Non-disposable Wires Put Patients at Risk

Excerpted from: Electrocardiography Wires: A Potential Source of Infection by: Donna Quinton Brown, RN

Drug-Resistant Streptococcus pneumoniae (DRSP) and gram negative bacilli possessing the ability to produce Extended Spectrum Beta-Lactamases (ESBL) have become frequent pathogens causing infections in both hospital and community settings. The increase in resistance leads to greater morbidity, mortality, and cost, and has challenged the medical field and pharmaceutical industry in the development of prevention and treatment strategies.

... Using disposable equipment has become a credible method of reducing the risk of transmission of nosocomial infections through cross-contamination. Not only is the use of such disposables more sanitary and convenient, but the high cost of each nosocomial infection allows us to make a case for disposable items being more cost-effective.

Historically, from metal reusable bedpans to multipatient pulse oximetry probes, the understanding that bacteria are transmitted from patient to patient via reusable equipment vectors has led to this drive toward disposable, single-patient-use medical equipment.

Incredibly, one potential source of infection has yet to be significantly examined. Where once everything from bedpans and enema bags to patient drains and tracheostomy tubes was reusable, now the only pieces of medical equipment that come in contact with the patient’s torso that are not single patient use and disposable are the electrocardiography (ECG) wires. How
these nondisposable wires used on multiple patients have escaped close scrutiny until now is difficult to understand.

According to Infection Control Today, the American Society of Microbiology did a study in which they found that 47.6% of 42 neckties worn by male clinicians “harbored potential pathogens.” The study concluded, “the link between a necktie and the potential for transmission (of pathogens) must be considered.”

A physical barrier is usually present between a patient’s skin and a clinician’s tie. If clinicians’ ties are contamination risks, how much more of a risk are ECG monitoring wires, which are in direct contact with patients’ skin? These wires have multiple surfaces that are difficult to reach with cleaning agents. The wires also frequently come in contact with patients’ blood and body fluids, which seep into the smallest recesses of connections, thereby providing a perfect, virtually unreachable medium for the growth of bacteria.

ECG wires attached to even the least mobile patients can be found wrapped around endotracheal tubes, tracheostomy tubes, chest tubes, drains, urinary catheters, and so on, and the methods used to clean these reusable wires between patients is usually not effective enough to prevent cross-contamination of bacteria. A recent article in Cardiology News stated that antibiotic-resistant bacteria were found on 77% of ECG lead wires that were cultured after they were reprocessed and just before they were attached to new patients in the intensive care unit (ICU).

The researcher, Dr. Paul R. Brookmeyer of the University of Wisconsin Hospital and Clinics, Madison was quoted as saying the wires are “‘an unappreciated reservoir’ of multidrug-resistant nosocomial pathogens.” In addition, the article concluded that “attachment of contaminated lead wires to a new patient can result in colonization and ultimately in invasive infection by multiresistant nosocomial microorganisms.”

ECG wires, thus identified as carriers of resistant strains of bacteria and an invasive infection risk, were thus linked directly to the root cause of cross-contamination infection in an article from the Division of Infectious Diseases at the University of Texas, Medical Branch in Galveston. The burn unit of that university hospital experienced “an outbreak of colonization and infection caused by vancomycin-resistant enterococci.” Five weeks after the apparent eradication, the outbreak reoccurred. The reemergence of the infection was traced to one ECG lead wire.

In addition to this account, Wisconsin hospital epidemiologists attributed an outbreak of Serratia marcescens infection to insufficiently decontaminated ECG leads. Unfortunately, these reports show that merely following a cleaning protocol for ECG wires is not sufficient to eliminate the risk of cross-contamination. What unit would be more diligent in decontamination
than a burn unit attempting to eradicate an outbreak of vancomycin-resistant enterococci?

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) considers infection control of sufficient import to include it as 1 of 3 goals in each of its 2005 patient safety goal categories. The overwhelming JCAHO focus is on prevention. They state: “Prevention of health care-associated infections (HAIs) represents one of the major safety initiatives an organization can undertake.” They further state that “Joint Commission standards focus on reducing the risks of such infections and, in the case of hospitals, call for at least one activity in the infection control process to be aimed at preventing the transmission of infections.”

Elimination of an identified source of transmission of resistant bacteria, such as reusable ECG wires, would be an ideal response to JCAHO guidelines; but more importantly, use of disposable leads would improve patients’ safety. An action plan to eliminate this patient safety risk by incorporating it in infection control measures can be developed by using the JCAHO publication titled Failure Modes and Effects Analysis in Health Care: Selecting a High-Risk Process and Assembling a Team as a guide.

Separately, 2 hospitals in south Florida and 1 in Southern California initiated the use of disposable ECG leads in their cardiovascular ICUs as part of a program to reduce the incidence of sternal wound infections.

The frequency of sternal wound infections decreased more than 90% in all 3 hospitals. Hospital administrators attribute those results, in significant part, to the use of disposable ECG leads. Bon Secours St. Frances Hospital, in Midlothian, Va, opened its doors for the first time in September 2005. Ricky DeJesus, administrative director of criticalcare, states, “The concept of Bon Secours St. Frances is that we are the medical facility of the future.

In keeping with this, we started using disposable leads from the beginning in our critical care and telemetry areas. There is enough evidence out there to convince me that there is a significant risk of infection in reusable ECG wires. Although we have had many central [catheters] and surgical patients, we have not had 1 nosocomial infection attributable to ICU and telemetry since we opened our doors 4 months ago. I credit that statistic, at least in part, to the use of disposable ECG leads.”

... Using disposable equipment to avoid spreading nosocomial infections must remain at the forefront of prevention measures. In this clinical path of prevention, no reusable equipment that comes in direct contact with the patient’s body can be overlooked. Reusable ECG wires have been identified in several studies as a carrier of resistant bacteria and a cause of nosocomial infection. Therefore, these wires must be considered a potential source of hospital-acquired infection in any institution that uses them.

Disposable ECG wires would eliminate this threat to both patients’ safety and healthcare economics. The move toward eliminating reusable ECG wires is not only the natural progression in the process toward standardization of the use of disposable equipment that comes in contact with patients, but it is the next step in a strong infection control program. Moving toward the exclusive use of disposable ECG leads has only positive implications for medical patients and the healthcare facilities providing for them.