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SPHYGMOMANOMETERS AS A RESERVOIR OF PATHOGENIC BACTERIA

Authors: M.A. Beard, A. McIntyre, P.M. Roundtree

OBJECTIVE: The purpose of this study was
to identify the type and level of the bacterial contamination of sphygmomanometers in use week and sampled at 0, 24 and 48 hours after introduction. Three sites on the cuff were sampled each designated as high, medium, SUMMARY: The bacterial strains were
and low level of contact with the patient's compared by clinical unit with those strains skin. Results indicated that the number of from isolated patients during a six week bacterial colonies increased from time 0 hours period before and after the sampling period. to 48 hours. Not unexpectedly, the site with Sources of patient samples included skin greatest contact with the patient's skin yielded lesions, blood, wounds and sputum. Sixty the greatest number of bacterial counts. percent of the cuff isolates were identical to strains that had caused infection in the clinical arm before and after application of the blood units in which two were found. Two strains pressure cuff. Staphylococci of the same type were cross infecting organisms across four were identified from the patient only after clinical units during the time of the survey. usage. Results were similar when the staff's Since no attempt was made to determine the hands were tested. The same bacteria type length of time these cuffs had been use prior was identified after, but not prior to, handling to sampling, another study was initiated. of the contaminated blood pressure cuff by SETTING & PATIENTS: Forty-eight
clinical units in a hospital were tested during a CONCLUSIONS: While no attempt was
three week period. Samples were taken from made to link bacterial contamination to the the part of the cuff that comes in contact with direct cause of infection, the implication of the patient’s arm. The sphygmomanometers direct transfer of microorganisms from cuff to tested were those that where in common use patient and staff is clear. No other piece of equipment was in more common use without adequate disinfection than the blood pressure RESULTS: Staphylococcus aureus was found on
cuff. Strategies subsequently suggested by the authors that were aimed at risk reduction such Psuedomonas aeruginosa was isolated from only as daily washing of the cuff, sterilizing the one cuff (2%) on a surgical unit. A range in entire blood pressure set up, or cleansing the number of colonies (1-500+) and multiple strains of S. aureus were isolated. unacceptable by clinicians. (The Medical Journal of Australia. October 11, 1969;2: 758-60). NEW THREATS TO THE CONTROL OF METHICILLIAN-RESISTANT
Staphylococcus Aureus

Author: M.W.

Casewell
INTRODUCTION: New threats to the control
MRSA, there is the opportunity for the emergence of methicillin-resistant Staphylococcus aureus (MRSA) of vancomycin-resistant MRSA. There may be no can be recognized, some due to the evolution of effective antimicrobial prophylaxis or treatment the organism and others arising from changing hospital populations and organization. This paper attempts to identify these threats and encourage RECOMMENDATIONS: It is increasingly
important to persuade hospital managers that even minimizing the morbidity and mortality from partial control of MRSA, while expensive, is still staphylococcal infection on those issues that cost-effective and is a quality issue for individual hospitals. The control of EMRSA-16 in one hospital has recently been estimated to have saved SUMMARY: Several countries have achieved
more than £629,000 or $997,594 (1995 values) in considerable success in the control of MRSA. extra costs. MRSA continues to be at the However, in several hospitals in the UK, MRSA forefront of those organisms that seriously strains of enhanced epidemicity*, notably challenge modern technological medicine and surgery. (J Hosp Infect 1995 Jun;30 Suppl:465-471). delivery that hinder control of MRSA include a * epidemicity – the quality of being widely shortage of inpatient beds which results in patients diffused and rapidly spreading throughout a being moved more often from unit to unit, and more mixed-specialty units, both known to be ** endemic – present in a community at all times factors that encourage the spread of MRSA. Increasing use of day treatments leaves an inpatient hospital population with more risk factors for infection. Early discharge of infected patients to convalescent homes or to homes for the elderly, has created a new reservoir of infected and colonized patients. from Enterococcus faecium to a laboratory strain of S. aureus suggests that, especially in hospitals with both vancomycin-resistant enterococci and NORWEGIAN SCABIES – DISSEMINATION OF MITES BY MEDICAL
INSTRUMENTS

