Tag Archives: patient monitoring

May 27, 2016

One Impactful Thing You Can Do to Reduce Alarm Fatigue

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It’s safe to say that you and your staff hear a lot of alarms – in fact, one study suggests that health care professionals can hear up to 700 alarms per patient day.1 Did you estimate that many? This is the real danger of alarm fatigue. It doesn’t necessarily mean you’re tired of hearing alarms. It means you may have stopped hearing them altogether.2

It’s no wonder that the ECRI Institute has identified monitoring alarms as a top technology health hazard3 and dedicated a great deal of time and resources to reduce ECG monitoring alarms. In fact, the danger of false and clinically insignificant alarms (or more accurately, the likelihood that the ones that are significant will go unnoticed) has been among its top 10 health technology hazards every year since 2008.4

The good news: there are measures you can take. The AACN recently published a Practice Alert containing seven items that can reduce the frequency of false monitoring alarms. At the top of the list with the highest level of evidence: “Provide proper skin preparation for ECG electrodes (Level B).”2

Electrodes and the Skin

If this is surprising, consider the role of a typical electrode. The electrode must effectively read the signal from within a patient’s body through the skin – which itself can vary greatly from patient to patient. Multiple factors such as the presence of hair, diaphoresis and the patient’s use of lotions directly affect the contact, and therefore the effectiveness, of the electrode.5 The price of inefficient ECG signal conduction is poor ECG trace quality and frequent false alarms.6

Multiple studies have shown the dramatic difference that proper skin preparation makes in reducing skin impedance, or the barrier of the skin to passing ECG signal from inside the body to the electrode on the skin’s surface.6   One, conducted in 2007, showed nearly a 97% reduction in skin impedance when a mildly abrasive skin prep product was used at electrode application sites.7 Others were very comparable.

The above mentioned studies involved abrading the skin before electrode application, a fast and efficient method. Along with a selection of electrodes for a range of conditions and environments, 3M provides lightly abrasive 3M™ Red Dot™ Trace Prep specifically for reducing skin impedance and gaining a better trace.5

Another concern: in 1998 a survey conducted at the AAMI Annual Meeting and an AACN National Teaching Institute™ & Critical Care Exposition showed that most nursing professionals were not aware of skin impedance, and only 17% had a protocol in place requiring pre-electrode skin prep.5 This has almost certainly improved over time. But this is also certain: the alarms continue.

Our white paper, Proper Skin Preparation Improves Trace Quality and Reduces ECG Monitoring Alarms, can tell you more about the number one thing you can do to counteract alarm fatigue. It covers the history, factors, concerns and solutions for better alarm management through proper skin preparation. It also provides information on electrode application, troubleshooting ECG artifacts and signing up for our Alarm Fatigue Reduction Program.

For more information about abrasive skin preparation products such as 3M™ Red Dot™ Trace Prep, talk to your 3M representative.

Sources:

1. Cvach M, Monitor Alarm Fatigue: An Integrative Review, Biomedical Instrumentation & Technology, July/August 2012, pgs 268-277.

2. AACN Practice Alert, Alarm Management, April 2013 http://www.aacn.org/wd/practice/docs/practicealerts/alarm-management-practicealert.pdf.

3. ECRI Institute. Top 10 Health Technology Hazards for 2016. Health Devices. November 2015

4. ECRI Institute. Top 10 Health Technology Hazards 2008-20016. https://www.ecri.org/Pages/default.aspx

5. Oster C, Improving ECG Trace Quality: Biomedical Instrumentation & Technology 34(3):219-22·December 1999

6. Melendez, Luis A., and Richard M. Pino. “Electrocardiogram interference: a thing of the past?.” Biomedical Instrumentation & Technology 46.6 (2012): 470-477.

7. Jonasson, Linda. A prospective study on the relevance of skin preparation for noise, impedance and ECG intervals among healthy males. http:// www.essays.se/about/ Skin+preparation

Feb 25, 2016

Nosocomial Infection: Reduce the Risk of a Surgical Site Infection

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Nosocomial-Infections-Reduce-the-Risk-of-a-Surgical-Site-Infection

Ways to help reduce the risk of a nosocomial infection during surgery

Prevention of nosocomial infections is critical. These infections are more commonly known as healthcare-associated infections (HAIs).

