Use infection control tips from CCU nurses
Shelley Calder, RN, CEN, MSN, clinical nurse specialist for the ED at Beth Israel Deaconess Medical Center in Boston, has partnered with her hospital's critical care nurses to give ED nurses tips to prevent hospital-acquired infections when patients are held for long periods. Some examples:
- Ensure central lines are sterile.
Before a central line is placed in the Beth Israel's ED, nurses fill out a procedural checklist stating that the procedure is performed on the appropriate patient and site, and that sterile technique is used. "If the line is placed emergently, this checklist is not completed, alerting the intensive care unit team that the line may need to be removed due to risk of infection," says Calder. "However, at the time of placement, the benefit outweighs the risk."
When central lines are placed in the ED, nurses and physicians practice aseptic technique closely, says Mickey Heidt, RN, BSN, an ED nurse at St. Vincent Hospital in Portland, OR. "Each member of the team is compliant to ensure the best technique is followed."
St. Vincent's ED nurses use a checklist for inserting a central line. It requires following hand hygiene, draping, skin cleansing, using sterile gloves, maintaining a sterile field, and using a sterile dressing.
- Don't open up intubation equipment in advance.
All equipment including blades, endotracheal tube, and stylet should remain in sterile secure packaging until time of use, to avoid introducing microorganisms during intubation, says Calder. Nurses and physicians would routinely begin their shift by checking and preparing equipment for any emergent intubations. This included loading the endotracheal tube with the stylet and assessing the presence of the light source on the blade.
"This seems like a safe and reasonable practice. However, once the equipment is opened or removed from the sterile packaging, it has now been exposed to the environment and may increase the risk of microorganisms," says Calder. "We did a huge education blitz for this."
Once this behavior was identified, Calder worked with the physicians, nurses, and technicians to help them understand the risks that they were exposing their patients to by opening this equipment. This message was delivered at weekly morbidity and mortality rounds.
"We also incorporated a check into the daily equipment and room rounds. The nurse or tech would remove any open packages," she says. Nurses now collect the necessary equipment at the bedside, but it remains sealed until time of use.
- Elevate the head of the patient's bed 30-45 degrees.
"This reduces risk of aspiration of gastric contents and the development of ventilator-acquired pneumonia," Calder says.
- Always clean equipment.
Cleaning should occur before the next patient is placed in the bed, and shared equipment needs to be cleaned between patients, says Nancy Church, RN, St. Vincent's nurse manager of infection control.
Each team member in St. Vincent's ED — nurses, techs and health unit coordinators — cleans equipment between patient visits to decrease the spread of organisms. "The equipment in the ED is heavily used," says Heidt. "We clean the stretchers, monitor cables, bedside carts, and any other surfaces that have been contaminated."
Shelley Calder, RN, CEN, MSN, clinical nurse specialist for the ED at Beth Israel Deaconess Medical Center in Boston, has partnered with her hospital's critical care nurses to give ED nurses tips to prevent hospital-acquired infections when patients are held for long periods. Some examples:You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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