K.W. Kim, Y.J. Oh, B.K. Cho, W. Houh, J.A. Kim, Y.S. Lee
INTRODUCTION: Norwegian scabies is a
DISCUSSION: The occurrence of scabies
clinical variant of human infestation with Sarcoptes infestation in these two hospitalized patients was scabiei and is characterized by extensive, heavily traced to contaminated medical instruments. crusted skin lesions. Persons most frequently Norwegian scabies may be difficult to diagnose affected are the elderly, debilitated of all ages, and clinically because it may resemble chronic eczema, the immunosuppressed. They have a high rate of infectivity with transmission by close personal contact. The authors feel that the use of medical until biopsy is done or an epidemic of secondary instruments on more than one patient is an scabies breaks out among contacts of the patient. important factor in spreading the disease Delayed diagnosis or unrecognized cases of crusted scabies frequently contributes to secondary transmission especially in hospitals and CASE REPORT: In March 1989, several
institutions. Because of current wide spread use members of the nursing team and medical staff complained of itching papules and were felt to anticipated that the number of Norwegian scabies have scabies. A source was sought among the cases will increase.1 (Annals of Dermatology, Vol.2. patients on the ward. A 77 year old patient was examined and showed the presence of numerous their blood pressure recorded with the same monitoring cuff previously used on the patient immunosuppressive therapy. Cutis 22: 81-84, with Norwegian scabies complained of similar symptoms. Another patient who had shared a clinical thermometer with the Norwegian scabies patient also complained of pruritic papules in the axilla. hospitalized patients received treatment and showed improvement within a week. All the bed linens and clothes were thoroughly cleaned and the contaminated medical instruments were sterilized. TWO MIILLION ARE INFECTED IN HOSPITALS EACH YEAR

Author: A.

INTRODUCTION: The rate of infections
Another concern is the increasing rate of picked up by patients while they’re in the hospital antibiotic-resistant organisms found in hospitals. has increased 36% since the last count made in a At least 70% of the bacteria that cause nosocomial 1975-80 study reported at an international infections are resistant to at least one antibiotic. conference on emerging infectious diseases. RECOMMENDATIONS: Nosocomial
SUMMARY: About 2 million people a year
infections add about $4.5 billion a year to health acquire such infections, and nearly 90,000 die of care costs. About a third of them could be them, according to a survey of 265 hospitals prevented with simple procedures such as nationwide, as reported by the Centers for Disease frequent hand washing by health care workers, but many are unavoidable, caused by microbes carried programs, required for hospital accreditation since 1976, there would have been a 50% to 70% before touching patients and making sure increase in such infections because the proportion antibiotics are taken according to prescription, can of severely ill patients has increased. Hospitals reduce the risk of infection. (USA TODAY [US] have become ICUs, treating very sick patients vulnerable to infections because of their depressed immune systems or requiring the use of invasive equipment such as intravenous lines that provide and entry route for infection.
Title: NONDISPOSABLE

SPHYGMOMANOMETER CUFFS HARBOR FREQUENT
BACTERIAL COLONIZATION AND SIGNIFICANT CONTAMINATION BY
ORGANIC AND INORGANIC MATTER


Authors: V.

Base-Smith
OBJECTIVE: The purpose of this study was to
determine if significant bacterial colonization and infection may be magnified when introduced to organic or inorganic contamination occurred on susceptible patients, such as those hospitalized in presumed “clean” blood pressure cuffs in critical CONCLUSIONS: Results indicate that frequent
SETTING & PATIENTS: Blood pressure cuff
samples were selected from the OR, medical intensive care unit (MICU), surgical intensive care substances did occur on “clean” nondisposable (SICU), burn special intensive care unit (BSICU), blood pressure cuffs. The need for better cardiac intensive care unit (CICU), ER, PACU and sanitation and disinfection of the cuffs between the neurosurgical intensive care unit (NSICU) patient use is evident. (JAANA, 1996 April 64(2): from a 707-bed tertiary care, level-one trauma
RESULTS: In 70 separate cultures collected
over 6 weeks, bacterial colonization occurred on
57 (81%) of the blood pressure cuffs. Bacterial
colonization was discovered on 100% of the cuffs
sampled from the OR, PACU, BSICU, and ER.
Of the cuffs from SICU and MICU, 90% and
80% were colonized respectively, while the
NSICU and CICU demonstrated no growth.
Thirty-two (45.7%) of the “clean” cuffs were
contaminated with organic and/or inorganic
substances that should not have been present.
Additionally, the patient contact sides of cuffs
were contaminated twice as often as the
nonpatient sides.