Healthcare facilities and operating rooms are fast moving places with many things to keep track of. But, there are four principles that can help reduce the risk of spreading a HAI during surgery to always keep top of mind:

  1. Diligent hand hygiene. Hand hygiene should be practiced by everyone in a healthcare facility. Patients, visitors, and healthcare professionals should understand and practice the World Health Organization (WHO) Five Moments for Hand Hygiene. The perioperative team uses more specific guidelines from the Association of perioperative Registered Nurses (AORN). The periop team should know and remind each other when to practice hand antisepsis.
  2. Reduce Bacteria on the Patient. Bacteria from the skin are the leading cause of surgical site infections. Microorganisms such as Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus (MRSA) are serious threats that can cost a hospital as much as $60,000.1 The skin cannot be sterilized, but by using a surgical skin prep and an incise drape, a sterile operating field can be created. Evidence now suggests bacteria from the patient’s own nares can contribute to surgical site infections (SSIs). Clinical evidence demonstrates that using a nasal antiseptic helps reduce the risk of SSI when part of a comprehensive preoperative protocol.
  3. Maintain normothermia. Operating rooms are typically cold and patients are often exposed. Maintenance of normothermia is important to help reduce the risk of SSIs.2-5 Even a 1.6°C decrease in body temperature can produce inadvertent perioperative hypothermia.6-7 Forced-air warming is a technology that has been proven safe and effective for over 25 years. Maintaining normothermia is one of the easiest, least expensive, and most effective benefits you can offer to patients.
  4. Mitigate cross-contamination. In a clinical study, 77% of reusable ECG leadwires were found to be contaminated with antibiotic-resistant nosocomial pathogens even after being cleaned.8 This is one reason to use disposable leadwires. Disposable leadwires can also remain with the patient even while they are being transported.

Prevention and reduction of HAIs are a priority for the U.S. Department of Health and Human Services (HHS).

For more information on the HHS plan, visit the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination. There is no one way to stop HAIs, prevention relies on people. By practicing proper protocols and looking out for the patient, we can all work together to improve infection rates.

1 Anderson DJ, Kaye KS, Chen LF, et al. Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PLoS ONE. 2009; 4(12): doi: 10.1371/journal.pone.0008305
2Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med. 1996;334:1209-15.
3 Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: A randomized controlled trial. Lancet. 2001;358:876-880.
4 Barie PS. Surgical site infections: epidemiology and prevention. Surg Infect. 2002;3:S9-S21.
5 Seamon, M.J., et. al. The effects of intraoperative hypothermia on surgical site infection: An analysis of 524 trauma laparotomies. Ann of Surg. 2012;255(4)
6 Sessler DI. Current concepts: mild perioperative hypothermia. N Engl J Med. 1997; 336:1730-1737.
7 Barie PS. Surgical site infections: Epidemiology and prevention. Surg Infect. 2002; 3: S-9 – S-21.
8 Jancin, Bruce. Antibiotic-resistant pathogens found on 77% of ECG lead wires. Cardiology News. 2004;2(3):14.
Nov 23, 2015

The Chain of Infection: A Patient Journey

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The Chain of Infection

Passing Thru the Gauntlet of Healthcare Associated Infections

Meet Mary J, an incoming patient. She’s been referred to your hospital because of its reputation as a state-of-the art facility and one that has minimized healthcare-associated infections – HAIs. Mary’s OB/GYN insisted that yours is the best hospital for her to have her surgery. What began as a persistent pain in her pelvic region has been diagnosed as ovarian cancer and a complete hysterectomy has been ordered. The life of this otherwise healthy, 46 year old mother and elementary school teacher has taken a dramatic turn. She must put her care in someone else’s hands, something she’s unaccustomed to doing. With her family and her students relying on her, the last thing Mary needs is to come through the procedure successfully but encounter an HAI. HAIs can be harbored in virtually any place Mary will be transiting.  According to a recent HAI prevalence survey1 administered by the CDC, 1 in 25 hospital patients in the US have experienced at least one HAI. Read how ready this facility is to mitigate and minimize the occurrence of HAIs in its commitment to patient safety.

