2004 OPEN FORUM Abstracts
IMPROVING INFECTION CONTROL IN THE UTILIZATION OF OXIMETRY:
Herzig RRT, RCP, Jan Phillips-Clar RRT, RCP, Richard Ford RRT,
RCP, Timothy Morris MD UCSD Medical Center San Diego, California
OBJECTIVE: Obtaining a patient’s oxygen saturation has become a routine value when obtaining vitals signs by the nursing staff. Additionally respiratory care practitioners use this value daily to aid in oxygen titration. The Respiratory Care staff utilizes Nonin pocket oximeters while nursing staff uses oximetry devices that are attached to their blood pressure monitors on wheels. When staff was asked what method was used to clean the sensor, the answers varied. We sought to determine if there was a significant problem that existed in the current practice of cleaning the oximetry sensor between patients. If so, would this allow for cross contamination risks and potential for nosocomial infections?
METHOD: Our team preformed a random and anonymous baseline survey of 61 nursing and respiratory care staff to inquire if the sensors were in fact being cleaned between patients. Random cultures on these sensors were performed on two separate days. The first day cultures were done on two nursing unit sensors and one Respiratory Care pocket oximeter. A week later 3 more sensors were cultured on the nursing units.
RESULTS The results of the survey showed that 61% of staff was not cleaning the sensors between patients. Many nurses commented that they were told that alcohol would ruin the sensors like that of the glucose monitor The cultures showed growth of Staphylococcus epidermidis on all six sensors. We contacted the manufacturers to inquire of cleaning methods that were effective and not harmful to the oximetry sensor. 70% alcohol was the recommended solution. Because of it’s convenience, we asked if the Purell hand gel, that is used throughout the hospital, would be an acceptable product. Because no studies had been performed with Purell and due to the possibility of residue build up, that option was not recommended.
CONCLUSIONS: While Staphylococcus epidermidis may be a normal finding on the human skin, finding this on an oximetry sensor is not. We also learned that, on one nursing unit, disposable sensors were placed on the patient and left on for periodic checks. No routine removal or site change was being performed. It was necessary to re-educate staff that all equipment that is used between patients should be properly cleaned. To improve the compliance in the cleaning of these sensors, alcohol prep pads were stocked on all nursing staff oximetry/blood pressure carts and respiratory care staff were asked to carry alcohol prep pads with them. We added, “The proper cleaning of non-disposable oximetry sensors” to the respiratory care oximetry policies. This policy was then disseminated to all staff that utilizes oximetry sensors between patients. A follow-up survey was performed to again inquire what method is used to clean the sensors. This revealed an increased compliance to 99%. Random surveillance will continue to be carried out to ensure compliance.