1. INFECTION CONTROL
AND THE
BLOOD PRESSURE
CUFF
By Shelley Hill RN
Role of The Advanced Practice
Nurse
Western Governor’s University

2. WHAT WOULD FLORENCE
NIGHTINGALE THINK ABOUT THIS?
Contact
Precautions
•
•
•
•
Gown
Gloves
Mask
Hair covered
No germs getting out
of this room ….Right?

3. THINK TWICE
Meet the Vital Machine
A wonderful machine that
can be wheeled room to
room to check vitals.
…AND THAT’S THE
PROBLEM.
It’s fast, convenient, and
pretty accurate, but it goes
ROOM TO ROOM.

4. WHAT WOULD FLORENCE SAY?
“Oh my,
does that
machine get
used on
every
patient?”
“YES, IT DOES.”
“I attribute my success to this – I never gave or took
any excuse.” Florence Nightingale
“Does the cuff get
washed after each
usage?”
“WELL…
I’M NOT
SURE WHO
CLEANS IT.”

5. WHEN A NURSE WRAPS A BLOOD
PRESSURE CUFF AROUND A PATIENT’S
ARM…
• Introduces bacteria, possibly MRSA
• Bacteria doesn’t have to go far to the
fingertips
• From fingertips to face and other parts of the
body

6. THE BLOOD PRESSURE CUFF
Vectors for the spread of
pathogens
• 1969 Study identified the blood
pressure cuff as a “reservoir for
bacteria, no other piece of
equipment was used more without
adequate disinfection” (Beard,
Mcintyre & Roundtree).
• 2003 Study states that 77% of
blood pressure cuffs on trolleys in
hospitals were contaminated (83%
of cuffs in the ICU ), 45%
CARRIED MRSA (McCaughery,
2007).
• a Study reported in the AARP
Bulletin states, “ 39% of medical
personnel didn’t know that C.diff
could be spread on stethoscopes,
blood pressure cuffs and other
…
equipment (Dubay, 2009).

7. HOSPITAL ACQUIRED INFECTIONS
 Nearly two million patients in the U.S. gets a hospital
acquired infection each year.
 90,000 of those patients die as a result of their
infection.
 Hospital Acquired Infection kill 5 times as many
Americans as AIDS.
 Annual cost to treat these infections in the U.S. is 30.5
Billion dollars.
 Average cost of $15,272 per patient.
CDC, 2009

8. EXAMPLE: MRSA
• Resistant to
Antibiotics
• Increasing rates –in
2011 70% of Staph
Infections were
MRSA
(themrsa.com)
• 18,000 deaths in the
U.S. per year (JAMA,
2007)
• Most serious cases take
place in the healthcare
setting (CDC, 2007).

9. “MRSA IS LURKING IN EVERY U.S.
HOSPITAL,”
“…and poses a serious and sometimes deadly health
risk to patients who are unwittingly exposed to these
superbugs.”
 We know how to control MRSA, but hospitals are not
being consistent in their infection control measures.
 Hospitals need to make a commitment and invest the
resources to protect patients from MRSA.
 In the long run, it will save money and lives.

Lisa McGiffert, Director of
The Consumers Union

10. LET’S TALK SOLUTIONS
Are there EBP Recommendations to
curb hospital acquired infections.
Propose new policy or enforce present
policy.
 Propose introduction of new products.
Evaluate if changes make a difference in
hospital acquired infection rates.

11. MRSA SCREENING ALONE?
 It is important to identify patients with MRSA.
 Note: MRSA Screening is controversial. The agent used to
decolonize the nasal passageway may make the resistance even
worse.
 MRSA Screening needs more controlled studies.
 Rapid screening before admission is “no more effective than
conventional screening” and it is more expensive.
 MRSA CAN be reduced by rigorous application of standard
control principles, along with TARGETED screening.
Mark Wilcox, 2008
professor of medical
microbiology
Leeds Teaching Hospital

12. ACTIVE SURVEILLANCE
 Physicians, hospitals and other healthcare facilities need to work
together to identify patients with MRSA and other resistant
infections.
 Record keeping is essential.
 Once identified, Contact Precautions and Isolation can be used to
prevent the spread of the bacteria.
 “Contact precautions with single room isolation or cohorting were
associated with a 60% reduction in MRSA acquisition” (Marshall,
Richards, McBryde, 2013)
What other measures could be
taken to prevent the spread of
resistant bacteria?

