Discarding Bedside Cart Paper-Packaged Supplies Between Patients: What Evidence Is Required?

Abstract

Background Discarding paper-packaged sterile supplies from bedside supply carts between patients in pediatric intensive care units (PICUs) is a potential practice to target for environmental stewardship. Objectives To determine opinions about this practice, including what evidence should be required to implement and what evidence would be adequate to abandon it. Methods A survey was distributed to all pediatric intensivists engaged in multicenter research in Canada and to all PICU nurses at one institution in Canada. Results The response rate was 75 of 254 (30%). The practice occurred in 54 (72%) of the respondents’ units. Ten respondents (13%) agreed the practice was effective in preventing nosocomial infections. Most respondents agreed the practice should be based on empirical evidence, including a combination of improved patient outcomes (n = 57, 76%), rate of contamination of supplies within the supply carts (n = 55, 73%), and survivability of pathogens inoculated onto paper (n = 56, 75%). Most respondents agreed they would be comfortable with a randomized controlled trial (n = 52, 69%) and would support action based on the results (n = 54, 72%). The potential trial outcome most highly ranked was next-patient nosocomial infection with pathogen from the previous patient (n = 23, 31%); this was ranked more often by intensivists (P = .005). Other outcomes highly ranked included next-patient colonization with pathogen from the previous patient (n = 44, 59%) and pathogen detection on supplies within the supply cart (n = 43, 57%). Conclusions Most respondents agreed that the practice was not based on empirical evidence, agreed the practice should be based on empirical evidence, and would agree to a randomized trial with patient-important outcomes.