Debra Johnson, RN, OCN, Infection Control, The Westerly Hospital
Generic Basin Sampling Protocol
1
<CUSTOMIZABLE PROTOCOL FOR PATIENT BATH BASIN SAMPLING>
<SAMPLE TITLE:> PROSPECTIVE SAMPLING OF PATIENT BATH BASINS
IN AN ACUTE CARE SETTING: EVALUATING BACTERIAL
COLONIZATION
STUDY DIRECTORS:
<Add info please>
I.
TITLE OF STUDY:
Prospective sampling of patient bath basins in a <describe clinical setting>: evaluating
bacterial colonization.
II.
PURPOSE OF STUDY
This prospective sampling of patient bath basins evaluates patient bath basins as a
possible source for bacterial colonization. The study’s purpose is to assist in
identification of possible etiologies for bacterial colonization to better assist in efforts of
preventing hospital-acquired infections (HAIs).
III.
BACKGROUND/RATIONALE
One of the major public health concerns is prevention of HAIs, with annual estimates
ranging from 1.75 to 3 million patients in the United States, with associated significant
morbidity, mortality, and economic burden.1-3 Multiple studies have shown the cost of
care is higher in patients who contract MRSA.4-6
Additional studies have proven water can serve as a conduit for biofilm-forming
pathogens, such as Enterobacter, and these biofilm-forming pathogens may contaminate
compromised skin or wounds once water comes into contact.1,7,8 Without appropriate
education and hygiene standards, hospital staff can transmit pathogens both into and via
water that has become contaminated after contacting a contaminated surface.9,10
Hospitalized patients themselves can harbor potentially dangerous
microorganisms. Mechanical friction during bathing can release skin flora into bath
water, and contaminated water in bath basins can become a source for the cross
contamination of organisms from one body system to another and serve as a potential
reservoir for the transmission of HAI.10, 11 The bath basin itself can often becomes
contaminated with gram-negative bacteria.12,13
The purpose of this basin sampling test is to identify whether used patient bath
basins in the clinical environment have the presence of harmful organisms <this sentence
can be modified to identify the bacteria you are looking for, e.g., MRSA, VRE,
gram-negative organisms>, potentially resulting in increased patient risk of HAIs.
1.
2.
Exner M, Kramer A, Lajoie L, Gebel J, Engelhart S, Hartemann P. Prevention and control of
health care-associated waterborne infections in health care facilities. Am J Infect Control.
2005;33:S26-40.
Anaissie EJ, Penzak SR, Dignani C. The hospital water supply as a source of nosocomial
infections: a plea for action. Arch Intern Med. 2002;162:1483-1492.
Debra Johnson, RN, OCN, Infection Control, The Westerly Hospital
Generic Basin Sampling Protocol
3.
4.
5.
6.
2
Panhotra BR, Saxena AK, Al-Mulhim AS. Contamination of patients’ files in intensive care units:
an indication for strict handwashing after entering case notes. Am J Infect Control. 2005;33:398401.
Gavalda L, Masuet C, Beltran J, et al. Comparative cost of selective screening to prevent
transmission of methicillin-resistant Staphylococcus aureus (MRSA), compared with the
attributable costs of MRSA infection. Infect Control Hosp Epidemiol. 2006 Nov;27(11):1264-6.
Epub 2006 Sep.
Shorr AF, Tabak YP, Gupta V, Johannes RS, Liu LZ, Kollef MH. Morbidity and cost burden of
methicillin-resistant Staphylococcus aureus in early onset ventilator-associated pneumonia. Crit
Care. 2006;10(3):R97. Epub 2006 Jun 29.
Nixon M, Jackson B, Varghese P, Jenkins D, Taylor G. Methicillin-resistant Staphylococcus
aureus on orthopaedic wards: incidence, spread, mortality, cost and control. J Bone Joint Surg Br.
2006 Jun;88(6):812-7.
7.
8.
9.
10.
11.
12.
13.
Clark AP, John LD. Nosocomial infections and bath water: any cause for concern? Clin Nurse
Spec. 2006; 20:119-123.
Leprat R, Demzot V, Bertrand X, Talon D. Non-touch fittings in hospitals: a possible source for
Pseudomonas aeruginosa and Legionella spp. J Hosp Inf. 2003;53:77-82.
Assadin O, El-Madini N, Seper E, et al. Sensor operated faucets: a possible source of nosocomial
infection? Infect Control Hosp Epidemiol. 2002;23 44-46.
Sehulster L, Chinn RYW. Guidelines for environmental infection control in health-care facilities:
recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee
(HICPAC). MMWR Morb Mortal Wkly Rep . 2003;52:1-42.
Sheffer P, Stout J, Wagener M, Muder R. Efficacy of new point of use water filter for preventing
exposure to Legionella and waterborne bacteria. Am J Infect Control. 2005;33:S20-S25.
Larson EL. Comparison of traditional and disposable bed baths in critically ill patients. Am J Crit
Care. 2004;13:235-241.
Skewes SM. No more bed baths! RN. 1994; 57(1):34-5.
IV.
RESEARCH PLAN
1.
This study will evaluate patient bath basins as a possible etiology for
bacterial colonization and increased risk for HAIs.
2.
Patient caregivers will be blinded to the study.
3.
Patients bath basins will be sampled provided the patient has been
admitted >48 hours and bathed twice, as confirmed by patient record.
4.