13. WHAT ABOUT BLOOD PRESSURE
CUFFS?
Make changes to improve or reinforce
BP Cuff cleanliness policies

14. CDC RECOMMENDATIONS ON
EQUIPMENT USAGE
In acute care hospitals, long term care and
other residential settings, use disposable
noncritical patient care equipment (e.g.
BLOOD PRESSURE CUFFS) or implement
patient-dedicated use of such equipment. If
common use of equipment for multiple patients
in unavoidable, clean and disinfect such
equipment before use on another patient.
CDC, 2007

15. SOCIETY FOR HEALTHCARE EPIDEMIOLOGY OF AMERICA
RECOMMENDATIONS FOR EQUIPMENT
“Dedicate the use of noncritical patient-care
equipment to a single patient (or cohort of
patients infected or colonized with the same
pathogen), avoid sharing between patients. If
use of common equipment or items is
unavoidable, then adequately clean and
disinfect them before use for another patient.”
Muto, 2003

16. STAFF EDUCATION &
REINFORCEMENT
For Equipment
• Disposable when possible
• Dedicated to patient
• Clean and disinfect all
equipment before
removing from this room.
•
•
•
•
In-service Lessons
Posters
Infection Control Rounds
Positive Reinforcement

17. #1 INFECTION CONTROL
MEASURE
Still is… good old hand washing.

18. #2 KEEPING EQUIPMENT CLEAN
Wiping down with disinfectants

19. #3 WASHING THE BP CUFFS
Product called,
“Cuff Care
Systems”
Washing
Machine for
blood pressure
cuffs.

20. #4 USING BARRIERS
Using a disposable
sleeve on the
patient’s arm.
It protects the patient
by not letting the
blood pressure cuff
touch the patient’s
skin.
http://www.eleemedical.com/bar
riers.htm

21. #5 SINGLE PATIENT DISPOSABLE
CUFFS
By staying with patient, this cuff prevents
cross contamination

22. # 6 ANTIMICROBIAL TREATED
REUSABLE CUFFS
Prevents fungal and bacteria growth on BP CUFF

23. DO THESE IDEAS
AND PRODUCTS WORK?
 In Denmark, MRSA peeked in the 1960s at 33%. After a strict MRSA
control transmission policy, the rate dropped to less than 1%. This
was maintained for 25 years. (Muto, 2003)
 The VA healthcare System in Pittsburgh had a 70% reduction of
infections in the surgical unit, and an 82% reduction of MRSA after
two years of a staff-owned prevention program that included active
surveillance, hand hygiene, strict contact precautions. (Richmond,
2007)
 University of Pittsburgh had a 90% reduced MRSA rate in there ICU
units. They used a program using screening tests, and gowns. They
spent $35,000 and saved over $800,000 in infection costs.
(McCaughery, 2006)
 A U.S. study, published in the American Journal of Infection Control,
showed a “53% drop in rates of C.difficile infection when disposable
BP (blood pressure) cuffs were used” (Alexander, 2013).
Preventing Hospital Acquired Infections
YES!

24. DOES THERE NEED TO BE
MORE STUDIES DONE ON THE
RELATIONSHIP OF BP CUFFS AND CROSS
CONTAMINATION?
YES!
This is a good start

26. IS THIS THE FUTURE?
Ultra Violet Light
http://www.xenex.com/howuv-disinfection-light-works/

27. WHAT WOULD FLORENCE SAY?
“The very
first
requirement
in a hospital
is that it
should do the
sick no
harm.”
Florence
Nightingale

28. DESIRED OUTCOME
Decreased Hospital Acquired Infections
Risk mitigation – Keep hospitals in
business.
Ultimate GOAL?
Going to the hospital, and not getting
something worse than what you went in
for!

29. REFERENCES
 Alexander. ,May 2013. American Journal of Infection Control. Vol

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37 #5.
Beard, Mcintryre, Roundtree. 1969. The Sphygmomanometers as
a reservoir of Pathogen bacteria. The Medical Journal of Australia.
Retrieved from www.gehealthcare.com.
CDC. 2007. Guideline for isolation Precautions. Retrieved from
www.cdc.gov.
CDC. 2009. Retrieved from www.cdc.gov.
Dubay. 2009. AARP Bulletin Today.
JAMA. 2007. as cited by the CDC in MRSA in Healthcare
Settings.
Marshall, Richards, McBryde.2013. Do Active Surveillance &
Contact Precautions Reduce MRSA. PUB Med.gov.

30. REFERENCES (CONTINUED)
 McCaughery. (14 Nov 2006). To Catch a Deadly Germ. New York





Times.
McCaughery. Betsy. 2007. New Research & Compelling Economic
Data in Support of Infection Prevention. Committee to Reduce
Infection Deaths.
McGiffert. 2007. Consumers Union Urges Hospitals to Adopt
Aggressive New Aprroaches to Stop the Spread of Deadly AntibioticResistant Infections. Infection Control Today.
Muto, Jernigan,Ostrowshy, Richet, Jarvis, Boyce. 2003. SHEA
guidelines for preventing nosocomial transmission of MRSA.
Retrieved from www.ncbi.nim.nih.gov.
Richmond, Ira. 2007. Best-Practice Protocols: Reducing harm from
MRSA. Nursing Management.
Wilcox, Mark. 2008. Screening for MRSA. BMJ. Retrieved from
www.ncbi.nim.nih.gov.