Implementing and Sustaining Best Practices in Mobile Equipment Disinfection

 

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Approximately 1.7 million healthcare-associated infections occur in America's hospitals each year. Roughly five in every 100 patients admitted to the hospital contract an HAI.

Not only do HAIs impact the health of patients, their outcomes and quality of life, but they are also costly. HAIs account for an estimated $28 million to $33 million in unnecessary cost each year, according to the Centers for Disease Control and Prevention.1

Sadly, many HAIs are preventable. Standardized, evidence-based infection prevention efforts can greatly reduce the occurrence of HAIs. In fact, one CDC estimate found that up to $31.5 billion in costs could be removed from the delivery system through better infection control practices.1

Infection preventionists, charged with educating healthcare providers on techniques to reduce infection, draw upon a variety of best practices to promote HAI awareness and risk prevention practices.

However, one area that is often overlooked, but presents a significant opportunity to reduce infection risk, is the disinfection of mobile equipment.

Mobile equipment, such as wheelchairs, IV poles and computers/workstations on wheels, are touched thousands of times every day by patients, visitors and staff. As this occurs, pathogens can spread from the individual to the equipment, and vice versa, and bacteria spreads from one area of the hospital to another

Numerous studies have shown that hospital surfaces and frequently used medical equipment become contaminated by a variety of pathogenic and nonpathogenic organisms.2,3 Common human pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), Clostridium difficile, Acinetobacter species, and noroviruses can survive for prolonged periods on hospital equipment.3

According to the CDC, "surfaces frequently touched by hand potentially could contribute to secondary transmission [of infection-causing bacteria] by contaminating hands of healthcare workers or by contacting medical equipment that subsequently contacts patients."4 Proper decontamination of mobile equipment, therefore, plays an important role in stopping the spread of HAIs.


Disinfection of mobile equipment falls short in U.S. hospitals

Yet, hospitals often fall short when it comes to disinfecting these surfaces. Procedures and practices for disinfecting mobile equipment vary greatly among facilities, if they are in place at all. In a study in the September 2012 issue of Infection Control and Hospital Epidemiology, researchers observed that only 50 percent of high-touch surfaces in the operating rooms at a 1,500-bed teaching hospital were cleaned properly. Some of the surfaces sampled included "anesthesia-related equipment — keyboards, knobs, switches, oxygen reservoir bags and adjacent medication drawers — bed control panels, Mayo stands, intravenous poles, intravenous pumps, OR entry doors, overhead lamps and the floor."5

It's been shown that computer keyboards are reservoirs for bacteria. A 2009 study of computer stations on wheels revealed that daily cleaning of the keyboard was at zero percent over a baseline evaluation period of several weeks.6 And, in 2013, researchers in Israel identified that "wheelchairs are contaminated by several pathogenic bacteria, among them antibiotic resistant strains."7


Mobile equipment disinfection best practices

While proper disinfection of mobile equipment continues to be a challenge for hospitals, it shouldn't be. There are several best practices hospital staff can follow to ensure hard and mobile surfaces are properly treated to prevent the spread of HAIs.

According to the CDC's 2008 guidelines for Disinfection and Sterilization in Healthcare Facilities, mobile equipment largely consists of "noncritical items" — items that come in contact with intact skin, but not mucous membranes — under the Spaulding Classification of Medical Devices and Levels of Disinfection system. The CDC's guidelines recommend the use of a low-level, EPA-registered disinfectant with broad efficacy against bacteria, viruses and fungi, for disinfecting noncritical items unless they are visibly soiled with blood or bodily fluids.

Any mops and other non-disposable cleaning cloths used for cleaning must be laundered frequently to ensure proper decontamination. According to the CDC, these items "are often not adequately cleaned and disinfected, and if the water-disinfectant mixture is not changed regularly (e.g., after every three to four rooms, at no longer than 60-minute intervals), the…procedure actually can spread heavy microbial contamination throughout the healthcare facility."

As a result, hospital infection prevention staff must ensure non-disposable items are laundered daily, as recommended by the CDC, or encourage the use of single-use, disposable towels impregnated with a disinfectant to achieve the low-level disinfection required for non-critical items.

