What is the evidence linking disposable ECG cables and lead wire systems to decreased hospital acquired infections (HAIs)? What would the cost savings be?

Posted on September 15, 2014 by Amy

Studies focus on identifying presence of bacteria on devices, as opposed to devices being associated as the cause of HAI cases. Likewise, no published literature was identified that specifically demonstrated that use of disposable leads reduces the rate of HAIs.

Evidence Summary sources:

Joanna Briggs
Xue, Yifan. Noninvasive Portable Clinical Items: Healthcare Associated Infections. [Evidence Summaries]. JBI11266, 2014.
Cites studies demonstrating the prevalence of low-risk, potentially pathogenic, and multidrug resistant bacteria on non-invasive devices, including ECG lead wires.

Literature databases:

PubMed: cross infection AND (electrocardiography OR noninvasive devices) AND (disposable OR reusable OR reuse OR “single use”)

Microbial colonization of electrocardiographic telemetry systems before and after cleaning.
Reshamwala A, McBroom K, Choi YI, LaTour L, Ramos-Embler A, Steele R, Lomugdang V, Newman M, Reid C, Zhao Y, Granger BB.
Am J Crit Care. 2013 Sep;22(5):382-9. doi: 10.4037/ajcc2013365.
PMID: 23996417
contamination after cleaning reusable leads

Disposable vs reusable electrocardiography leads in development of and cross-contamination by resistant bacteria.
Brown DQ.
Crit Care Nurse. 2011 Jun;31(3):62-8. doi: 10.4037/ccn2011874.
PMID: 21632593
Review article

Cleaned, ready-to-use, reusable electrocardiographic lead wires as a source of pathogenic microorganisms.
Albert NM, Hancock K, Murray T, Karafa M, Runner JC, Fowler SB, Nadeau CA, Rice KL, Krajewski S.
Am J Crit Care. 2010 Nov;19(6):e73-80. doi: 10.4037/ajcc2010304.
PMID: 21041188
presence of pathogens on reusable leads

Potential micro-organism transmission from the re-use of 3M Red Dot adhesive electrocardiograph electrodes.
Daley AJ, Hennessy D, Cullinan J, Thorpe S, Alexander R.
J Hosp Infect. 2005 Nov;61(3):264-5. Epub 2005 Jul 5. No abstract available.
PMID: 16002182

CINAHL

A similar search of CINAHL did not identify any unique, relevant articles.

Cost savings

The cost savings of decreasing HAIs can be calculated by multiplying the estimated cost of an HAI by the number of HAIs in a given period of time. Then, subtract the cost of disposable equipment for all procedures occurring during that time period (i.e., the number of disposable cables that would be used with patients).

The CDC provides data on estimated cost of HAIs. Start at http://www.cdc.gov/hai/surveillance/. The Direct Medical costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention, 2009, includes estimates for specific types of infections beginning on p. 5.

Are there studies on the safety of midline catheters?

Posted on May 9, 2014 by John

Sharp, Rebecca, et al. “The safety and efficacy of midlines compared to peripherally inserted central catheters for adult cystic fibrosis patients: A retrospective, observational study.” International journal of nursing studies 51.5 (2014):694-702.

Alexandrou, Evan, et al. “Central venous catheter placement by advanced practice nurses demonstrates low procedural complication and infection rates–a report from 13 years of service.” Critical care medicine 42.3 (2014):536-543.

Kanokkantapong, C, N Leeaphorn, and T Kanjanabuch. “The effects of peritoneal dialysis catheter insertion using paramedian versus midline approach on CAPD patients.” Journal of the Medical Association of Thailand = Chotmaihet thanphaet 94 suppl. 4 (2011):S52-S57.

Amerasekera, S S H, et al. “Imaging of the complications of peripherally inserted central venous catheters.” Clinical radiology 64.8 (2009):832-840.

Griffiths, Vivien. “Midline catheters: indications, complications and maintenance.” Nursing standard 22.11 (2007):48-57.

Anderson, N R. “Midline catheters: the middle ground of intravenous therapy administration.” Journal of infusion nursing 27.5 (2004):313-321.

“Applying current research to influence clinical practice: utilization of midline catheters.” Journal of intravenous nursing 21.5 (1998):271.

“Complications related to intravenous midline catheter usage: a 2-year study.” Journal of intravenous nursing 21.2 (1998):76.

The risk of midline catheterization in hospitalized patients: a prospective study… republished with permission from Dr. Leonard Mermel. The risk of midline catheterization in hospitalized patients. Ann Intern Med. 1995; 123:841-844. 1996; 12.1:6

“Initiating a pediatric peripherally inserted central catheter and midline catheter program.” Journal of intravenous nursing 17.4 (1994):201.

Reviewed and updated 4/8/2014 ldt

Should needleless caps be changed before drawing blood samples?

Posted on April 23, 2014 by Lisa

Mathew, Alice, et al. “Central catheter blood sampling: the impact of changing the needleless caps prior to collection.” Journal of infusion nursing 32.4 (2009):212-218.
This study of 91 patients compared 3 methods of blood draws (old cap (existing cap), new cap (replacing old cap with a sterile one), and peripheral methods). Nine false positive cases of bacteremia were identified using the old cap. Researchers recommending changing the cap before drawing culture samples.

What are the best practices for peritoneal dialysis general care and exit site care?

Posted on January 30, 2014 by Amy

Rahman M. Peritonitis in Peritoneal Dialysis: Catheter-Related Interventions and Transfer Set Modifications. [Evidence Summaries], AN: JBI741, Last updated: 21 Jan 2014.

