Hospital-acquired/healthcare-associated infections (HAIs)
HAIs are common, costly, deadly, and largely preventable.1,2 According to the Centers for Disease Control and Prevention, every day one in 31 hospital patients acquires an HAI.2
The cost of treatment can run from approximately $1,000 to $50,000 depending on the type of infection and the overall health of the patient.1 But by implementing appropriate patient safety protocols HAIs can be reduced by up to 70 percent.1
One of the top ten goals set by The Joint Commission in the 2019 National Patient Safety Goals for hospitals is to decrease the risk of HAIs.3
In 2015, the Centers for Medicare and Medicaid Services implemented the Hospital Acquired Condition Reduction Program. The purpose was to help hospitals make continuous and concerted efforts to implement protocols that reduce HAIs. As part of the program, hospitals performing in the lowest quartile are negatively impacted by reimbursement reductions.4
It is important for hospitals to consider the impact reusable pulse oximetry sensors can have on HAIs. Reusable sensors could potentially introduce Methicillin-resistant staphylococcus aureus (MRSA) and clostridium difficile infection (CDI) to patients. A major teaching university initiated a pilot study to better understand the HAI risk associated with reusable sensors — and its financial and clinical impact. A key result showed that even following a cleaning protocol, 25 percent of the Nellcor™ pulse oximetry DS100-A sensors that were swabbed still harbored MRSA.5
Choosing the right sensor for the patient
Is it time to restock Nellcor™ pulse oximetry sensors in your facility? Think about the variety of patients for whom you are purchasing and consider how different sensors could impact their care. Here’s a tip. Remember the four Cs when deciding on the type of sensors you choose to purchase. They include patient:
Naturally, you need to consider cost and the impact on your facility’s budget. Cleaning reusable sensors can affect clinician workflow and can be impacted by necessary cleaning agents, such as convenient disinfectant wipes.
Patient Condition. For patients who are experiencing low saturation, or are at risk for respiratory compromise, consider stocking accuracy-tested disposable sensors. Based on the Nellcor™ pulse oximetry oxygen saturation accuracy specification grid, Nellcor™ pulse oximetry reusable sensors have not been tested for low saturation accuracy, but disposable Nellcor™ pulse oximetry with OxiMax™ technology sensors have been tested under low saturation conditions and offer ±3, accuracy, depending on the disposable sensor selected.6
Patient comfort and compliance. Consider patients requiring longer-term pulse oximetry monitoring when evaluating reusable versus disposable pulse oximetry sensors. Disposable adhesive sensors offer a very natural fit like a second skin. And improved patient comfort typically leads to improved patient compliance.
The skin integrity of every patient is unique, and therefore choosing the right sensor for each patient is critical. With some sensors, like the Nellcor™ pulse oximetry sensor DS100-A, you can use a finger clip style sensor on the same site on which you should use a disposable sensor. The DS100-A can be used for up to four hours with routine checks for skin integrity. 10 Depending on the patient, it may be necessary to change the sensor site more frequently because of compromised skin integrity. When the DS100-A sensor is used, it’s important to follow the cleaning instructions in the product directions for use to help prevent HAIs. Click here for a quick reference cleaning guide.
Similarly, the Nellcor™ flexible SpO2 sensor (FLEXMAX and FLEXMAX-P) directions for use advise to visually monitor the sensor site at least every six hours. This helps ensure skin integrity and confirm no pressure injury is developing. The directions for use indicate that for cleaning the sensor between patients, use both distilled water and 70 percent isopropyl alcohol for a full 17 minutes .11
How to help reduce HAIs in your facility
To help decrease the risk:
- Consider the use of disposable pulse oximetry sensors instead of reusable sensors
- Use the four Cs to help you purchase sensor inventory that permits a set of sensors to accommodate patient needs
- Routinely check the patient’s skin integrity — regardless of the sensor type — at the sensor site following sensor manufacturer instructions
- If reusable pulse oximetry sensors are being used, follow your facility’s cleaning and disinfecting protocol and sensor manufacturer cleaning instructions
1. Hospital on Nationally Reported Metrics. Castlight Health, Inc. The LeapFrog Group website. Hospital Acquired Infections. https://www.leapfroggroup.org/news-events/troubling-new-report-hospital-infections-comes-while-centers-medicare-medicaid-services. Published June 20, 2018.
2. Centers for Disease Control and Prevention. HAI data. CDC website. https://www.cdc.gov/hai/data/index.html. Reviewed 10/5/18. Accessed 6/1/19.
3. The Joint Commission. National Patient Safety Goals Effective January 2019. Hospital Accreditation Program. 2019.
4. Center for Medicare and Medicaid Services. CMS website. Hospital-Acquired Condition Reduction Program(HACRP). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program.html. Fiscal Year 2019. Fact Sheet. July 2018.
5. Based on Medtronic internal report #09-PM-6537. Reusable Pulse Oximetry Sensors: a vector for infection. 2009.
6. Based on Medtronic internal report #10091796 Rev B 01/2013. Nellcor™ Oxygen Saturation Accuracy Specification Grid. 2012.
7. Nesseler N, Fre´nel JV, Launey Y, Morcet J, Mallédant Y, Seguin P. Pulse oximetry and high-dose vasopressors: a comparison between forehead reflectance and finger transmission sensors. Intens Care Med (2012) 38:1718–1722.
8. Agashe GS, Coakley J, Mannheimer PD. Forehead pulse oximetry: Headband use helps alleviate false low readings likely related to venous pulsation artifact. Anesthesiology. 2006;105(6):1111–1116<
9. Bebout DE, Mannheimer PD. Effects of cold-induced peripheral vasoconstriction on pulse amplitude at various pulse oximeter sensor sites. Anesthesiology. 2002;96(Sup 2):A558.
10. Nellcor™ Adult SpO2 Sensor, Reusable [instructions for use]. Medtronic; 2011.
11. Nellcor™ Flexible SpO2 Sensor, Reusable [instructions for use]. Medtronic; 2015.
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About the AuthorMore Content by Shayna Bryant