowed them to be much more mobile without being tethered to a bed and to a cable and a monitor. Another reason we liked it was because it’s one-patient use and the LeadWear® is thrown away after each patient so that each patient coming in gets their own set of LeadWear®.
The LifeSync worked with our patient monitoring system, and it actually has adapters so that it works with pretty much any system as far as I can see. We have it on several different systems here in our hospital. They put a transceiver on the current monitor and then that connects to the monitor itself. The patient also wears a transceiver and it communicates between the transceiver and the monitor.
Your patient’s, pre-op, are allowed to get up and walk around before the procedure?
Yes. We have a lot of patients that come in as same-day caths. Basically they come in from their homes, and we’ll get them ready for the procedure. But you know procedure times aren’t predictable. And in the meantime we do allow them to get up and go to the bathroom and kind of ambulate and sit in the chair and things like that. Post procedure, we also need to get them up ambulating before they can go home. So there’s quite a bit of mobility in our patient population.

 

How has this affected patient satisfaction?

Our patients love the system. Actually several of them commented when we first implemented it, that they had been in recently, and when they came back they said how much more they liked this system because they did not feel as tethered and as hemmed down in the bed. They felt like they had a lot more freedom, it was more comfortable. When they turned over they were not twisting up in wires or lying on wires. So it really was a huge patient satisfier.

 

What about during the actual cath procedure?

One of the reasons we went with this product was because it could be used with our system and also with the system in the cardiac cath lab and in the EP lab. Both areas were a little bit leery about trying the LeadWear® because our typical procedure was to change the leads when the patient got into the cath lab room and put them on the back of the shoulders so that it wouldn’t interfere with the fluoroscopy. And the doctors were a little bit leery about trying it because they really expected it was going to impact their views. And much to everyone’s surprise, due to LeadWear’s radiolucency, the fluoroscopy was clear as a bell. We don’t have to move the leads. We don’t have to take them off. And we just switch the cable from the cath lab monitoring to the short stay monitoring and then back again when they return post-op.

 

Did you notice any difference in the quality of ECG signal with the LifeSync® System?

We noticed a huge difference after implementing the LifeSync® System. In fact, there was much, much less artifact. Our EP lab, who had a system that was different from the cath lab and from short stay, asked if they could use it as well and trialed it on theirs. They typically have a lot of noise with their monitors. So we switched them over to the LifeSync® System, too. They use the LifeSync®12-lead. And they absolutely loved it. They got a much clearer picture, there was much less noise in artifact, and they’ve never gone back.

Because the tracing is easier to look at, it’s easier to interpret. And when the patient is walking around, you can still see them on the monitor because it has a very decent range that it will pick up the patient trace as well.

 

How you noticed any difference in your staff’s productivity as patient move through the cath and EP labs?

Well, there’s a lot less time connecting, disconnecting, reconnecting and moving leads when changing patients over from one monitoring system to another. Basically we put LeadWear® on when they are admitting to the short stay area. The patient wears it through their procedure until they are discharged. Since the rest of the hospital now has areas of using LifeSync® System, when a patient is admitted to one of our cardiac units they continue wearing the LeadWear®. It’s really helped with our transport because you don’t need a special monitor, you can sync to the transport monitor. Patients can just transfer as they are.

 

Has the LifeSync® System increased productivity in your procedures?

Yes. We’ve saved a lot of time. Before we’d have to not only move the patient but take them off one set of leads and move the leads from the chest to the back. Afterwards, the leads had to come off again and be moved. With LeadWear® you can just put it on once and leave it there. So it’s really expedited the process.
Have you notice any difference in leads-off or in-ops alarms with the LifeSync® System?

We rarely have a leads off alarm with this system. We don’t spend time connecting and reconnecting leads because with the LeadWear® they just don’t fall off. We used to spend time checking false alarms because the leads would fall off. And all of that’s very irritating to the patient’s skin, too, plus you know it hurts when you pull off those sticky electrodes. I don’t think we’ve had any leads fall off. My recollection is that we have not had one of those alarms since we’ve implemented the LifeSync® System and LeadWear® . I’m assuming we must have some, but you never hear alarms – it’s one of the quieter places. You know when you’re in the ICUs you always hear the monitors going off for one thing or another. With the LifeSync® System and LeadWear® it’s much, much quieter now.

