I have returned with comments all the papers that have been sent to me as drafts for part 1. Now our job is to get them finished as part 1 and put the completed perfect paper aside and prepare part 2

Running head: DISINFECTING NURSING EQUIPMENT 1

Importance of disinfecting nursing equipment to prevent hospital-acquired infection in

Bukola R. Adebayo

Lincoln University of Pennsylvania

Based on my clinical experiences at some medical facilities such as a community hospital and a mental health facility, some hospital equipment like blood pressure cuffs, thermometers, pulse oximetry, electrocardiographic telemetry etc., are not frequently disinfected before usage. This practice improvement project will address the disinfecting of this equipment before usage on patients. Most of the time, this equipment was only disinfected either at the beginning of the shift or possibly at the end of the shifts. However, they are not disinfected in between usage. This increases the risk of hospital-acquired infections (HAI) in patients during their stay at the facility. Possible solutions to this problem are contained in current literature as shared by

Farhadloo, R., Goodarzi Far, J., Azadeh, M., Shams, S., & and Parvaresh-Masoud, M. (2018).​

The goal of this practice improvement project is to explore methods of disinfecting hospital equipment to help reduce the risk of patients getting HAI during hospital stays. A current proposal is the assigning of individual patient blood pressure cuffs upon admission to be utilized on only the assigned patient.

Will the addition of infection control measures as suggested in the current literature be adequate to prevent or at least reduce hospital-acquired infection?

From a qualitative perspective, staff will be interviewed to determine the perception of the possible effects of the initiation of a new procedure.

increase the space

From a quantitative perspective will the requisition of single patient use equipment be effective in preventing hospital-acquired infections. A retrospective review of documented HAI rates in the past six months will be compared to the current HAI after implementation of new protocols, including assigning single patient BP cuffs.

For the purpose of this PI proposal, both perspectives (Qualitative and Quantitative) will be utilized to test for effectiveness in reducing HAI infection rates.

A literature search was conducted using Google search engine, PubMed, Ebscohost and google scholar. A total of 120 articles were retrieved but only eight were chosen. The years of the articles chosen in this literature review are 2014 - 2019. These articles were selected and reviewed based on the relevance to the research topic. Keywords used included: bacteria disinfectants, healthcare workers, patient care equipment, blood pressure cuffs. The literature review is divided into three categories: They are bacteria contamination, the content of disinfectants, and disinfectant contact time.

It is important to know the type of role the contamination of equipment and devices plays in causing nosocomial infections. Sarallah Sojael et al. (2016) comment: you did not include this author in your reference list – last name only should be used to cite in the text. Is Sojael the last name? conducted a quasi-experimental study to determine the effectiveness of a disinfectant on the rate of microbial contamination of ambulances in Qom Emergency Medical Services (EMS), Qom, Iran. At the end of the study, the result showed that the contamination rates before and after the use of disinfection solutions were 52% and 8% respectively. The contamination level in all equipment showed a significant reduction after applying a disinfectant, therefore, the suitable use of disinfectant had an effective role in the reduction of bacteria.

Due to the complex intricate surfaces, blood pressure cuffs and electrocardiographic telemetry leads may be harder than other equipment to disinfect. Risteen Riley et al,(2018). explored the effectiveness of 0.5% hydrogen peroxide wipes in cleaning and disinfecting inpatient hospital surfaces, including hook and loop (velcro) fasteners of blood pressure cuffs and electrocardiographic telemetry leads. A prospective study of an inpatient telemetry unit was designed to measure the persistence of a UV indicator and the presence of bacterial colonization on electrocardiographic telemetry leads and blood pressure cuffs. Call buttons and patient trays were used as control surfaces because they were often touched but are easy to disinfect through standard practices. A total of 392 samples were collected with a period of four weeks and cultured for microorganisms. In 247 samples (63%) of the cultures had at least 1 colony-forming unit. After adjustments in a multivariable analysis, odds of a contaminated surface (>​ 10 colony-forming​ units) after final cleaning with 0.5 % hydrogen peroxide wipes were 3.70 times greater for patient trays than for blood pressure cuffs (P= .03) and 3.80 times greater for telemetry leads than for blood pressure cuffs (P= .04). The UV indicator persisted longer on blood pressure cuffs and telemetry leads on patient trays or call buttons (P < .001). This result revealed that wipes with 0.5%, hydrogen peroxide adequately disinfect blood pressure cuffs but not telemetry leads.

