Which are cleaner? Disposable vs. Non-Disposable ECG Lead Wires

Purpose:
To compare the cleanliness of disposable and non-disposable ECG lead wires on post-operative pediatric cardiac surgery patients by measuring ATP levels. Adenosine triphosphate,ATP,measures residues left over from cells and is used in many institutions as a tool to assess hospital equipment hygiene.

Background/Significance:
Surgical Site Infections(SSI)and CLABSI's cost the hospital thousands of dollars a year and increase the incidence of patient morbidity and mortality. Pediatric cardiac surgery patients require continuous ECG monitoring. Bacteria from these lead wires may translocate to the sternotomy incision on post-operative(PO)patients which may contaminate a healing incision or a central line. No studies have quantitated bacterial counts on disposable and non-disposable ECG lead wires in pediatric patients.

Methods:
A prospective,randomized trial was initiated with IRB approval. Verbal consent was obtained from the parents/guardians for each subject.The trained PICU RN team swabbed the right upper and left upper ECG lead wires,while attached to a patient,at 24hr,48hr,and 72hr post-operative intervals and recorded the ATP levels. Adenosine triphosphate is the universal energy molecule found in all bacterial,yeast,and mold cells. ATP levels correlate with bacterial cell counts. The results from testing are displayed in Relative Luminescence Units(RLUs).The higher the level of RLUs,the more contamination is present.With regards to patient care items,a level of 100 RLUs or below is considered acceptable.

Results:
The study enrolled 51 PICU patients. Because the distributions of the bacteria counts were strongly skewed to the right and included outliers, t-tests comparing group means were not appropriate for the data. Mann-Whitney U tests were used to compare the bacteria counts between the disposable and non-disposable groups. The disposable ECG lead wire ATP count on PO day 1(median=157 RLUs) was stastically significantly lower than the non-disposable ECG ATP lead wire count (median=610 RLUs),where p<0.001. On PO day 2 the disposable ECG lead wire ATP count(median=200 RLUs)was also significantly lower than the non-disposable ECG lead wire ATP count (median=453 RLUs), with p=0.056.

Conclusions and Implications for Practice:
This clinical trial strongly supports the use of disposable ECG lead wires for at least the first 2 days after pediatric cardiac surgery. This selective utilization may result in lower bacterial colonization in the post-cardiotomy incision area, which may lead to a decrease in SSI's and CLABSI's.