Single patient use BP cuffs

[sharann, BSN, RN]

Hi,

Is there any evidence based practice regarding giving a patient a single use(dedicated to that patient) BP cuff that follows them from pre-op through discharge decreasing infection rates? We currently use the regular BP cuffs on all patients which should be cleaned between EVERY patient(but are in reality not always). At times the OR comes out so fast we cannot possibly disinfect the cuff! I am just worried that we ar possibly transmitting diseases from pt to pt. On the floors I know they do not clean these in between patients. Have seen it and it is worrisome as well. C-diff and MRSA are contact aren't they? What do you think? What do other facilities do in regards to BP cuffs etc.?

Thanks

[sharann, BSN, RN]

I guess this is not a common concern so I retract my question and will look elsewhere for some empirical data. It is not an easy topic to find info on, as I did alot of searching prior to coming here to ask you infection specialists. I am frustrated by the lack of data. I will continue our disinfection methods althogh I know for a fact that not every cuff is cleaned every time. It does not happen. It should, but doesn't. This is the truth as I have observed and experienced. It is a shame as MRSA is rampant and it is not necessary to sperad it when we can minimize exposures by simple measures(unfortunately all they see is the bottom line of what the cuffs cost, not the 21 days of antibiotic tx in the hospital after a surgical infection occurs.)

[Thunderwolf, MSN, RN]

sharann, it may be do to that your thread here needs more member visibility. I am moving it to the General Nursing Discussion forum to assist you in that. Maybe, this will help.

[meandragonbrett]

We use a new cuff for each and every patient.

[RN1989]

I have not seen any studies regarding this. I have worked for some hospitals that have a disposable cuff for every patient and others that use communal cuffs. And to be truthful, I can tell you that I have no idea whether the staff disinfected the cuffs between use of every patient or not. I prefer individual cuffs. Especially when you need a larger or smaller cuff than what is on the machine or wall. Sometimes no matter how much you disinfect a cuff, it just seem funky when you have a pt with skin oozing or one that wipes wound exudate on things.

[TigerGalLE, BSN, RN]

In our hospital every patient has a BP cuff on the wall above the bed. BUT everyone uses the nurse on a stick instead of taking a manual BP. So maybe if we actually used to manual BP cuff we could prevent infection spread. But the CNAs and PCTs don't carry stethoscopes when they do their vitals... And the are supposed to clean the BP cuff between rooms.... But I know they don't do it all the time.

[fizz2Nurse]

The hospital I'm on assignment with uses a new disposable cuff for every pt. It attaches to the Dynamap but each cuff is individual.

The rationale here is how many of your pts have some kind of weep or ooze from an IV site edema or some kind of cantact bacteris that they don't want to transmit.

First place I've ever been like this and when you think about it..... how often does the one BP cuff per floor REALLY get cleaned?

[GeauxNursing]

in our dialysis unit, the MRSAer's have their own cuff, stored in a plastic bag, in a separate drawer.

[twarlik]

Have you done a literature search? There was a recent article in Nursing Management regarding a hospital which was able to drastically reduce the spread of MRSA through a new infection control program. I don't think that the use of disposable blood pressure cuffs was one of their interventions.

I've heard that our local VA hospital uses individual cuffs for each patient and also swabs every patient for MRSA on admission. They have been able to almost eliminate the spread of MRSA (or so I've been told).

Todd

[Chaya, ASN, RN]

In our hospital every patient has a BP cuff on the wall above the bed. BUT everyone uses the nurse on a stick instead of taking a manual BP. So maybe if we actually used to manual BP cuff we could prevent infection spread. But the CNAs and PCTs don't carry stethoscopes when they do their vitals... And the are supposed to clean the BP cuff between rooms.... But I know they don't do it all the time.

"Nurse on a stick" Never heard that before, but I love it! (You can bet I'm hijacking that term first chance I get!).