Contact time is the amount of time that the item or surface is to be kept “wet” with the disinfectant up thro ugh the complete drying of the disinfectant on the surface (McGoldrick, 2009). The efficacy of disinfectants for hard non-porous surfaces was assessed by the Environmental Protection Agency (EPA). Test micro-organisms were dried on a glass surface prior to being treated by the disinfecting wipes in a standardized manner with environmental controls and contact time. Following the desired contact time (2 minutes), the glass surfaces were placed in a neutralizing growth medium to inactivate the active ingredient and determine if the test microorganisms were eradicated. The result of the study showed that as long as the surface is wiped and remains undisturbed (regardless of perceived ‘wetness’ or dryness’), efficacy can be assured. This is important because it plays a role in preventing the transmission of microorganisms on nursing equipment to patients at the hospital.

Approval from the Institutional Review Board (IRB) of Lincoln University of Pennsylvania would be required before data can be collected. A mixed-method would be employed for this research (QUAL/QUAN) as previously stated. The purpose of this research is to provide a solid reason evidence for the need to change the current protocol of decontamination of equipment from per shift- related timing to the adoption of the practice improvement of continuous, on-going disinfection of nursing equipment to prevent HAIs.

Bukola – your efforts are great and there is not a lot of change to make. Most of the changes have to do with citing in the text. You have cited 4 of the 8 articles but you must cite them all in the body of the text. One of the articles is not included in the reference list so that has to be added. In citing in text, you enter last names of authors followed by the year in parentheses. I showed that in my comments. Also when citing in text use and and not symbol for but when listing in your reference list use the symbol.

Anything in red is new content – anything with a line through it should be deleted – anything highlighted should be changed. I shortened the running head – it forced your number on to the next line – so change it to disinfecting nursing equipment as I have shown. Check the notations at the reference list.

References --------move to center

place all articles in alphabetical order indent second and following lines

Farhadloo, R., Goodarzi Far, J., Azadeh, M., Shams, S., & Parvaresh-Masoud, M. (2018).

Evaluation of Bacterial Contamination on Prehospital Ambulances Before and After Disinfection. Prehospital and Disaster Medicine,​ ​ 33​ ​(6), 602-606.

doi:10.1017/S1049023X1800095X

• you did not cite in paper Kenneley, I. L. (2007). Infection Control and Prevention in Home Healthcare. Home Healthcare​ Nurse: The Journal for the Home Care and Hospice Professional​, 25​ ​(7), 459–469. doi: 10.1097/01.nhh.0000281613.89047.11

• you did not cite in paper West, A. M., Teska, P. J., Lineback, C. B., & Oliver, H. F. (2018). Strain, disinfectant, concentration, and contact time quantitatively impact disinfectant efficacy. Antimicrobial​ Resistance & Infection Control​, 7​​(1). doi: 10.1186/s13756-018- 0340-2

Risteen, R., Cohen, S., Mooney, L., Giovanniello, E., Miley, G. B., & Hollenbeck, B. L. (2018).

Disinfection of Blood Pressure Cuffs and Electrocardiographic Telemetry Leads With 0.5% Hydrogen Peroxide Wipes. American Journal of Critical Care​​, 27​ ​(4), 322–327. doi: 10.4037/ajcc2018743

Dumas, O., Wiley, A. S., Henneberger, P. K., Speizer, F. E., Zock, J.-P., Varraso, R., & Camargo, C. A. (2016). Determinants of disinfectant use among nurses in U.S. healthcare facilities. American Journal of Industrial Medicine​​, 60​ ​(1), 131–140. doi: 10.1002/ajim.22671

Henrique Rieth, G., Loro, M. M., Fernandes Stumm, E. M., Schmidt Piovesan Rosanelli, C. L., Bernat

Kolankiewicz, A. C., & SÃ, nego G. J. (2014). Use of Individual Protection Equipments by Nursing in a Hospital Emergency Unit. ​Journal of Nursing UFPE / Revista de Enfermagem UFPE​, ​8​(2), 365–371.

https://doi.org/10.5205/reuol.4688-38583-1-RV.0802201418

Romanowski, E. G., Yates, K. A., O’Connor, K. E., Mah, F. S., Shanks, R. M. Q., & Kowalski, R. P.

(2013). Evaluation of polyhexamethylene biguanide (PHMB) as a disinfectant for adenovirus. ​JAMA

Ophthalmology​, ​131​(4), 495–498. ​https://doi.org/10.1001/jamaophthalmol.2013.2498

Hubble, W. L., Austin Turner, J., & Heuertz, R. (2016). Effectiveness of Current Practices for Disinfecting Medical Equipment in a Radiology Department. ​Radiologic Technology​, ​87​(3), 250–260.

Go through your paper and make sure eachof the authors are shown under one of the 3 areas you chose. Also those not in your reference list are S. Sojeal and McGoldrick.

When you get the reference list corrected, and you add them to the text of your proposal, please return to me. You are very close and almost done. Let me know if you need any further assistance.