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Read the following and answer the questions below One issue I identified while doing one of my clinical rotations was after taking a set of vital signs on a patient using a portable vital signs monitor. The physician was in the room and identified that the patient might have scabies (but he had not previously been on isolation precautions). After he said that, I spent a lot of time wiping down the machine to prevent contamination to the next patient that needed vital signs. So, it got me thinking about infection control and how often portable medical equipment (PME) such as vital signs machines pose a risk in the transmission of healthcare-acquired infections (HAIs). Does portable medical equipment (PME) play a role in the transmission cycle of healthcare-acquired infections? The first research article I used is titled: Interaction of healthcare worker hands and portable medical equipment: a sequence analysis to show potential transmission opportunities (Jinadatha, et al., 2017). In summarizing this article, the authors identified PME as a source of transmission for which there is limited available research. PME includes devices such as computers on wheels (COW), vitals machines, intravenous (IV) pumps, and other devices used on multiple patients consecutively. The purpose of their study was to investigate the patterns and sequence of touch events among health care workers, patients, surfaces, and equipment in the hospital environment, to better inform our understanding of potential infection transmission pathways. They completed observations to find the average number of touches per encounter for each surface type and inpatient unit. They also observed infection prevention activities. Results: Out of 144 total hours of observation, there were 274 sequences that varied in length from 1 to 98 touches. Among all observation sequences, 151 (55.1%) involved the movement of PME in and out of the room. The top 10 items most touched in patient rooms were the patient (850 touches), COW (634), bedrail (375), IV pump (326), bed surface (302), tray table (223), vitals machine (213), wall shelf (110), door (90), and (10) in-room computer (78). Gloves were routinely used in only about half the encounters and hand sanitization only performed an average 1.2 times per encounter. Disinfection of PME upon entry or exit from room was observed to occur only 17 times over the 144 hours of observation (Jinadatha, et al., 2017). The study concluded that PME emerged as a potential source for transmission of both ABC and MRSA. The disinfection of the COW between patients was not required by policy based on CDC guidelines however, these guidelines may warrant reconsideration. Disinfection of PME, preferably in between patient interactions, may potentially be necessary, along with optimal hand hygiene, to reduce the possibility of transmission between patients (Jinadatha, et al., 2017). The second research article I used is titled: Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England (Moore, et al., 2021). This study aimed to understand how severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spread within the hospital setting. Doing so is essential to protect staff, implement effective infection control measures, and prevent nosocomial transmission. The methods used were to investigate (through environmental sampling) the presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalized patients. Findings: SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. In the non-ICU setting, 27% of surfaces contaminated with SARS-CoV-2 RNA were located outside the patient bed area. These included toilet door handles and portable vital signs monitors, which together accounted for 26% of all positive sites. They concluded that effective cleaning can reduce the risk of fomite (contact) transmission, but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2 (Moore, et al., 2021). Based on the evidence in these two studies, PME that is shared among patients is a potential source of pathogen transmission. Therefore, my recommendation is that all PMEs (including COWs, vital signs machines, etc.) is cleaned and decontaminated after each patient use. Now, this is much easier said than done. In fact, current guidelines recommend that medical equipment that comes into contact with intact skin is cleaned and decontaminated after each patient use. However, studies have reported that portable equipment was often not cleaned according to written protocols between each patient’s use (Pyrek, 2018). Therefore, the solution includes fully incorporating the wiping down of PME with disinfectant between each use in hospital practices. To implement the plan, all PMEs will be marked with color-coded stickers. Each color code will be associated with the frequency and cleaning product needed to clean the individual equipment item. Staff will be trained on the appropriate cleaning procedures and frequency needed. A policy will be written and disseminated to all staff. Leadership buy-in is essential and will be requested to do spot-checks (several per shift) to ensure the cleaning is taking place. Additionally, the results of the studies I used will be summarized and provided to staff to ensure they understand why they are being asked to apply the additional cleaning requirements. I found an interesting method used during a study that I would incorporate into an evaluation plan. Over a six-month period (and at random intervals after that), an invisible ink would be applied to pre-determined high-touch surfaces of equipment and serial numbers will be recorded to track devices. Later, the equipment will be checked for residual ink using an ultraviolet flashlight. Results will be tabulated as “clean” if the ink is not visible by the ultraviolet flashlight. If the ink is detected, staff will be notified, and appropriate cleaning will be demonstrated (Pyrek, 2018). To sustain the practice change, incentives will be applied. The shift with the least amount of residual ink found on equipment will be rewarded (pizza party, a few hours off, etc.). Additionally, if cleaning is not being done according to policy, staff should be held accountable. After the initial evaluation plan, I believe the invisible ink should be applied at random intervals (at least biannually) to sustain the change. Opinion if the proposed practice change was relevant and supported by the literature Discussion of the feasibility of a plan to implement, evaluate and sustain practice change At least one suggestion for how to improve the proposal for an evidence-based practice solution

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