Cleaning Up a Tragedy of the Commons: Disinfection of Shared Equipment

No healthcare worker wants to forget about disinfecting a surface. Poor disinfection places patients at risk for preventable harms, yet it is consistently overlooked, particularly in areas with an abundance of shared equipment.

Shared equipment is disinfected less often because it may not have a designated party responsible for the task. According to Elizabeth Ernst, RN, BSN, MS, PDI's senior director of regulatory, the equipment items most likely to be overlooked for disinfection are often noncritical in nature.

"Most attention is placed on critical items, but studies have shown a high incidence of cross-contamination for equipment that is shared," she says. According to Ms. Ernst, bed rails, IV poles, blood pressure cuffs and workstations on wheels/computers on wheels (WOWs) are the items most often overlooked when it comes time to disinfect an environment.

Items that haven't been disinfected harbor the usual suspects in infection control and prevention: Staph. Aureus, E. coli, C. diff and other standard organisms like MRSA (methicillin- resistant Staphylococcus aureus) and VRE (vancomycin-resistant Enterococci) may linger and multiply on shared items. These pathogens are spread from one place to the next primarily by touch.

To compound the issue, the mobile nature of the shared items most often overlooked for disinfection means any contamination may place many more people at risk than contamination from a stationary source.

Ms. Ernst points out that critical items or surfaces are often left contaminated as well, illustrating the scope of the problem. According to a 2012 study in Infection Control and Hospital Epidemiology, only 50 percent of high-touch surfaces in operating rooms at a teaching hospital were correctly disinfected. "[The OR] is a critical area with strict guidelines for cleaning. If 50 percent is overlooked in an area with a lot of oversight, imagine the lack of cleaning that occurs on less critical equipment," she says.

While no healthcare worker intends to neglect a disinfection routine, busy schedules, sicker patients and the length of time elapsed since formal training sessions are all contributing factors. "The mere presence of an infection prevention policy isn't enough. It requires commitment and ownership by all principles in nursing, physician, housekeeping and other positions," says Ms. Ernst.

To ensure shared equipment is properly disinfected, Ms. Ernst recommends creating a facility-specific assessment that includes standards and a baseline for disinfection of noncritical items, data on actual cleanliness of shared items and potential product options that could help healthcare workers do a better job disinfecting shared items.

"Every place is different; every center has its own issues. It's important to understand the specific environment — what the risks are, possible polices and procedures and standards of participation around that," she says. Above all, when in doubt, there is an obvious answer: "When in doubt, clean and disinfect again," she adds.

More Articles on Infection Control & Clinical Quality:

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