The bath basin will be sampled by an infectious disease specialist or
registered nurse (RN) trained in the culturing techniques by culturing the
entire interior perimeter and walls, as well as the base, <utilizing a
culture sponge (see methods below): this sentence can be modified if
you are using another type of swabbing tool>.
5.
The infectious disease specialist or registered nurse trained in the culturing
techniques will record the following data in spreadsheet format: <This
data can be customized for study: Patient primary diagnosis and
comorbidity; location of basin in patient’s room and unit designation;
and contents (if any) within the basin>.
6.
The infectious disease specialist or RN trained in the culturing techniques
will label each patient’s basin culture and data collection form with a
corresponding number for cross-checking results.
V.
STUDY OBJECTIVE
Debra Johnson, RN, OCN, Infection Control, The Westerly Hospital
Generic Basin Sampling Protocol
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2)
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To determine whether or not the patient bath basin is a source for bacterial
colonization and increased risk of HAI.
To <can be customized based on your measures: quantitatively and
qualitatively> culture patient bath basins to determine the type and amount of
bacteria existent on bath basins, and a total of <customize for your study: 1
culture sponge> will be utilized per basin, with all surfaces of the walls and base
of the basin cultured with the sponge.
VI.
STUDY DESIGN/METHODS
This is a prospective, non-randomized, <enter “single or multiple institution”>,
institution infectious disease study.
<Consult with your laboratory and determine what you need to provide the
laboratory & what the laboratory techniques for culturing include [sample text]:
The infectious disease specialist or RN trained in culturing techniques will measure
the dimensions of the basins and provide this information, along with the culture
sponge. The cultures will be packaged and expressed mailed to the microbiological
testing laboratory on the same day the samples were gathered.
Once specimens are received in the laboratory, the sponge will be provided pre
moistened with 10 ml of sterile diluent. The sponge will be aseptically removed
from the package and the sample collected from the basin. The sponge will be
returned to the package and sealed using the whirl-pak style tie. During testing an
additional 90 ml of sterile diluent will be added to the sample to yield a 10 to 100 or
1:10 dilution.
Aliquots will be plated on general and selective agars to yield countable plates at
dilutions of 10-1, 10-2, and 10-3. The general agar plates will be completed using the
pour plate technique and will yield a <10 CFU detection limit. The selective agar
plates will be completed using the spread plate technique and will yield a <20 CFU
detection limit.
LAB will utilize a standard enrichment procedure to detect low level or stressed
organisms present in the test fluid. After a 48 hour incubation period, aliquots will
be streaked again onto the selective agars in an attempt to isolate and identify
organisms from the sample. The results from the enrichment test will be
qualitative only and reported as presence/absence per device.>
Organism Identification & Confirmation: <Customize for the organisms you are
trying to identify and confirm with your lab [sample text]: Select or target
organisms such as S. aureus, P. aeruginosa, VRE, and C. albicans will be cultured
using selective agars to aid in the detection process. All colonies recovered from
these plates will need to be confirmed through standard techniques such as gram
stains, bio-chemical tests, and/or API Identifications. Any confirmed coagulase
Debra Johnson, RN, OCN, Infection Control, The Westerly Hospital
Generic Basin Sampling Protocol
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positive Staph colony will also further verified for a MRSA species by an
agglutination test.
All colonies isolated from the Total Aerobic Plate Count will be Gram stained. The
gram negative colonies isolated can be used for the identification and detection of
other gram negative bacilli in addition to E. coli not recovered on the specific
selective agar plates chosen for the testing.>
Reporting: <confirm that your lab will provide a report as follows> At the end of the
study for each location, LAB will provide a summary report comparing the organism
recovery. The report will include information detailing the types of organisms detected
and potential health concerns.
VII. STUDY POPULATION
<This section can be customized to your patient population> Patient bath basins are to
be sampled after patient has been admitted >48 hours and the basin utilized for whole
body bathing at least twice; this is to be confirmed through patient records.
VIII. EFFICACY ASSESSMENTS
Efficacy will be evaluated by observing <can be customized to either qualitative or
quantitative or both> qualitative and quantitative microbiological culture results.
IX.
SAFETY ASSESSMENTS
Not applicable.
X.
BIOSTATISTICAL METHODS
<Customize for the biostatistical analysis being conducted in this study> Alpha levels
will be calculated separately from qualitative and quantitative culture reports.
XI.
MONITORING TECHNIQUES:
A. Informed consent <customize: is not> necessary for this study.
B. One infectious disease specialist or RN trained in the culturing techniques from
each hospital will be assigned to carry out study activities, and patient caregivers
will be blinded to the study.
XII.
SIGNIFICANCE OF THE STUDY IN RELATION TO HUMAN HEALTH
BENEFITS
This study will demonstrate there may be a significantly increased patient risk of
HAIs due to patient bath basins being sites for bacterial colonization.
XIII. POTENTIAL RISKS
Not applicable.
XIV
PREVIOUS STUDIES
Not applicable.
Debra Johnson, RN, OCN, Infection Control, The Westerly Hospital
Generic Basin Sampling Protocol
XV.
INFORMED CONSENT
Not applicable.
XVI. ESTIMATED PERIOD OF TIME TO COMPLETE STUDY
1.
Time for basin sampling and data collection is <customize: 1 day>.
2.
The estimated length of the study is [customize: <30 days].
3.
Number of sampled bath basins sought is a minimum of <customize: 15
basins, maximum of 30 basins>.
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