Arrival – Let the Battle Begin

Hands, the most common source of pathogen transmission, are a critical battleground in the fight to reduce healthcare-associated infections so naturally they are at the center of the challenge. One challenge is that in order for any product to be effective, it would also need to be gentle enough to promote repeated and frequent use. In any hospital, an effective antiseptic hand solution should also be latex glove and Chlorhexidine Gluconate compatible. It should also be dye and fragrance-free and available in versatile and convenient point-of-care locations to promote compliance. Because your hospital has initiated a comprehensive hand hygiene policy using awareness training, products and tools that are effective against infection yet gentle on skin, Mary’s admission will be less of a risk. Your hospital has also incorporated appropriate environmental cleaning programs with detailed instructions to ensure consistent cleaning based on industry standards and best practices. Because of this, Mary’s chance to contract HAIs as she passes through the hallways and contacts various equipment is reduced. The OR has been cleaned and disinfected using a variety of cleaning products and tools including chemical management systems that mix disinfectants and other products in exacting quantities. Additionally, the Infection Preventionist and Environmental Services Manager routinely review a hygiene-management-system sampling plan to validate the cleaning process and address problem areas. In all areas where Mary will pass, particular attention is paid to disinfecting high-touch surfaces. Cleanliness is verified using a hygiene management and testing system that provides real-time results. The analysis confirms that environmental cleanliness is at or above the goal benchmark for frequently touched surfaces – where the risk of cross contamination tends to be the highest. In addition to physical testing, data-driven assessment tools also help provide facilities managers with the ability to track the cost of HAIs to their facilities and justify investments in infection prevention programs.

Pre-op – Even up Your Nose?

As Mary is prepped for her procedure, she is impressed and reassured to see that all personnel who come in contact with her sanitize their hands using an instant hand antiseptic. They are obviously well trained and sanitize their hands without a second thought. She changes into a forced-air warming gown which will keep her warm as she waits prior to surgery, as well as maintain a comfortable body temperature throughout her procedure. Her nurse administers the hospital pre-surgical cleansing policy, which includes nasal antiseptic applied to her intranasal cavity and even an oral rinse – no opportunity for an HAI is left to chance. Mary’s nurse explains that this routine will help minimize the bacteria in her nasal and oral passages, bacteria that could easily spread to her surgical wounds or her airway while she is on the breathing machine. Her skin is prepared for surgery using specially developed 2% chlorhexidine gluconate rinse-free cloths that address multidrug resistant organisms on the skin and are another layer of defense against surgical site infections. Mary is then transported into the operating room. Other members of the surgical team begin to arrive into the OR. The surgical assistant puts on a high fluid-resistant surgical mask, disinfects her hands with an antiseptic hand prep and then gowns up. All surgical tools are effectively monitored using chemical and biological indicators. These indicators serve as release criteria in the Central Sterile Supply Dept. (CSSD). CSSD places chemical indicators into each set before sterilization and then are checked prior to use in the OR to verify sterilization conditions have been met. This last step is adopted by the World Health Organization, Safe Surgeries Check List to indicate that sterilization conditions exist inside the set (http://apps.who.int/iris/bitstream/10665/44186/2/9789241598590_eng_Checklist.pdf)

The indicators show a “pass”, which means they have met the parameters for sterilization and the instruments are ready. Just before she goes under anesthesia, as part of the patient monitoring process, pre-wired monitoring electrodes are placed on Mary and connected to her monitors. These electrodes use a gentle, conductive adhesive that is repositionable and won’t tear delicate tissues when removed. Mary’s IV  is inserted and secured using a transparent dressing so her IV can be monitored without removing the dressing and exposing the IV site to additional bacteria. Your hospital realizes the importance and cost saving benefits to using dressings that provide superior wear time, gentle removal, and excellent moisture management in the battle against HAIs.