 

With the Joint Commission’s increasing emphasis on patient safety, how does the LifeSync®System support your efforts to improve patient safety?

Patient falls are a big focus right now for the Joint Commission patient safety. Our patients are ambulatory, so between the fact that some of them have had medications that could affect their balance and awareness and that we get them up and walking around for recover; it’s kind of double whammy for them.
Before the LifeSync® System we would have somebody walking beside the patient holding the monitor and their ECG leads or other cords would be dragging on the floor. It presented a real potential for tripping, not just for the patient but for the staff member as well. We have had doors close on the dangling ECG wires in the bathroom, which can trip up the patient because it puts a pull on their ECG leads.

Now, with the LifeSync® System, we find that the patients just really kind of walk around and the staff is just there to support the patient. But neither one of them has to worry about tripping over wires or getting tangled up in things or getting stuck in doors.
We feel it’s safer for our patients because they don’t have to worry about their leads – they can just look straight ahead and not worry about where the wires are or where the cords are. And it’s easier for staff as well.

 

How has the LifeSync® System affected your staff satisfaction?

My staff loves this product. They’ve always been very complimentary about the product. It was such a huge change for them. Most of them had come from ICUs where the patients are wired to the max. So to have a patient get up and just have a little box on their arm, (some of them wear the telemetry box in their front pocket) and they’re off and running.
Reusable ECG wires have been the standard in the hospital care for over 60 years. Studies have shown that the ECG lead wires can be a leading vector for hospital-acquired infections. How has the LeadWear® Disposable ECG lead wire, as a part
of your comprehensive infection control bundle protocol, contributed to reduction in your HAI rates?
I can tell you that patients like the idea that they’re the only ones that have had this LeadWear® Disposable on. When I’ve looked at other equipment that we have and the cleaning protocols, the wires are very difficult to adequately clean. This way there’s no chance for anything to be transmitted. Our infection control nurses really like LeadWear® as well, too, because they are familiar with the organisms that linger on wires, as well as the timeframes that they can stay on wires, which can be days and sometimes weeks.

 

With the improvements of productivity, patient safety and the possible reduction in infection rates that you’ve seen with this new technology, has the LifeSync® System paid for itself in your facility?

Not everything can be quantified from a monetary perspective. I think in terms of what we’ve prevented,
even one patient fall would pay for an awful lot of LeadWear®. One infection, same thing. The costs associated with
hospital acquired infections are huge. So from the perspective of promoting a better patient experience, we get a lot of repeat patients that are happy to come back here. In that sense it’s paid for itself because people like coming to our facility and they like the technology that we have here.

How do you budget for the LifeSync System, including the LeadWear®, on an ongoing basis?
We put it in as part of our cost of supplies and it’s just budgeted on an annual basis as part of our kind of the cost of doing business.

 

Any other comments you would like to add?

I had heard about LifeSync® System very early in its development. We were very pleased to be one of the first hospitals to use it on the East Coast. We’ve had very good experiences with the company and with the product. And as a result of our experiences, the CCU is now using it, the cardiac step-down unit is using it, and our cardiovascular floors are using it as well. And they have had kind of the same experiences with the decrease in alarms and greater patient safety that we had. It’s streamlined the whole process because now LeadWear® is more cost effective when patients can keep it on throughout their hospitalization.

INVESTIGATING ELECTROCARDIOGRAPHY LEAD WIRES AS A RESERVOIR FOR ANTIBIOTIC-RESISTANT PATHOGENS

Hetal Gandhi M.D., Sonia Sharma D.O., Rebecca Beveridge BSN, donna Gilski APN, Parag Patel, D.O. Advocate Lutheran General Hospital, Park Ridge, IL

 

Background

Nosocomial infections are by far one of the foremost threats to the healthcare system today, leading to increasing health-care costs, increased morbidity and mortality for the patients who acquire them, as well as being one of the principal factors contributing to the multi-drug resistant strain of pathogens which are currently on the rise (Table 1).¹  Steps of limiting the spread of infection have been underway for some time now, including proper hand washing techniques using stronger cleansers and restricting potential carriers of infection.  One thing that these measures may have overlooked as a source of drug-resistant bacteria is reusable electrocardiography wire.  Bedside ECG lead wires have the potential to harbor organisms, leading to serous nosocomial infections in hospitalized patients.² ³  This study investigates ECG lead wires as a reservoir for pathogens that are resistant to antibiotics.