I'm troubled by use of a common cuff also, same for the common finger probe on the pulse-ox. I'm not sure if the probes are even designed to be exposed to a harsh disinfectant or even EtOH that often. We don't have a clear procedure for cleaning cuffs between uses, and I suspect the most they get is a cursory swipe before being put away. If someone thinks to do it. And has time to let it dry before it's needed again. We do Q 4 hr VS, plus PRN before BP meds of if pt is feeling CP, SOB or otherwise ill. We have 3 VS machines on an 18 pt unit. There is a sphing/ cuff in each room and all rooms are singles but again- I'm not sure if these are reliably cleaned between on pt's discharge and the next admission to the room. We try to leave a machine in the room if we have a pt on contact precautions and all precaution pts do get a disposable steth but frequently we have 3 or more pt on precautions...I don't know what the answer is but this does seem like a probable vector for all sorts of bad bugs and I would like to know how well say, MRSA grows on the surface of a cuff...Yeesh.

[sharann, BSN, RN]

Thank you all for the information. I am not the infection control nurse but I do work in an area that gets patients from all over the hospital and some from home to outpatient. It helps to disinfect in our unit I am sure, but when the patient leaves our area then it is the next areas issue. Maybe I should just request a meeting with the IC nurse and that will be that. My manager asked for some EBP about this but I have not found any specifically regarding BP cuffs. I have read about swabbing each patient but do you do that for all the pre-op elective outpatients as well?

Well, anyways, thanks again. Thunderwolf, you were right this is a more read forum I was just trying to keep within the specialty. I guess almost everything can fall under "general nursing forums"!

[wtbcrna, MSN, DNP, CRNA]

Here is what I found on pub med( one on nondisposable BP cuffs and one on disposable BP cuffs):

Blood pressure cuff as a potential vector of pathogenic microorganisms: a prospective study in a teaching hospital.

de Gialluly C, Morange V, de Gialluly E, Loulergue J, van der Mee N, Quentin R.

Laboratory of Microbiology and Hospital Hygiene, University Hospital, Tours, France. [email protected]

OBJECTIVE: To investigate the potential role of blood pressure (BP) cuffs in the spread of bacterial infections in hospitals. DESIGN: A comprehensive, prospective study quantitatively and qualitatively evaluating the bacterial contamination on BP cuffs of 203 sphygmomanometers in use in 18 hospital units from January through March 2003. SETTING: A university hospital with surgical, medical, and pediatric units. RESULTS: A level of contamination reaching 100 or more colony-forming units per 25 cm(2) was observed on 92 (45%) of inner sides and 46 (23%) of outer sides of 203 cuffs. The highest rates of contamination occurred on the inner side of BP cuffs kept in intensive care units (ICUs) (20 [83%] of 24) or on nurses' trolleys (27 [77%] of 35). None of the 18 BP cuffs presumed to be clean (ie, those that had not been used since the last decontamination procedure) had a high level of contamination. Potentially pathogenic microorganisms were isolated from 27 (13%) of the 203 BP cuffs: 20 of these microorganisms were Staphylococcus aureus, including 9 methicillin-resistant strains. The highest rates of contamination with potentially pathogenic microorganisms were observed on cuffs used in ICUs and those kept on nurses' trolleys. For 4 patients with a personal sphygmomanometer, a genetic link was found between the strains isolated from the BP cuffs and the strains isolated from the patients. CONCLUSIONS: The results of this survey highlight the importance of recognizing BP cuffs as potential vectors of pathogenic bacteria among patients and as a source of reinfection when dedicated to a single patient, emphasizing the urgent need for validated procedures for their use and maintenance.

Article 2:

AANA J. 1997 Feb;65(1):28.

Nondisposable sphygmomanometer cuffs harbor frequent bacterial colonization and significant contamination by organic and inorganic matter.

Base-Smith V.

University of Cincinnati College of Nursing and Health, Ohio, USA.

In the hurried milieu of operating rooms, emergency departments, and intensive care units, contaminated sphygmomanometers (blood pressure cuffs) may not be routinely sanitized or replaced with clean cuffs between patient use. Previous investigations, though few in number, have identified blood pressure cuffs as potential sources of nosocomial infection or vehicles for transmission of contagion in selected patient populations. In this study, presumed "clean" blood pressure cuffs were cultured and evaluated for organismal proliferation and contamination by organic and inorganic debris. Results indicated that frequent bacterial colonization and soiling with organic and inorganic substances did occur on "clean" blood pressure cuffs. Although risk of disease transmission was not measured, the need for better sanitation and disinfection of the cuffs between patient use became evident.