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.

pouch

 Transceiver Pouch

LifeSync Corporation recommends the use of the Patient Transceiver Pouch to better isolate and locate the patient transceiver when connected to the LeadWear® Disposable. The pouch features resealable openings for easy insertion and removal of the LeadWear® Disposable product, the Smart Battery and the Token.

 

 

battery-image

LifeSync® Smart Battery

The LifeSync® System uses rechargeable 3.6 Volt lithium-ion batteries. The battery is used to power the Patient Transceiver and is interchangeable with Monitor Transceiver. When plugged into the Monitor Transceiver the battery is charged in under eight hours. A fully charged battery will power a LifeSync® System Patient Transceiver for a minimum of 24 hours, or a LifeSync® System Monitor Transceiver for a minimum of 12 hours.

 

 

token

LifeSync® Token

The LifeSync® System Token is used to sync the Patient Transceiver and Monitor Transceiver. The Token is not specific to any particular transceiver but works by transferring information between two transceivers during the synchronization process.

 

 

 

armband

Arm Band

An Arm Band is available which allows the LifeSync® System Patient Transceiver to be worn securely on a patient’s upper arm. Recommended for the stress lab.

REVOLUTIONARY ECG SOLUTIONS

REVOLUTIONARY ECG SOLUTIONS

HealthEdge Completes Acquisition of LifeSync

Tampa, FL – May 4, 2012

HealthEdge Investment Fund II, L.P. (“Fund II”) announced today that it has acquired a majority interest in LifeSync Corporation (“LifeSync”), its first portfolio company in Fund II.

Headquartered in Ft. Lauderdale, Florida and founded in 2000, LifeSync is a manufacturer and distributor of patent-protected, disposable, wireless, radiolucent ECG (or EKG) devices that have applications in numerous and diverse departments in hospitals and other surgical facilities. The product is designed to lower hospital costs due primarily to increased nurse productivity and patient mobility, improve the quality of vital signs and data transmission, reduce false alarms, enhance imaging results, and reduce the rate of infection at hospitals. The company has an excellent blue chip customer list, and the product is currently sold in the U.S. market through direct sales representatives.

In connection with the transaction, LifeSync has appointed Kim Davis as its Chief Executive Officer. Mr. Davis is a 25 year+ seasoned executive with a track record of improving shareholder value by making companies more efficient, productive, profitable, and global. Mr. Davis was most recently the Chairman, CEO, and President of SmartFlow Technologies, a company in the crossflow filtration space, where he held responsibility for all aspects of worldwide operations including sales, marketing, research and development, manufacturing, and finance. Mr. Davis successfully revived a near failed business (and investment) on behalf of a private equity fund culminating in a positive exit to a strategic buyer. Prior to that effort, Mr. Davis was the President and CEO of Porex Corporation, a subsidiary of WebMD Corporation, where he grew annual sales from $56 million to $122 million through organic growth, international expansion, and acquisition. Mr. Davis has also served as President and CEO of Gelman Sciences Inc., a manufacturer of life science disposables, FDA approved medical devices, and process filtration, where he grew annual sales from $81 million to $125 million and sold the business to Pall Corporation, and COO of Promega Corporation (a Baird Capital Partners portfolio company), a developer of molecular biology reagents, DNA and protein purification kits, fluorescent tags, and cellular regulation kits supplied to the pharma and biotech markets.

According to Mr. Davis, “I am very pleased and enthusiastic about joining the LifeSync team and working with HealthEdge to build a leading platform in the patient monitoring device space. I look forward to working closely with our sales team and supporting the growth and success of LifeSync.”

HealthEdge Managing Partner Brian Anderson said, “We are thrilled about entering the patient monitoring device market and believe LifeSync’s wireless and disposable alternative to fixed wire transmission has significant advantages over traditional lead wires. We intend to work closely with the LifeSync management team to grow the business organically and will also use the existing infrastructure as a platform to acquire new products in the patient monitoring space.”

ABOUT HEALTHEDGE
HealthEdge Investment Partners, LLC is an operating-oriented private equity firm founded in 2005 that focuses exclusively on the healthcare industry. HealthEdge seeks to achieve superior returns by investing in businesses that benefit from the knowledge, experience and network of relationships of its partners. HealthEdge’s partners have more than 85 years of combined operating experience in healthcare as CEOs and investors. For more information on HealthEdge, visit www.healthedgepartners.com.

ABOUT LIFESYNC CORPORTATION
LifeSync, headquartered in Ft. Lauderdale, Florida, and founded in 2000, is a medical device company that develops and markets disposable, patient-worn devices that acquire and wirelessly transmit vital signs to patient monitoring systems. The LifeSync Wireless ECG system consists of a disposable LeadWear® set that aggregates ECG and resp iration date from the patient and, through its proprietary Bluetooth® transceiver devices, wirelessly transmits high quality data to any bed-side monitor. The LifeSync system is the first wireless electrocardiogram (ECG) data communications system appropriate for use in high acuity settings. For more information on LifeSync, visit www.lifesynccorp.com.
For more information, please contact Brian Anderson at HealthEdge Investment Partners at (813) 490-7100.

Phone: 954.745.3510
Email: customerservice@lifesynccorp.com
Web: http://www.lifesynccorp.com

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