Identifying 'Probable' Sources of Nosocomial Infections on a BMT ICU Point to Areas Needing Cleaning

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WASHINGTON, DC—An ongoing investigation at Brigham and Women's Hospital is seeking to determine whether identifying sources of cross-contamination on a single bone marrow transplant (BMT) intensive care unit can lead to interventions that reduce nosocomial infections, a study presented at the Oncology Nursing Society (ONS) 38th Annual Congress outlined.



“Nurses have the unique opportunity to provide continuous surveillance of compliance to infection control policies,” noted Michelle Ranaghan, RN, BS, OCN®, of Brigham and Women's Hospital, Boston, MA. She added that the investigation was prompted when “monthly infection audits revealed a progressive increase in nosocomial infections on a 10-bed BMT intensive care unit, prompting staff to look for probable sources.”

The staff conducted a unit-wide investigation that included email surveys and discussions, which produced a list of suspected areas of cross-contamination. “From this list, nine areas were cultured onto blood agar plates before and after being disinfected for 2 minutes,” Ranaghan noted.

Two samples came from curtains dividing the room, both at waist and out-of-reach levels. All plates were incubated at 37°C for 96 hours, photographed to record growth, and marked with UV for a 48-hour follow-up observation “to determine if cleaning protocols were observed during that timeframe,” she stated.

After the results were compiled, pictures were posted in the staff break room. “Areas with the most microbial growth were the curtain at waist level, Omnicell, and medication computer,” Ranaghan pointed out. Staff intervention suggestions included a monthly curtain cleaning schedule; updating a list of areas requiring daily cleaning daily; collaborating with pharmacy to keep the Omnicell clean; service-wide reminders to clean shared equipment; and reinforced education of staff, patients and visitors.

Ranaghan noted that these findings can be applied not only to BMT, but to oncology units.

Since instituting the interventions, overall cases of C. diff and MRSA on the target unit are down compared to the rest of the Hematology/Oncology/BMT Service. VRE rates remain at or slightly below previous levels. Cultures taken from various areas on the unit show a significant decrease in the number of colonies, except for the in-room sink button. In addition, staff awareness of the culture results from highly contaminated areas resulted in a decreased incidence of HAIs even before a curtain cleaning schedule and nightly wipe-down were initiated.

“We found that all staff, especially nurses, need to hold themselves accountable to ensure patient safety. Nursing awareness of environment and infection control can reduce HAIs in the BMT and likely oncology populations,” the researchers concluded.

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