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Prevent infections caused by contaminated ED equipment
Don't use unsafe practices
If a tuberculosis patient just left your ED to go to a negative pressure room, housekeeping must come and disinfect the room wearing full contact precautions garb, leave the room unused for four hours, and remove all hanging curtains and replace these with clean ones.
"Basically, the room that patient was in is a HAZMAT scene," says John Provost, RN, BSN, an ED nurse at St. Mary's Hospital in Tucson, AZ. "Yet all too often, equipment, such as fluid pumps, are quickly snatched up because there is a dire need for it in another room."
After being alerted to the fact that the pump was in a tuberculosis-positive room, an ED nurse may respond, "Thanks. I'll wipe it down," says Provost, but this isn't sufficient.
"Clearly, equipment in a patient's room is open to the organisms that the individual is being treated for," he warns. "Now tuberculosis is introduced into the environment — and especially to the nurse who has just grabbed it." Use these practices:
• Don appropriate disposable personal protective equipment (PPE) before entering the patient's room, and dispose of it before exiting the room.
"At my current facility, our negative pressure room has a subroom used for putting on and taking off PPE, to best allow for a noninfectious individual entering the general population," says Provost.
• Never allow equipment to be reused.
"If your facility is stocking disposable items for the treatment of infectious organisms, don't make the mistake of recycling," says Provost. "It may seem like an excellent idea at the time of an emergency, but this is such bad practice."
He says to ask yourself this question: "Am I simply going to make a bad situation much worse by using an item that was used on an infectious patient?"
• Use disposable items such as gowns, gloves, goggles, masks, shoe covers, stethoscopes, blood pressure cuffs, pulse oximiters, and anything else your facility has to offer.
"By transporting ED equipment from room to room without wiping it down and cleaning properly, we run the risk of exposing our patients to infections," warns Delores Alexander, RN, BSN, MBA, clinical outcomes manager at Mercy Continuing Care Hospital in Chesterfield, MO.
• Label and bag items properly so the cleaning team can easily identify these.
"If the patient was identified to have a difficult-to-treat infectious organism, a barrier such as a plastic bag needs to cover the entire item, which will not allow any of the organism out," Provost adds. (See clinical tip, below on avoiding infection in intubated patients.)
Place any used disposable instruments or equipment in biohazard bags before discarding them, says Alexander, and closely follow your hospital's protocol for disposal.
• If disposable items such as suture trays and intubation equipment aren't possible due to cost issues, clean equipment appropriately. (See related story on endotracheal tubes, below.)
"We use Saniflush wipes. They must be allowed to dry on the equipment for two minutes to kill infectious material," Alexander says. "Bleach wipes have a one-minute contact time."
However, you have to be careful that the equipment you use can be cleaned with these products, cautions Alexander. "Make sure you know what the user manual states before using any products on your equipment," she says.
For more information on preventing infections from contaminated ED equipment, contact:
Delores Alexander, RN, BSN, MBA, Clinical Outcomes Manager, Mercy Continuing Care Hospital, Chesterfield, MO. Phone: (314) 392-6389. E-mail: Delores.Alexander@mercy.net.
Kelly Coddington, RN, BSN, Nurse Manager, Emergency Services, OSF St. Joseph Medical Center. Phone: (309) 661-5114. E-mail: Kelly.C.Coddington@osfhealthcare.org.
John Provost, RN, BSN, Emergency Department, St. Mary's Hospital, Tucson, AZ. E-mail: firstname.lastname@example.org.
Never reuse ET tube in this circumstance
Has an attempt at intubation resulted in the endotracheal (ET) tube going into the patient's esophagus? If so, use a new ET tube to avoid introducing bacteria from the esophagus into the airway, advises Kelly Coddington, RN, BSN, nurse manager of emergency services at OSF St. Joseph Medical Center in Bloomington, IL.
Make sure the cuff is properly inflated to decrease the chance that oral secretions will pass into the airway, she adds, and secure the tube well to prevent movement and accidental extubation. "A well-secured tube is less likely to move or be pulled out, which can result in needing to adjust or reintubate," says Coddington.