In the OR Zone

While Mary’s forced-air warming gown is keeping her warm before surgery, another warming product will be used during her procedure – a full access underbody blanket. (Recent studies found that underbody blankets delivered significantly warmer patients than resistive warming devices or standard warming therapy).2-5 Maintaining normothermia helps reduce the risk of infections as well as the hospital length of stay. Warmed blood and fluids are also beneficial in an effort to maintain normothermia and they will be administered using a leading blood and fluid warming device. Once Mary is anesthetized, her skin previously clipped of hair, done in periop, is prepared for surgery using an iodine povacrylex and isopropyl alcohol surgical solution, which keeps bacteria counts below baseline for at least 48 hours. During this time, the rest of the surgical team disinfects their hands with an antiseptic hand prep. Mary is then draped using a surgical drape that has an antimicrobial incise film to create a sterile surface. This front-line barrier provides a sterile surface all the way to the wound edge, and provides continuous broad-spectrum antimicrobial activity to further reduce the risk of SSIs and HAIs. Before making any incision, the team conducts a “time out” to make sure they are doing the right operation on the right patient, have all of the appropriate instrumentation present and confirm that the correct pre-surgical protocols have been followed. The team also makes introductions and states the roles they have in the surgery, all part of your hospital’s head- to-toe patient safety attitude. Satisfied that all of the proper procedures have been followed, her gynecologic oncologist initiates the operation. After successfully removing her uterus, fallopian tubes, omentum and ovaries, fluid and tissue samples are collected and sent for testing. Mary’s skin incision is then closed using a disposable skin stapler. Closing the incision this way maintains wound edge apposition, allowing for appropriate edema to occur and facilitate proper healing. The final touch is dressing the incision. Your hospital stocks an all-in-one dressing that is highly conformable; one that flexes with movement and swelling and provides a better exchange of moisture vapor and oxygen to reduce skin maceration. The post-surgical dressing of choice protects the wound while absorbing drainage, all of which promotes healing and greater comfort. At last, Mary is transferred to the recovery room and then the ICU.

Post op Success and New Horizons

As the staff ushers Mary though recovery, a new set of pre-wired monitoring electrodes are placed on her and connected to the patient monitor. Oral care is started with an oral rinse (Chlorhexidine Gluconate 0.12%). This process is done every four hours while Mary is in the Post Anesthesia Recover Unit, or PACU. Because the staff at your hospital had the right processes and products in place, from the surgical prep station to the sterilization room to the OR and onto the ICU, they helped reduce the risk of Mary walking away with a healthcare-associated infection. Why subject patients to needless risk of a HAI when risk can be mitigated?

References:

  1. CDC, Healthcare-associated Infections (HAIs), HAI Prevalence Survey, 2011, http://www.cdc.gov/HAI/surveillance/
  2. Tominaga A., Koitabashi T., et al. Efficacy of an underbody forced-air warming blanket for the prevention of intraoperative hypothermia. Anesth. 2007;107:A91.
  3. Insler SR., et al. An evaluation of a full-access underbody forced-air warming system during near-normothermic, on-pump cardiac surgery. Anesth Analg. 2008. 106(3):746-750.
  4. Teodorczyk JE., et al. Effectiveness of an underbody forced-air blanket in preventing postoperative hypothermia after coronary artery bypass graft surgery with normothermic cardiopulmonary bypass.  Critical Care. 2009. 13(1):P71.
  5. Engelen S, et al. A Comparison of under-body forced-air and resistive heating during hypothermic bypass. ASA Abstract. 2010. A075.
  6. World Health Organization, Health care-associated infections FACT SHEET, http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf
Oct 13, 2015

Nosocomial Infections: Important Facts to Know

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Nosocomial infections, according to the World Health Organization (WHO), are “infections  acquired in hospital by a patient who was admitted for a reason other than that infection.”These infections are otherwise known as healthcare-associated infections (HAIs). HAIs can happen during a patient’s hospitalization or after discharge. Organisms from HAIs can also affect healthcare personnel and visitors.

