Blood pressure cuffs as a vector for transmission of multi-resistant organisms: Colonisation rates and effects of disinfection

Guidelines for reducing the environmental impact of general anaesthesia

OBJECTIVE

To provide guidelines for reducing the environmental impact of general anaesthesia.

DESIGN

A committee of ten experts from SFAR and SF2H and SFPC learned societies was set up. A policy of declaration of competing interests was applied and observed throughout the guideline-writing process. Likewise, it did not benefit from any funding from a company marketing a health product (drug or medical device). The committee followed the GRADE® method (Grading of Recommendations Assessment, Development and Evaluation) to assess the quality of the evidence on which the recommendations were based.

METHODS

We aimed to formulate recommendations according to the GRADE® methodology for three different fields: anaesthesia vapours and gases; intravenous drugs; medical devices and the working environment. Each question was formulated according to the PICO format (Population, Intervention, Comparator, Outcome). The literature review and recommendations were formulated according to the GRADE® methodology.

RESULTS

The experts' work on the synthesis and application of the GRADE® method led to the formulation of 17 recommendations. Since the GRADE® method could not be entirely applied to all of the questions, some of the recommendations were formulated as expert opinions.

CONCLUSION

Based on strong agreement between experts, we produced 17 recommendations designed to guide reducing the environmental impact of general anaesthesia.

What is essential remains invisible to the eyes? Blood pressure cuffs colonized by bacterial diversity

Using sphygmomanometers to measure blood pressure is a common practice in the healthcare context. The disinfection and maintenance of these devices is essential in clinical practice to prevent the proliferation of microorganisms. The aim of this study was to determine the presence of pathogenic microorganisms in sphygmomanometer cuffs in the clinical setting. A cross-sectional study was carried out. Five types of healthcare centers, selected through convenience sampling, participated in this study. Samples were collected from the inside of sphygmomanometer cuffs, and labeled and delivered to the laboratory for analysis. The samples were incubated in an oven at 35.5 °C for 24 h. A total CFU count was carried out on the plates that were cataloged as positive. Colonies that showed growth were identified using the matrix-assisted laser desorption/ionization-mass spectrometry technology. Of the total sample, (N = 372), 69.1% were positive and were isolated. In 30.9% (n = 115), no bacterial development was found within 48 h. A total of 257 microorganisms were found. The mean number of colony-forming units was 29.62 (SD = 32.33). The socio-health centers had the highest amount of bacterial contamination in the cuffs. In regards to the type of microorganisms, 31.5% (n = 81) found were Bacillus cereus, followed by 26.8% (n = 69) of Staphylococcus hominis and 9.7% (n = 25) were Pantoea agglomerans, among others. Statistically significant differences were found between the type of microorganism and the hours elapsed since the last disinfection (X²(19) = 44.582; p = 0.001). Statistically significant differences were found between the time elapsed since the last disinfection and the type of sphygmomanometer (X² (2) = 117.752; p = 0.000). Despite the fact that most hospitals and health centers have established infection control policies and protocols, the results of this study indicate the presence of pathogenic microorganisms in blood pressure cuffs in the clinical setting.

Remote investigation and assessment of vital signs (RIA-VS)-proof of concept for contactless estimation of blood pressure, pulse, respiratory rate, and oxygen saturation in patients with suspicion of COVID-19

BACKGROUND

Vital signs are critical in assessing the severity and prognosis of infections, for example, COVID-19, influenza, sepsis, and pneumonia. This study aimed to evaluate a new method for rapid camera-based non-contact measurement of heart rate, blood oxygen saturation, respiratory rate, and blood pressure.

METHODS

Consecutive adult patients attending a hospital emergency department for suspected COVID-19 infection were invited to participate. Vital signs measured with a new camera-based method were compared to the corresponding standard reference methods. The camera device observed the patient's face for 30 s from ∼1 m.

RESULTS

Between 1 April and 1 October 2020, 214 subjects were included in the trial, 131 female (61%) and 83 male (39%). The mean age was 44 years (range 18-81 years). The new camera-based device's vital signs measurements were, on average, very close to the gold standard but the random variation was larger than the reference methods.

CONCLUSIONS

The principle of contactless measurement of blood pressure, pulse, respiratory rate, and oxygen saturation works, which is very promising. However, technical improvements to the equipment used in this study to reduce its random variability is required before clinical implementation. This will likely be a game changer once this is sorted out.

