Reusing IPC single-patient use garments can cause cross infection, as they can be colonised by pathogenic and other bacteria from a patient’s skin
Carol Tweed, MSc, BSc, is an independent consultant, Wellington, New Zealand; Neil Wigglesworth, PhD, BSc, RN, is nurse consultant, infection control, Salford Royal NHS Foundation Trust; both authors undertake consultancy work for ArjoHuntleigh.
Tweed C, Wigglesworth N (2009) The infection control risks of reusing intermittent pneumatic compression garments. Nursing Times;105: 43, early online publication.
Intermittent pneumatic compression garments used for DVT prophylaxis can act as a vehicle for bacteria and should not be cleaned and reused.
Keywords: Infection control, Intermittent pneumatic compression garments, DVT
- This article has been double-blind peer reviewed
Venous thromboembolism (VTE) is a frequent cause of preventable illness and death in inpatients. It is a complex vascular disease with a multifactorial pathogenesis and includes deep vein thrombosis (DVT) and pulmonary embolism.
Intermittent pneumatic compression (IPC) devices involve the use of inflatable garments wrapped around the foot, calf or both calf and thigh. A pump provides intermittent cycles of compressed air that alternately inflate and deflate the garments, enhancing venous return (NICE, 2007).
Venous stasis is prevented. The movement of blood stimulates the release of fibrinolytic and anti-thrombotic substances from the endothelial lining of the vein that assist in both dissolving any existing clot and preventing formation of any new thrombus (Morris, 2008; NICE, 2007).
IPC is recommended as an alternative or an addition to pharmacological prophylaxis or graduated compression stockings for patients at risk of VTE (NICE, 2007). It is most commonly used for surgical patients both peri- and post-operatively, until they become fully mobile.
As with any device that is in direct contact with a patient, it is reasonable to assume that IPC garments will carry a bacterial bio-load after use. This is particularly true if the patient is a “high shedder” of skin cells – typically those with dry skin or conditions such as eczema and psoriasis.
This study aimed to determine the bacterial bio-burden on a selection of DVT prophylaxis IPC garments from different manufacturers after an episode of single-patient use.
Eighteen individuals used IPC garments produced by three manufacturers. The garments were collected using a standardised method from three unrelated hospital sites that followed the single patient use policy.
Garments were transported to a hospital microbiology laboratory where a senior member of the hospital infection control team undertook all sampling (contact plating/swab testing) and read all the plates, post incubation, for the number of colonies and for identification of the organisms.
Three pairs of unused (clean) single-patient use garments were used as controls. These were designed to be clean rather than sterile and came directly from the manufacturer, sealed in polythene bags and boxed. They were tested at the same facility and using the same methodology as the used garments.
The results were categorised into five groups, as follows:
- No growth;
- 1-10 colony-forming units (CFU) present;
- 11-100 CFU;
- >100 CFU;
- Confluence (continuous growth).
Sixty-one per cent of used garments had >100 colony-forming units (CFUs) recorded on at least one sample plate, while the samples taken from unused garments reported either no growth (67%) or had very few organisms (<5 CFU) present (33%).
The time the garments were worn for IPC and/or presence of graduated compression stockings worn beneath the garment had no impact on the garment bio-burden.
The predominant organism observed was Staphylococcus epidermidis, which forms part of the normal skin flora and is not usually pathogenic. This was present in large numbers on the used IPC garments.
The presence of S. epidermidis and, on one occasion, MRSA on the used garments raises the possibility that their reuse could provide a vehicle for the transfer of pathogens such as MSSA, MRSA and coliform organisms.
The results show the potential for cross infection with any bacterial species present.
Single-patient use medical devices have been developed, in part, as one way to prevent cross contamination and limit infection.
The combination of IPC garment construction and type of fabric used provides consistent and reliable delivery of IPC, helps maintain patient comfort and prevents moisture build-up. However, it also permits the garment to carry a bio-burden after use.
The manufacturers intend these garments to be used on a single patient and not reprocessed (by cleaning/decontamination) and reused. Therefore, they have not tested or validated any cleaning or reprocessing methods for them.
The only way to minimise the risk of cross infection is to use IPC garments on a single-patient use basis. Organisations that are considering reprocessing them need to take into account both the costs and risks associated with such an approach.
This is a summary of a paper published in British Journal of Infection Control; 10: 4, 128-133.
Morris RJ (2008) Intermittent pneumatic compression – systems and applications. Journal of Medical Engineering and Technology; 32: 3, 179-188.