2004 OPEN FORUM Abstracts
IMPROVING INFECTION CONTROL IN THE UTILIZATION OF OXIMETRY:
Suzan
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.