CLINICAL TRIAL REGISTRATION

Universal Trial Number (UTN) U1111-1251-4114 and the ClinicalTrials.gov Identifier NCT04383457.

Review of decontamination protocols for shared non-critical objects in 35 policies of UK NHS Acute Care Organisations

BACKGROUND

Decontamination of non-critical objects shared by patients is key in reducing HAIs, but it is a complex process that needs precise guidance from UK NHS Acute Care Organisations (ACOs).

AIM

To review the indications given by NHS ACOs' policies regarding the decontamination of shared non-critical devices.

METHODS

Detailed lists of decontamination protocols for shared non-critical objects were retrieved from cleaning, disinfection, and decontamination policies of 35 NHS ACOs. Three parameters were considered for each object: decontamination method, decontamination frequency and person responsible for decontamination.

FINDINGS

1279 decontamination protocols regarding 283 different shared non-critical objects were retrieved. 689 (54%) did not indicate the person responsible for decontamination, while only 425 (33%), were complete, giving indications for all three parameters analysed. Only 2.5% (32/1279) decontamination protocols were complete and identical in two policies. In policies where cleaning represented the major decontamination method, chemical disinfection was rarely mentioned and vice versa. A general agreement among policies can be found for four main decontamination methods (detergent and water, detergent wipes, disinfectant wipes, use of disposable items), two decontamination frequencies (between events, daily) and two responsible person designations (nurses, domestic staff).

CONCLUSIONS

Decontamination protocol policies for shared non-critical objects had some similarities but did not concur on how each individual object should be decontaminated. The lack of clear indications regarding the person responsible for the decontamination process put at risk the ability of policies to serve as guidance.

Moving towards green anaesthesia: Are patient safety and environmentally friendly practices compatible? A focus on single-use devices

OBJECTIVE

Discuss if the use of disposable or reusable medical devices leads to a difference in terms of hospital-acquired infection or bacterial contamination. Determine which solution is less expensive and has less environmental impact in terms of carbon footprint, energy and water consumption and amount of waste.

METHODS

We carried out a narrative review. Articles published in English and French from January 2000 to April 2020 were identified from PubMed.

RESULTS

We retrieved 81 articles, including 12 randomised controlled trial, 21 literature reviews, 13 descriptive studies, 6 experimental studies, 9 life-cycle studies, 6 cohort studies, 2 meta-analysis, 4 case reports and 8 other studies. It appears that pathogen transmission in the anaesthesia work area is mainly due to the lack of hand hygiene among the anaesthesia team. The benefit of single-use devices on infectious risk is based on weak scientific arguments, while reusable devices have benefits in terms of costs, water consumption, energy consumption, waste, and reducing greenhouse gas emissions.

CONCLUSION

Disposable medical devices and attire in the operating theatre do not mitigate the infectious risk to the patients but have a greater environmental, financial and social impact than the reusable ones. This study is the first step towards recommendations for more environmental-friendly practices in the operating theatre.

Efficacy of an Ethanol-Based Hand Sanitizer for the Disinfection of Blood Pressure Cuffs

Blood pressure cuffs (BP cuffs) have been implicated in some nosocomial outbreaks. We compared the efficacy of an ethanol-based hand sanitizer (EBHS) with a detergent/disinfectant for the disinfection of BP cuffs. The inner sides of 30 BP cuffs were sampled for bacterial culture. Then, the same area was divided into halves. One half was disinfected by a detergent/disinfectant and the other was disinfected by an EBHS. The bacterial count decreased significantly with both disinfectants (p < 0.0001 compared with before disinfection). The bacterial count decrease seemed greater with the EBHS compared with the detergent/disinfectant, but the difference was not significant. Therefore, within the limits of a single application, the EBHS was an efficacious means of BP cuff disinfection. However, the repeated exposure to emollients contained in EBHS may require further studies before validating these results.

Contamination of reusable electroencephalography electrodes: A multicenter study

BACKGROUND

Reusable electroencephalography cup electrodes and lead wires (rEEGs-CELWs) could be a source of microorganisms capable of causing hospital-acquired infections. The purpose of this study was to investigate for bacterial species of cleaned rEEGs-CELWs.

METHODS

This microbiologic evaluation involved 4 epilepsy monitoring units where rEEGs-CELWs were swabbed for bacteria using standard techniques. Analyses involved descriptive statistics and logistic regression (across sites).