HAIs are dangerous. Based on the 2011 U.S. CDC HAI prevalence survey, they found:

On any given day, 1 in 25 hospital patients has at least 1 HAI

An estimated 722,000 HAIs occurred in U.S. acute care hospitals in 2011

75,000 hospital patients with HAIs died during their hospitalization

Using the 2011 Data, the U.S. CDC Estimates of HAIs Occurring in Acute Care Hospitals in the United States

Major Site of Infection                                                Estimated Number of Infections

Surgical site infections from any inpatient surgery                  157,500

Pneumonia                                                                         157,500

Gastrointestinal Illness                                                        123,100

Urinary Tract Infections                                                         93,300

Primary Bloodstream Infections                                             71,900

Other types of infections                                                       18,500

Estimated total number of infections in hospitals            721,800

Important facts about nosocomial infections

  • Surgical site infections (SSIs) and pneumonia are tied as the number one type of HAI.
  • Surgical site infections on average can add 7-10 postoperative hospital days.1
  • Ventilator-associated pneumonia can be spread from bacteria on hands that is transferred to ventilator equipment.
  • 77% of reusable ECG leadwires were found to be contaminated with antibiotic-resistant nosocomial pathogens even after being cleaned.2
  • The greatest risk factor for developing a catheter-associated urinary tract infection (CAUTI) is prolonged use of a urinary catheter.
  • About 37,000 central line-associated blood stream infections (CLABSIs) happen each year to kidney dialysis patients with central lines.

The U.S. CDC’s National Healthcare Safety Network (NHSN) is an initiative to track and monitor HAI rates and prevention progress. The January 2015 National and State Healthcare-associated Infections Progress Report (based on 2013 data) gives national and state-by-state information for HAIs. The update shows significant progress, but more work around patient safety and infection prevention is needed. This helpful CDC infographic, 6 Ways to Be a Safe Patient, will help patients better understand what they can do to protect themselves from infection.

For more information about diseases and organisms that can be found in healthcare facilities, visit the US CDC definition and information page.

1 Anderson DJ, et al. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29:S51-S61
2 Jancin, Bruce. Antibiotic-resistant pathogens found on 77% of ECG lead wires. Cardiology News. 2004;2(3):14.
Feb 15, 2015

Learn About the Patient Monitoring Process

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Patient Monitoring - infection prevention

Patient monitoring electrodes are one of the best ways for nurses and doctors to understand what is happening to a patient. But, using electrodes can be challenging. 3MSM Health Care Academy offers healthcare providers free continuing education (CE) courses to help better understand how to properly use patient monitoring electrodes. We are excited to offer a series of free, self-study CE webinars that provide in-depth instruction and insight into patient monitoring techniques for the purpose of helping to reduce the risk of infection, elevating quality of care and enhancing patient health.

All webinars are 60 minutes in length and available at your convenience. Save this page in your favorites or share it with a colleague.

Anatomy and Physiology of the Heart

An Economic Valuation of the use of Disposable vs. Reusable ECG Leads

Eliminating a Risk of HAIs with Disposable ECG Leads

Resistant Bacteria Development and Cross-Contaminate Risk with Reusable ECG Leads

Optimizing Cardiac Monitoring While Reducing ECG Alarms

Reusable ECG Leads: Pathway Component in Cross Contamination HAIs

Congestive Heart Failure and Pulmonary Edema

Cerebral Vascular Accident vs. Transient Ischemic Attack

Disposable vs. Reusable in the Hospital – An Evaluation of the Data

A Practical Approach: Infection Prevention Related to Cardiac Monitoring

A Practical Approach: Optimizing Heart Monitoring When Using Disposable Electrodes

Economic Benefits of Disposable ECG Leads vs Reusable ECG Leads

Use of Disposable ECG Leads to Eliminate Pathways of Cross Contamination of Resistant Bacterial Hospital Acquired Infections (HAI)

The Risk of Antibiotic Resistant Bacteria Developing and Multiplying on Reusable ECG Leads

Optimizing Heart Monitoring

Electrophysiology and ECG Basics

Identifying the Risk of Resistant Bacterial Hospital Acquired Infections (HAI) from Cross Contamination due to Reusable ECG Leads

12 Lead EKG’s

Infection Prevention Related to Cardiac Monitoring

We update healthcare CE courses each week. If you don’t see a topic that you want to learn more about, check out the complete library. Each patient monitoring healthcare CE course is one contact hour.