Title: ENVIRONMENTAL
CONTAMINATION DUE TO METHICILLIN-RESISTANT
Staphylococcus Aureus: POSSIBLE INFECTION CONTROL IMPLICATIONS

Authors:

J.M. Boyce, G. Potter-Bynoe, C. Chenevert, T. King
OBJECTIVE: To study the possible role of
contaminated. Environmental contamination contaminated environmental surfaces as a occurred in the rooms of 73% of infected patients reservoir of methicillin-resistant Staphylococcus and 69% of colonized patients. Frequently contaminated objects included the floor, bed DESIGN: A prospective culture survey of
inanimate objects in the rooms of patients with CONCLUSIONS: Inanimate surfaces near
affected patients commonly become contaminated SETTING AND PATIENTS: Thirty-eight
consecutive patients colonized or infected with contamination is affected by the body site at which patients are colonized or infected. Personnel may contaminate their gloves (or possibly their hands) by touching such surfaces RESULTS: Ninety-six (27%) of 350 surfaces
suggests that contaminated environmental sampled in the rooms of affected patients were surfaces may serve as a reservoir of MRSA in contaminated with MRSA. When patients had hospitals. (Infection Control and Hospital Epidemiology, MRSA in a wound or urine, 36% of surfaces were contaminated. In contrast, when MRSA was isolated from other body sites such as sputum, blood and conjunctivae, only 6% of surfaces were THE MICROBIAL FLORA OF IN-USE BLOOD PRESSURE CUFFS

Authors:

M.G.M. Cormican, D.L. Lowe, P. Flynn, D. O'Toole

OBJECTIVE:
This study was conducted to
policies that prohibit the transfer of cuffs contamination on blood pressure used in the outside a room where isolation precautions operating and recovery rooms of a teaching are in effect is very difficult. In addition, hospital. The authors suggest that the blood general use blood pressure cuffs are handled pressure cuff is as yet an unrecognized source by many health care workers and patients. of bacterial contamination, which may play a Because there is often no visible signs of part in the hospital's nosocomial infection contamination, no disinfecting procedures are employed on the cuff. The potential for cross contamination magnifies as often as patients, SETTING & PATIENTS: As part of this
study, new blood pressure cuffs were placed pathogens, are unknown to the hospital staff. in six operating rooms, and one recovery Blood pressure cuffs attached to resuscitation room. A defined area of the cuff in contact equipment were identified as another source with the patient was sampled before issue and at the end of the operating day for a period of five days. Swabs were plated, incubated and CONCLUSIONS: This study emphasizes
potential for cross contamination to patients RESULTS: Results indicated that 68
different microorganisms were isolated from the forty-two samples. Seventy-one percent equipment, specifically blood pressure cuffs. (Irish Journal of Medical Sciences 1994; 4:112-3). Staphylococcus aureus was found to be resistant
to methicillin, gentamycin and erythromycin.
The remaining twenty-five organisms were
thought to be skin and environmental
representatives although they may pose a risk
to certain groups of patients.