RESULTS

Of 124 swabs, 31 (25.0%; range, 13.3%-43.3%) showed positive bacterial cultures, without between-site differences (P = .17). Bacteria were labeled by risk for hospital-acquired infection: no risk, potential risk (primarily in immunocompromised patients), and at risk (associated with infections and antibiotic resistance). At-risk bacteria species were Staphylococcus epidermidis (38.7%), Staphylococcus capitis subsp ureolyticus (3.2%), and Staphylococcus haemolyticus (9.6%). Potential-risk species were Micrococcus spp (22.6%), Acinetobacter lwoffii (6.5%), Staphylococcus hominis subsp hominis (6.5%), and Staphylococcus warneri (6.5%). Bacillus (9.6%) was the only no-risk species. Of 18 antibiotics tested on positive cultures, resistant bacteria were found in a median of 1 (range, 0-11) positive culture, equating to a 6.7% (range, 0%-61.1%) resistant antibiotic rate; no microorganisms were resistant to all antibiotics tested.

CONCLUSIONS

Bacteria that were potential risk or at risk for infection were found on 22.6% of cleaned rEEGs-CELWs. Use of single-use electrodes and research on scalp infection and infection reduction interventions are warranted.

Instilling a culture of cleaning: Effectiveness of decontamination practices on non-disposable sphygmomanometer cuffs

Background

Sphygmomanometers and their cuffs are non-critical items that can act as a fomite for transmission of pathogens which may cause healthcare-associated infection (HAI), leading to an argument that disposable equipment improves patient safety.

Aim

The aim of this study was to demonstrate that decontamination decreased in microbial contamination of non-disposable sphygmomanometer cuffs, providing evidence to negate the need to purchase, and dispose of, single-patient-use cuffs, reducing cost and environmental impact.

Methods

A pre-post intervention study of available sphygmomanometer cuffs and associated bedside patient monitors was conducted using a series of microbiological samples in a rural emergency department. A Wilcoxon signed-rank test analysed the effect of the decontamination intervention. To further examine the effect of the decontamination intervention, Mann-Whitney U-tests were conducted for each aspect.

Findings

Contamination was significantly higher before decontamination than afterwards (Z = -5.14, U = 55.0, P < 0.001, η2 = 0.61 inner; Z = -5.05, U = 53.5, P < 0.001, η2 = 0.59 outer).

Discussion

Decontamination of non-disposable sphygmomanometer cuffs decreases microbial load and risk of HAI, providing evidence to negate arguments for disposable cuffs while being environmentally sensitive and supportive of a culture of patient safety and infection control.

Hand-touch contact assessment of high-touch and mutual-touch surfaces among healthcare workers, patients, and visitors

BACKGROUND

Unlike direct contact with patients' body, hand hygiene practice is often neglected by healthcare workers (HCWs) and visitors after contact with patients' environment. Contact with hospital environmental items may increase risk of pathogen transmission.

AIM

To enumerate the number of hand-touch contacts by patients, HCWs and visitors with any hospital environmental items.

METHODS

All contact-episodes between person and item were recorded by direct observation in a six-bed cubicle of acute wards for 33 working days. High-touch and mutual-touch items with high contact frequencies by HCWs, patients, and visitors were analysed.

FINDINGS

In total, 1107 person-episodes with 6144 contact-episodes were observed in 66 observation hours (average: 16.8 person-episodes and 93.1 contact-episodes per hour). Eight of the top 10 high-touch items, including bedside rails, bedside tables, patients' bodies, patients' files, linen, bed curtains, bed frames, and lockers were mutually touched by HCWs, patients, and visitors. Bedside rails topped the list with 13.6 contact-episodes per hour (mean), followed by bedside tables (12.3 contact-episodes per hour). Using patients' body contacts as a reference, it was found that medical staff and nursing staff contacted bedside tables [rate ratio (RR): 1.741, 1.427, respectively] and patients' files (RR: 1.358, 1.324, respectively) more than patients' bodies, and nursing staff also contacted bedside rails (RR: 1.490) more than patients' bodies.

CONCLUSION

Patients' surroundings may be links in the transmission of nosocomial infections because many are frequently touched and mutually contacted by HCWs, patients, and visitors. Therefore, the focus of hand hygiene education, environmental disinfection, and other system changes should be enhanced with respect to high-touch and mutual-touch items.