 

Method

  • 35 EKG lead wires randomly selected from the Intensive Care Unit.
  • EKG leads disinfected ( using standard protocol) and cultured prior to patient use.
  • 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 try pie sory broth ( TSB ) .
  • Culture incubated for 12 – 24 hours.
  • Culture medium separated into 2 Petri dishes: one with blood agar, the other with MacConkey medium.
  • Samples monitored over 48 hours and organism growth was identified.

 

Results

  • Out of 35 cultures, 57 organisms were detected.
  • Of these 35, 65% (n=23) were positive for Coagulase negative staphylococcus, 11% (n=4) were methicillin sensitive staphylococcus aureus (MSSA), 14% (n=5) were vancomycin sensitive enterococcus, 6% (n=2) were vancomycin resistant enterococcus (VRE), 3% (n=1) were found to be highly resistant acinetobacter baumanii, 20% (n=7) were other organisms including: Clostridium, Flavimonas, Dipthroids, Enterobacter (Figure 1,)
  • Out of these isolates, 74% (n=42) of the organisms were found to be resistant to one or more antibiotics.

 

Discussion

Nosocom1al infections pose a tremendous health hazard, not only to critically ill patients, but also to hospital staff. Over the years. measures have been taken to limit the spread of infection, such as proper hand-washing techniques . better cleansers, replacing reusable medical equipment, and the removal of certain reservoirs of infection . This Study illustrates that ECG lead w ires are reservoir source for multidrug resistant organisms in intensive care unit. Failure to effectively decontaminate ECG leads wire can result in an invasive infection by multidrug resistant organisms. Decontamination methods applied to reusable leads have not been shown to be very effective in eliminating these organisms. Disposable ECG lead wires may reduce the risk of transmission of hospital infection and improve patient safety.

 

References

1. HealthGrades. Fourth Annual Patient Safety In American Hospitals Report. April 2007. Available at: http:// www.eureka lert.org/ lmages/re!ease_graohics/pdf/PatientSafetylnAmerlcanHospitalsStudy2007Embargoed.pdf Accessed March 30. 2008.

2. Jancin 8 . Antibiot ic resistant pathogens found on 77% of ECG lead w ires. Cardiol News. March 2004; 2:14.

3. Quinton Brown 0. Elect rocardiography W ires: A Potential Source of Infection. NT/ News. May 2006: 23:1-4 .

 

Acknowledgement

The authors wish to thank Marguerlte Grlboglannls. SM (ASCP), MPA,  CIC of Advocate Lutheran General Hospital Infection Control Department for her assistance In this study.

Optimizing Bedside ECG Monitoring with Wireless System

H Gandhi MD, S Sharma, DO, D Gilski APN, R Beveridge RN BSN, D Kantoris RN BSN, N Davis PhD, P Patel DO FACC

 

Background

In the critical care environment, false alarms and nuisance alarms associated with traditional ECG wires pose a safety risk to patients and burden the nursing staff by taking them away from the bedside. Lutheran General Hospital conducted a study of traditional ECG monitoring with lead wires and LifeSync® Wireless ECG System with LeadWear®. Each system was evaluated for bedside alarm accuracy and consistency of 12-lead ECG recordings.

 

Method

Forty-seven medical and cardiac intensive care unit patients were monitored for alarm accuracy over a 24 hour period. Each patient was monitored for the first 12 hours by using either traditional ECG monitoring and lead wires or the LifeSync® Wireless System with LeadWear® followed by the other system for the next 12 hours. True and false alarms were analyzed for both systems using Chi-square test. In addition, 47 medical and cardiac intensive care patients were evaluated for consistency in 12-lead ECG recordings. There 12-lead ECGs were recorded from each patient using both traditional ECG monitoring and lead wires and the LifeSync® Wireless System with LeadWear®.