SUMMARY:
It was concluded that the
majority of microorganisms isolates in this
study posed little risk to healthy patients
undergoing surgery. The one case where the
gentamycin-methicillin resistant pathogen was
identified caused concern since no patient
known to have that pathogen had been in the
operating room during the corresponding day
of data collection. Therefore, the bacteria then
would have had to survive for some time on
the cuff implying therefore, that the cuff acts
as a vehicle of infection.
AN OUTBREAK OF MUPIROCIN-RESISTANT Staphylococcus Aureus ON A
DERMATOLOGY WARD ASSOCIATED WITH AN ENVIRONMENTAL
RESERVOIR


Authors:

M.C. Layton, M. Perez, P. Heald, J.E. Paterson
OBJECTIVE: To investigate a cluster of
mupirocin-resistant Staphylococcus aureus on a personnel were negative for mupirocin-resistant culturing revealed that a blood pressure cuff and DESIGN: An outbreak of mupirocin-resistant S
the patients’ communal shower were positive for aureus was noted on the dermatology ward during a prospective epidemiological study of methicillin- PFGE of all mupirocin-resistant isolates resistant S aureus (MRSA) and borderline demonstrated that the nine patients and both methicillin-susceptible S aureus (BMSSA). Pulsed- environmental sources had identical DNA typing field gel electrophoresis (PFGE) of whole cell DNA digested with Sma I was used as a marker of INTERVENTIONS: Changing of blood
pressure cuffs between patients and more SETTING AND PATIENTS: An 850-bed
stringent cleaning of communal areas was university hospital with a 12-bed inpatient initiated. Repeat environmental cultures were dermatology ward. Most patients have severe, CONCLUSIONS: S aureus is not usually
RESULTS: MRSA and BMSSA were isolated
associated with an environmental reservoir; from 13 patients on the dermatology ward over a 14-month period. Eleven of these isolates (84.6%) were mupirocin-resistant. Nine isolates were environmental contamination. (Infection Control and present on admission (81.8%); 8 of these patients Hospital Epidemiology, 1993 Jul:14(7): 369-375). had been hospitalized on the same ward within the last two months. LONGITUDINAL EVALUATION OF NEONATAL NOSOCOMIAL INFECTIONS:
ASSOCIATION OF INFECTION WITH A BLOOD PRESSURE CUFF


Author: M.G.

OBJECTIVE: To determine the rate of
penetrating the dermis, blood pressure cuffs are nosocomial infection and to demonstrate the made of fabrics on which organisms may persist effect of specific infection control measures in a for significant periods of time.5,6 and may also be associated with hospital-acquired infection. In this study, surveillance was conducted SETTING & PATIENTS: Longitudinal
by peers of the ward physicians and was closely infection surveillance in a special care nursery was supervised, so that definitions and reporting of performed for a 21-week period. All infant charts nosocomial infections remained constant during were reviewed along with culture information; this the surveillance. This method of surveillance has information was recorded and infections were introduced a novel form of physician education, categorized as community- or hospital-acquired, making them particularly aware of the magnitude of nosocomial infection. (Pediatrics, 1978 Jan:61(1): SUMMARY: During the 21-week surveillance
period, 46 of the 248 infants at risk (18.5%) acquired 52 infections giving a nosocomial 1. Weinstein RA, Stamm WE, Kramer L, Corey infection rate of 21.0%. Increased infection L: Pressure monitoring devices: Overlooked control measures were instituted with an apparent source of nosocomial infection. JAMA reduction in the nosocomial infection attack rate, but which returned to the same rate or higher by 2. Stamm WE, Colella JJ, Anderson RL, Dixon RE: Indwelling arterial catheters as a source blood pressure apparatus was used on all the caused by Flavobacterium species. N Engl J Med children in the nursery area. A portion of the blood pressure cuff was cultured with several 3. Morse LJ, Williams HL, Grenn FP Jr, et al: microorganisms recovered including Klebsiella Septicemia due to Klebsiella pneumoniae pneumonia and Staphylococcus aureus. originating from a hand-cream dispenser. N RECOMMENDATIONS: Nosocomial
infection epidemiology is complex and dependent upon antimicrobial usage, and increasing population of susceptible patients, and varying hospital flora. Outbreaks of nosocomial infection have been related to arterial monitoring catheters disseminators of viruses: I. Persistence of 1,2 and material applied to the skin such as lotions 3 vaccinia virus on cotton and wool fabrics. and stethoscopes.4 It is not surprising that blood pressure cuffs may also be associated with 6. McNeil E: Dissemination of microorganisms by fabrics and leather. Dev Ind Microbiol 5:30, 1964

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