Rahman M. Peritoneal Dialysis: Clinician information. [Evidence Summaries], AN: JBI104, Last updated: 21 Jan 2014.

Clinical effectiveness of different approaches to peritoneal dialysis catheter exit-site care. Best Practice: evidence-based information sheets for health professionals. 8(1):1-7, 2004. [Best Practice Information Sheets]. Last updated: 29 Apr 2011.

Reviewed by John Nemeth 4/14

Use of betadine on postoperative surgical sites

Posted on December 9, 2013 by John

“Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery.” Spine (Philadelphia, Pa. 1976) 30.15 (2005):1689.

Lid scrub may reduce endophthalmitis rate when used with topical Betadine… including commentary by Trattler WB. Ocular Surgery News 2009 vol:27 iss:19 pg:16

Swenson BR ; Hedrick TL ; Metzger R ; Bonatti H ; Pruett TL ; Sawyer RG. Effects of preoperative skin preparation on postoperative wound infection rates: a prospective study of 3 skin preparation protocols. Infection Control & Hospital Epidemiology, 2009 Oct; 30 (10): 964-71.

Giordano, Salvatore, et al. “Povidone-iodine combined with antibiotic topical irrigation to reduce capsular contracture in cosmetic breast augmentation: a comparative study.” Aesthetic surgery journal 33.5 (2013):675-680.

Haas, David Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database of Systematic Reviews. 2014 Dec 21;(12):CD007892. doi: 10.1002/14651858.CD007892.pub5.

Spinal Surgery: Prevention and Management of Infection. [Recommended Practices] 2013

Searched CINAHL, PubMed & Joanna Briggs. Keywords: Betadine or Povidone-iodine, postoperative

Reviewed by John Nemeth 4/14

Updated links for last two items, 10/16/2017 ldt

Is there benefit to routinely screening for urinary tract infection (bacteruria) in hospitalized patients without urinary catheters?

Posted on August 15, 2013 by Amy

The information below pertains to asymptomatic bacteruria because the assumption is if the patient were symptomatic, diagnostic testing would be administered as standard care for the patient.

Here are guidelines for diagnosing and managing asymptomatic bacteruria.

Infectious Diseases Society of America (IDSA) guideline on diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005 Mar 1;40(5):643.
- Based on evidence from at least 1 quality RCT in each case, IDSA recommends AGAINST screening premenopausal, nonpregnant women, women with diabetes, elderly institutionalized persons, older persons living in community, patients with spinal cord injury, patients with indwelling urethral catheter. Also recommends screening pregnant women.
- IDSA does recommend screening prior to transurethral resection of prostate (based on at least 1 RCT) and before other urologic procedures (based on descriptive studies and expert opinion)
- IDSA does not make any recommendation about screening renal or other solid organ transplant recipients

United States Preventive Services Task Force (USPSTF) recommendation on screening for asymptomatic bacteriuria in adults. National Guideline Clearinghouse 2008 Aug 4:12619 or Ann Intern Med 2008 Jul 1;149(1):43.
- Only recommends routine screening for pregnant women.

Guidelines suggest further research is needed to address management of asymptomatic bacteruria in these populations: chronic kidney disease, indwelling urinary devices other than catheters (eg, urinary stents, nephrostomy tubes), selected immunocompromised patients (eg, neutropenia, transplant recipients), and patients undergoing prosthetic implantation (orthopedic or vascular procedures).

Evidence from the guidelines includes hospitalized and non-hospitalized patients. Details of the evidence are provided in the guidelines.

Searches of Medline and CINAHL using combinations of these terms did not identify any papers on routine testing of hospitalized patients.

Urine analysis
Routine, screening
Hospitalized, inpatients
Transplant, immunocompromised

Nursing care for a patient with externalized shunt

Posted on August 9, 2013 by John

Hill, Michelle A multidisciplinary approach to end external ventricular drain infections in the neurocritical care unit. Journal of Neuroscience Nursing, 2012 Aug; 44 (4): 188-93.

Henman, Lita Checklists and Bundles-Not Just for Central Lines Anymore: Using a Standardized Insertion and Maintenance Approach to Eliminate External Ventricular Drain Infections. American Journal of Infection Control, 2011 Jun; 39 (5): E195.

Orsi GB Hospital-acquired infection surveillance in a neurosurgical intensive care unit. Journal of Hospital Infection, 2006 Sep; 64 (1): 23-9.

Cummings R Understanding external ventricular drainage. Journal of Neuroscience Nursing (J NEUROSCI NURS), 1992 Apr; 24 (2): 84-7.

Lwin, Sein, et al. “External ventricular drain infections: successful implementation of strategies to reduce infection rate.” Singapore medical journal 53.4 (2012):255-259.

Littlejohns, Linda R, and BrettTrimble. “Our policy on external ventricular drainage systems includes the procedure for priming the system. Does it really have to be primed?.” Critical care nurse 25.3 (2005):57-59.

Criddle, Laura M. “Is it an expected practice for critical care nurses to irrigate an external ventriculostomy drainage (EVD) system with tissue plasminogen activator (tPA) to break up blood clots in the tubing to facilitate drainage, thereby preventing increased intracranial pressure?.” Critical care nurse 27.3 (2007):78-78, 81.

Searched PubMed & CINAHL. Keywords: external shunt, externalized shunt, (nursing or nurse)

Evidence Matters

Evidence-based information for Emory

Category Archives: Nosocomial Infections