 

Results

A total of 513 alarm events occurred with traditional ECG monitoring with lead wires of which 73% were due to true patient alarm conditions and 27% were due to motion artifact or other causes of artifact such as poor connections, poor skin preparation, or other cause of electrical noise. A total of 400 alarm events occurred with LifeSync® Wireless ECG System with LeadWear® of which 83% were true and 17% were false alarms due to motion artifact or other factors. The LifeSync® Wireless ECG System with LeadWear® demonstrated a 37% decrease in false alarms and 14% increase in true alarms. The data for false alarms was statistically significant between the two systems. Consistency of 12-lead ECG recordings demonstrated that the traditional lead wire system had 4 patients with lead misplacement, while there were no lead placement issues noted with the LifeSync® Wireless ECG System with LeadWear®.

 

Conclusions

LifeSync® Wireless ECG System (LS WECG) with LeadWear® provided more alarm accuracy and less incidence of false alarms resulting from motion artifact or other cause of artifact compared with traditional ECG wired system (TECG). In addition, consistent lead placement for accurate 12-lead ECG recording was confirmed.

 

Update

Following the study, Lutheran General Hospital, Park Ridge IL incorporated LifeSync® Wireless ECG System in its medical ICU, Cardiac ICU, and Surgical ICU. The Lifesync® System will be expanded to all critical care and intervention unites in the hospital’s new expansion through 2009.

 

Source: AHA, “2008 Scientific Sessions Poster Session, November 10, 2008, Available at http://circ.ahajournals.org

Heart Center Documents 58% Decrease in Lead-Off Alarms using LifeSync® System

Florida Hospital Orlando

 

Introduction

Florida Hospital Orlando, the largest of seven hospitals in the Florida Hospital System, houses the Florida Hospital Cardiovascular Institute, ranked number three in the nation for number of open heart surgeries. Twenty-five thousand patientsi are admitted into the Institute where 11,000 cardiac proceduresii and 2,000 open heart surgeriesiii are performed annually. Since 1981, the Institute has performed more than 82,000 heart surgeries.iv

 

Study

In 2008, a research study was conducted to determine if disposable LeadWear® from LifeSync Corporation reduced infection and increased nursing productivity by decreasing time spent replacing ECG leads off and detangling wires. The IRB-approved protocol was written and conducted by Florida Hospital, Center for Nursing Research & Innovation Department. LifeSync Corporation donated the LeadWear® for the study.

 

Protocol

The study tracked ECG-lead dislodgement for 40 days by determining the number of times the ECG tech called a nurse to correct such a problem on a wired system and compared the result to the same data on patients wearing LeadWear®. A mean staff time required to correct the dislodgement was determined.

 

Results

Nurse Productivity:

When the data was compared, it was found that the volume of calls due to dislodgement dropped from 1,541 calls in 40 days while the patient was on traditional ECG wires to 647 calls in 40 days with the patient on the LeadWear®, representing a 58% reductions in leads off or 38.53 daily calls dropping to 16.18. The average time to correct the problem by the nurse was 6.61 minutes per call, a decrease in unscheduled nursing time spent handling dislodged ECG wires.

Patient Safety:

Time-off-monitor is a critical safety factor. Using the same data collected and accounting for the patient safety aspect of time off monitor, the study found that while using the LeadWear®, the patient time “off monitor” decreased by 105 minutes per day.

Infections v:

Prior to the use of disposable LeadWear® the infection rate was a very low 2.6%. After implementing the use of disposable LeadWear® the infection rate further reduced to 1.6% or equivalent to a 38% reduction in infection incidence.

 

i See www.flheart.org , accessed 3/10/2009.

ii Ibid.

iii See www.floridahospital.com/Services/CardiovascularInstitute.aspx, accessed 3/10/2009.

iv Ibid.

v Calculated by LifeSync Corporation from data provided by Florida Hospital Orlando, March 4, 2009.

LifeSync® Wireless ECG System Reduces Time Off Monitor by 90% and Provides 87% Alarm Accuracy

Summary of Data by Donna Quinton Brown RN, AASN, Alumnus CCRN, LifeSync® Corp. and M. Ann Anderson, MS, RN Director of Clinical Affairs, LifeSync Corporation

 

In January of 2008 a 395-bed hospital located in St. Petersburg, Florida added the LifeSync® Wireless ECG System to their infection control bundle and monitoring procedure. The hospital began a three month study using the LifeSync® Wireless ECG System in order to determine the effectiveness of the LifeSync® System for three primary points of interest:

The first was the amount of time off monitor for patient ordered on monitor (i.e., lead pop off, electrode off, etc.);

