According to the critical care Clinical Nurse Specialist at a rural southeast hospital there is acute awareness of this problem. The CNS at this local facility obtained cultures from blood pressure cuffs in the ICU, CCU, and overflow units. In all three units a number of the cuff cultures grew a gram negative rod which is an organism normally found in the gut. In this facility, a blood pressure sleeve was trialed for several weeks and repeat cultures were obtained. All repeat cultures were negative for organisms.

      Increasing rates of drug resistant diseases such as MRSA and VRE make it imperative that the spread of pathogens from patient to patient be contained. The study by Walker, Gupta, and Cheesbrough (2006) reinforce these facts when they found multiple pathogens on the same cuffs. The results of the study prompted recommendation that a barrier between cuff and skin would be a viable option to help prevent this spread of pathogens.

      The ongoing research on blood pressure cuff contamination only reinforces these results and the need for more vigilance with the use of equipment. Literature review of the evidence shows the same theme-blood pressure cuffs are vectors for the spread of pathogens.

Analysis

      There are several options available to help reduce the spread of pathogens by blood pressure cuffs. The CDC (2007) recommends the use of disposables blood pressures cuffs in the guidelines for control of pathogen transmission. These cuffs would cost more and also disposal would be a consideration. The economics associated with the cost of disposable cuffs may not make this a realistic situation for many facilities. Units with high risk patients such as those in ICU, CCU, surgery, and renal dialysis may be able to obtain these disposable cuffs. The cost of using a disposable cuff needs to be considered in relation to treating the cost of a noscomial infection, especially with the new Medicaid/Medicare mandates of not paying for certain hospital acquired infections.

      The use of a barrier such as a blood pressure sleeve is well supported in the review of literature by (Webb, 2002, Hwang et al, 1998, Marion et al, 1996). The blood pressure sleeve is an alternative that would be more cost effective, with prices between sixty-nine cents to ninety six cents per unit. (Bowen Medical, 2009). Staff education is vital for implementing changes such as the use of a blood pressure cuff sleeve. In the rural southeast hospital survey there were several staff complaints including: too much time to change the sleeves, cuffs not always available, and the correct size was not always available. Managers would need to address these concerns and assure that the product was available and the sizes of cuffs needed were supplied. Disinfecting and cleaning cuffs is by far the most common method used, but even after cleaning, organisms are still cultured from blood pressure cuffs, especially in areas such as the ICU (de Gialluly et al, 2006).

      Hand washing has always been the tried and true practice to reduce transmission of pathogens between patients and patient to staff /others and is still needed with using blood pressures cuffs between patients.  Hand sanitizers are becoming more popular, but staff needs to keep in mind that not all pathogens are killed by hand sanitizers. The current practice of using hand sanitizers appears to have become more attractive as the products become more user-friendly and not as rough on skin integrity. Deshpande and Rothchild (2006) suggest that infectious control providers need to incorporate behavior change interventions that will appeal to the healthcare worker. The benefits of using hand sanitizers are such that “even busy healthcare workers will find hand rubs fast, convenient, and effective at killing the superbugs on their hands” (2006). Medical providers can help with the growing numbers of drug resistant pathogens by carefully prescribing antibiotics, ordering and monitoring cultures, and prescribing medications according to culture results (Muto et al, 2003). Patient education in the hospital and in the community is another area where physicians and other providers can help with prevention.

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