Cleanliness of Disposable vs Nondisposable Electrocardiography Lead Wires in Children

Abstract

Background Mediastinitis costs hospitals thousands of dollars a year and increases the incidence of patient morbidity and mortality. No studies have been done to evaluate adenosine triphosphate (ATP) counts on disposable and nondisposable electrocardiography (ECG) lead wires in pediatric patients. Objective To compare the cleanliness of disposable and nondisposable ECG lead wires in postoperative pediatric cardiac surgery patients by measuring the quantity of ATP (in relative luminescence units [RLUs]). ATP levels correlate with microbial cell counts and are used by institutions to assess hospital equipment and cleanliness. Methods A prospective, randomized trial was initiated with approval from the institutional review board. Verbal consent was obtained from the parents/guardians for each patient. Trained nurses performed ATP swabs on the right and left upper ECG cables on postoperative days 1, 2, and 3. Results This study enrolled 51 patients. The disposable ECG lead wire ATP count on postoperative day 1 (median, 157 RLUs) was significantly lower (P < .001) than the count for nondisposable ATP lead wires (median, 610 RLUs). On postoperative day 2, the ATP count for the disposable ECG lead wires (median, 200 RLUs) was also lower (P = .06) than the count for the nondisposable ECG lead wires (median, 453 RLUs). Conclusion Results of this study support the use of disposable ECG lead wires in postoperative pediatric cardiac surgery patients for at least the first 48 hours as a direct strategy to reduce the ATP counts on ECG lead wires.

A single-patient-use ECG system for cardiothoracic surgery admissions in the UK: A cost-consequence analysis

“…ln [1−SSI day ×1,440] , adjusted by 0.76 relative risk for the spECG arm (13, 15,16,31). For a "Low-risk wound, " the probability of developing a "Contaminated wound" is 0.25 times (one quarter) that of a "Clean wound."…”

“…Initiatives undertaken to improve the DSWI risk assessment and management have deemed certain “minor” aspects within the operating theater essential in preventing DSWI ( 9 , 10 ), in particular wary perioperative prophylaxis of ECG devices, known vectors of infection ( 11 ). The complex surfaces and grooves of equipment, the extra workload on ward staff, and inconsistent protocols make sanitizing reusable ECG (rECG) monitoring wires challenging and often ineffective, leading to an increased risk of cross-contamination ( 13 – 15 ). Single-patient ECG (spECG) components have been shown to reduce the likelihood of surgical site infections (SSIs) in several studies ( 12 , 15 – 17 ); The National Institute for Health and Care Excellence (NICE) assessed spECG technology in 2019 ( 18 ).…”

Research in Review: Driving Critical Care Practice Change

“…Disposable ECG lead wires have been found to decrease ECG wire contamination, 10 but this reduced contamination was not associated with a reduction in infections. 11 Despite these equivocal results, disposable ECG lead wires have been recommended as infection prevention measures.…”

Recent Advances in Multidisciplinary Critical Care

“…In turn, contaminated equipment may serve as a vector for bacteria to colonize and infect patients. Addison et al 84 investigated the cleanliness of disposable versus reusable electrocardiography (ECG) lead wires in children. Cardiac surgery patients were randomized to either disposable or reusable ECG lead wires.…”