The second was the validity of alarms; and

The third was infection rates for MRSA, VRE, Acinetobacter, and C. Difficile (combined) for the first quarter of this year compared to the average of those infection rates for the four quarters of the previous year

 

Study Population and Collection Methods

The patient populations studied for the alarm and time off monitor were chosen at random by the hospital clinicians from the ED, ICU, CVICU, CVT and PCU of the hospital. The information was collected by the hospital’s infection control nurse and consisted of retrospective infection rates from the previous year’s four quarters (averaged) as well as infection rates observed during the study. The alarm data for the consensus validation and for the period of the study was collected and reviewed in the same patient care areas by the staff clinicians and the LifeSync field employee who was providing validation support. Hard copies were made and reviewed by the hospital Director of Acute Inpatient Care. Any patient data that could not be printed for verification and backup were not used in the study. All data were reviewed by the Director of Acute Inpatient Care and have been supported by the hospital¹. Information for the time off monitor was collected by the LifeSync field employee and the staff clinicians. The hospital provided full disclosure of data acquired for monitoring time and monitoring subjects at the unit’s central stations for the consensus validation period. The patients involved in the alarm portion of the study were the same patients involved in the leads off portion of the study. All data were printed and reviewed by the Director of Acute Inpatient Care if hard copy back up could be obtained for review and verification.

 

The Hospital’s Findings, as Reported to LifeSync Corporation

Time off Monitor1:

The hospital saw a 90% reduction in unscheduled time off monitor with the LifeSync® Wireless ECG System compared to the wired monitoring system. Credit for this improvement in patient safety was given solely to the LifeSync® Wireless ECG System since that was the only difference in the two groups of monitored patients.1

 

Alarm Accuracy Data1:

The hospital reported that the alarms noted with patients on the wired ECG systems were 30% true (accurate) and alarms noted with patients on the LifeSync® Wireless ECG System were 87% true (accurate). Again, the improvement was credited by the hospital solely to the implementation of the LifeSync® Wireless ECG System since that system was the only difference in the groups of monitored patients.1

STEMI Time Reduction1:

Code STEMI time was reduced by 5 minutes¹

Infection Rate Data1:

The infection rate for the first quarter of 2008 compared to the average rate of the four quarters of 2007 showed a 71% drop in MRSA, VRE and acinetobacter and a 30% drop in C. difficile for which The hospital gave partial credit to the LeadWear® Wireless ECG System.

 

1. Article references availible upon request.

OPTMIZING BEDSIDE ECG MONITORING WITH A DISPOSALBE WIRELESS SYSTEM

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

 

Background

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.

 

Methods

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.

 

Results

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).

Conclusions

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.

 

References

1. HealthGrades. Fourth Annual Patient Safety in American Hospitals Report, April 2007. Available at: http://www.eurekalert.org/images/release_graphics/pdf/PatientSafetyInAmericanHospitalsStudy2007Embargoed.pdf Accessed March 30, 2008

2. Jancin, B. Antibiotic resistant pathogens found on 77% of ECG lead wires. Cardiol News, March 2004; 2:14.

3. Quinton Brown, D. Electrocardiography Wires: A Potential Source of Infection.” NTI News, May 2006; 23:1-4.

 

Acknowledgement

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.

Investigating Electrocardiography Lead Wires as a Reservoir for Antibiotic-Resistant Pathogens

Hetal Gandhi, Sonia Sharma, Donna Gilski, Rebecca Beveridge, Parag Patel, Advocate Lutheran General Hosp, Park Ridge, IL

 

Background

Hospital-acquired infections caused by antibiotic- resistant bacteria have become a major public health concern in recent years. Electrocardiography (ECG) lead wires conceal antibiotic-resistant bacteria and act as a vehicle for cross-contamination. The effects of these pathogens can be deadly to patients and detrimental to hospitals’ bottom line increasing costs and patient’s length of stay. A recent study examines the organisms found on ECG lead wires that are reused on patients.

 

Method

After terminally cleaning intensive care units including ECG wires and cables, 35 randomly selected ECG lead wires were cultured before patient use. The cultures were obtained by “dipping and swirling all five lead wires together in a sterile container with a trypic soy broth (TSB) for 15 seconds.” After incubating the TSB for 12-24 hours, two Petri dishes, one of blood agar and one of MacConkey medium were plated with TSB and observed for growth and identification of organisms for a period of 48 hours.

 

Results

Seventy-four percent (74%) of the 57 organisms found on the 35 cultures were resistant to one or more antibiotics. Of the 35 cultures, “65% (n=23) were positive for coagulase negative Staphylococcus (Staph), 11% (n=4) were Methicillin sensitive Staphylococcus aureus (MSSA), 14% (n=5) were Vancomycine sensitive Enterococci species (VSE), 6% (n=2) were Vancomycine resistant Enterococci (VRE), 3% (n=1) were highly resistant Acinetobacter baumanil and 20% were other organisms including Clostridium, Flavimonas, Diptheroids and Enterobacter.

 

 

 

 

 

 

 

Conclusions

Reusable ECG lead wires in the intensive care unit setting harbor a variety of drug resistant organisms that can cause serious nosocomial infections. Despite rigorous decontamination methods, organisms on the ECG wires were not eliminated increasing patient’s risk of a hospital-acquired infection. Therefore, the study concluded that disposable ECG lead wires may reduce the risk and spread of hospital infections as well as improve patient safety.

 

Source: AHA, “2008 Quality Outcomes Abstracts,”.Circulation Vol. 117, No 21. May 21, 2008. Available at http://circ.ahajournals.org/subscriptions/, accessed June 9, 2008

Early Patient Mobilization Key to Earlier Patient Recovery

The Problem

Physical deconditioning of ICU patients from illness, sedation and prolonged bed usage can occur within days of patient admission. The effect of deconditioning of the patient include weakness and neuromuscular abnormalities within 7 days of an ICU stay1, skeletal muscle strength may decline 1 to 1.5 percent per day of bed rest and up to 50% of the total muscle mass in two weeks2. Muscles that maintain posture, transferring position and ambulation tend to be the muscle groups that lose strength most quickly3. In addition, decrease in cardiovascular and respiratory reserves, neuropathies and myocardial dysfunction can also occur due to prolonged immobility3.

 

The Benefits

The benefits of mobility in traditional rehabilitation settings can also be seen in the ICU. The heart is 30% more efficient when not in a supine position as oxygen consumption is decreased. Venus statis, thrombophlebitis, deep vein thrombosis, and pulmonary emboli are all preventable by patient mobility. Kidney and urinary functioning are more effective in mobile patients. 1

 

Studies

Recent studies have discussed the benefits of early mobilization. Bailey et al proposes that activity earlier in the patient stay is a candidate therapy to prevent or treat neuromuscular complications of critical illness4. Perme et al suggest that improving mobility of patients has the potential to facilitate weaning from ventilation and improve outcomes of transplantation5. Stiller believes that mobility may decrease duration of mechanical ventilation and length of ICU and total hospital stay. Stiller also discusses the safety factors such as having to deal with patient attachments6.

 

Reduced Length of Stay

Peter Morris MD conducted a study to address the lack of data on early mobilization. The study found that patients receiving earlier mobility had their length of stay reduced by 3 days compared to the stay for patients who did not receive early mobility. This reduction included a reduced ICU stay by more than a day3. The study also found that patients receiving early mobilization were out of bed earlier, progressed more quickly to active physical therapy and experienced no adverse events during ICU therapy sessions7.

 

References

1. Pennington K. Beach, Catalyst Online. http://www. musc.edu/catalyst/archive/2008/co2-15beach.html. Accessed May 20, 2008.

2. Wagenmakers AJM. Muscle function in critically ill patients. Clin Nutr. 2001; 20(5):451-454

3. Morris PE. Moving our critically ill patients. Crit Care Clin. 2007; 23(1):1-20. doi:10.1016/j.ccc.2006.11.003.

4. Bailey P, Thomsen , Spuhler V, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007; 35(1):139-145

5. Perme C, Southard R, Joyce D, Noon G, Loebe M. Early mobilization of LVAD recipients who require prolonged mechanical ventilation. Tex Heart Inst J. 2006; 33(2):130-133

6. Stiller K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin. 2007; 23(1):35-53. doi:10.1016/j.ccc.2006.11.005

7. Physical therapy in intensive care reduces hospital stays. News-Medical.Net. http://www.news-medical. net/?id=32685/. Published November 20, 2007. Accessed May 20, 2008.

One Hospital’s Victory Over Hospital Acquired Infections Zero for 18 Months and Counting

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

 

Overview

Bon Secours, St. Francis Medical Center, a 319-bed facility located in Midlothian, VA, opened in September of 2005 using the LifeSync® Wireless ECG System with the LeadWear® Disposable Cable Replacement System as part of their safety strategy and infection control program in the Critical Care Units. Specific Critical Care Units include the following: ICU (10 beds), Telemetry (21 beds), IVCU (6 beds), Medical (36 beds) with Remote Telemetry (8 beds), Surgical (36 beds) and the New Life Center (21 beds).

As a result of the zero central line infections and ventilator associated pneumonia rates in the critical care areas, Bon Secours OR Adopted the LifeSync® ECG System.

  • “The surgical site infection (SSI) rate had been very good before the wireless ECG system began to be used in the OR, but after the first four months of using the system, the SSI rate dropped 40% without any changes being made to any other infection prevention practice.” 3
  • “The decrease in the total number of infections and the corresponding costs that were avoided as a result of implementing this new wireless and disposable system paid for the system in the first two months of use.” 3
  • MedMined, a Cardinal Health company, tracks infections and their corresponding impact to hospital budgets. They have determined that 4 percent of infections wipe out 185% of net inpatient operating profits. 4

As of July 2008, Bon Secours has experienced 18 months with zero central line infections or ventilator associated pneumonia events. 5

 

Background

St. Francis’ administrators are aware of the estimated two million hospital acquired infections (HAI) that occur each year. 4 These HAI’s result in 90,000 deaths a year, millions of days added to the patients’ length of stay and an estimated $30.5 billion in added hospital costs each year.4 St. Francis had an opportunity to implement solutions and technologies to protect their patients from adding to those statistics. Ricky de Jesus, Administrative Director for Critical Care at Bon Secours St Francis Medical Center stated, “A lot of research shows that even after you attempt to clean a room, there have been positive cultures on surfaces for MRSA and VRE in different ICU rooms. So, what I attempted to do was to eliminate as many of the factors that could potentially hold this MRSA and VRE.”1

Bon Secours identified ECG leadwires as a hidden area of infection within the hospital. A study conducted by Dr. Paul Brookmeyer from the University of Wisconsin Hospital and Clinics found that out of 100 randomly selected ECG lead wires tested, 77% were contaminated with one or more nosocomial pathogens.2 De Jesus commented that “No matter how much you attempt to clean, there’s always things that stay behind, the disposable leads provided an option for not having to be cleaning between patients for the transmission of disease.”1

“No matter how much you attempt to clean, there’s always things that stay behind, the disposable leads provided an option for not having to be cleaning between patients for the transmission of disease.”1

As of October 2008, the Centers for Medicaid and Medicare (CMS) will not reimburse hospitals for some HAI’s. Ricky De Jesus estimated that the cost associated with any wound infection to be $20,000 per patient. As infection rates increase the hospital’s bottom line decreases. The use of disposables may help to lower infections therefore increasing a hospital’s bottom line. 1

 

“Hidden Areas of Infection”

– Mission Critical Education Piece

A new public health education program, entitled “Hidden Areas of Infection,” (http://www.missioncriticaltv.com/index-8-1.html) documents how an acute care facility in Virginia is solving this enormous infection control problem through planning, education, and the right equipment – including the widespread use of disposable products. Prime targets for disposable technologies are reusable products that see use on thousands of different patients, which can dramatically increase the risk of cross-contamination. Examples include blood pressure cuffs, pulse oximetry sensors, and electrocardiogram (ECG) wires. 1

 

References:

1 Mission Critical: Hidden Areas of Infection. Public Health Education Program. Production script obtained 8/25/08 from Capital Media Group, Inc. (LS-954)

2 Jancin, B. (2004, March). Antiobiotic-resistant pathogens found on 77% of ECG lead wires. Cardiology News. vol 2.

3 Barnett, Todd. (2007, August). The not-so-hidden costs of surgical site infections. AORN Journal, 86 (2), 249-258.

4 Hess & Finck. Real-Time Infection Protection. Healthcare Informatics. August 2007.

5 Signed statement by Ricky de Jesus Administrative Director, Critical Care Bon Secours St. Francis Medical; Midlothian, VA.

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