Additionally, healthcare organizations should continue to encourage frequent hand washing among staff. Successful efforts to improve hand hygiene (e.g., asking providers to wash hands before entering and leaving a patient room) further reduce the risk of bacteria transfer to and from mobile equipment, since potential pathogens are eliminated before they are spread to hard surfaces.

Roadblocks on the way to better infection prevention
While these seem like fairly straightforward recommendations, hospitals often unwittingly fail to adhere to them. Adherence challenges are even greater for mobile equipment that, by its nature, doesn't stay in one place.

Accessibility of the disinfectant product is especially important to improve adherence. The easier it is for staff to easily locate the disinfectant product, the more likely they will be to use it, the more likely the hospital will be to achieve better disinfection rates, and the more likely patient outcomes won't be damaged because of an HAI.

Studies have shown that compliance increases with increased accessibility to disinfectants. A proactive environmental and hand hygiene initiative at a 137-bed long-term care facility identified a lack of convenient and accessible solutions for disinfection. In response, a greater number of products were installed and strategically placed on medication, treatment and housekeeping carts as well as in all nursing stations, dining, therapy and activity rooms, and public lounge areas. Staff input was solicited to determine optimal placement. This, coupled with intensive staff education for all shifts, resulted in a dramatic reduction of hospital transfers due to HAIs, reduced employee absenteeism and reduction in cost association with antibiotic use.8

Disinfection solutions should be placed in multiple areas where equipment may be used, stored or moved to. Ideally, products should be placed on, or connected directly to, the equipment so the ease of access and use is continuous. Product placement on equipment also serves as a constant reminder to disinfect, thereby improving compliance.

Ongoing education and monitoring
As with most healthcare improvement efforts, though, the problem doesn't lie with identifying best practices; rather, the challenge comes with ensuring adherence to best practices becomes an ongoing and ubiquitous part of organizational life.

To ensure this occurs, healthcare organizations must put a formal, written protocol into place that clearly defines who is responsible for disinfection, when it is to take place, and what standards, processes or procedures should be followed.=

After identifying the responsible staff members and training them on best practices, organizations should also offer regular education, reminding the staff of disinfection processes and its importance. Furthermore, organizations should put in place some mechanism to regularly monitor that the standardized processes are being appropriately followed.

A 2011 study in the American Journal of Infection Control suggests that monitoring is critical to ensuring compliance. In the study, a multi-disciplinary committee spanning many departments identified and assigned certain areas and equipment to be disinfected by either nursing staff or housekeeping staff. However, the subsequent analysis of rolling blood pressure units and compliance by nursing staff found that the equipment was not being sufficiently disinfected, despite the development of written procedures. The researchers' recommended periodic education and monitoring to ensure compliance.9


Conclusion

Given the prevalence, cost and negative impact, both on patients' lives and the reputation of American healthcare delivery, HAIs continue to be a major concern for healthcare organizations.

To combat them, healthcare organizations must implement standardized best practices that are maintained through education and monitoring. Proper disinfection techniques are imperative, even for less high-profile elements of a hospital, such as its mobile equipment, which have been shown to harbor potentially dangerous pathogens. To achieve true optimization of infection control efforts, mobile equipment can't be ignored.

1 Scott, D. (2009, March). The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. CDC report. 

Sehulster, L. M., et al. (2003). Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee.

3 Kramer, A., Scwebke, I., Kampf, G. (2006). How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infectious Diseases, 6,130.

4 CDC (2008). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008.

5 Munoz-Price, et al. (2012, September). Decreasing operating room environmental pathogen contamination through improved cleaning practice. Infect Control Hops Epidemiology, 33(9), 897-904

6 Po, et al. (2009, November) Dangerous cows: an analysis of disinfection cleaning of computer keyboards. Am J Infect Control, 37(9), 778-780.

7 Peretz, et al. (2013, August 11). Do Wheelchairs Spread Bacteria within hospital walls? World J Microbiol Biotechnol.

8 Schandel, J. M., et al. (n.d.) Project: Clean Sweep Reducing Healthcare-associated Infections, Employee Absenteeism, Healthcare Cost and Hospital Readmissions in a Long Term Care Facility.

9 Havill et. al. (2011, September). Cleanliness of portable medical equipment disinfected by nursing staff. Am J Infect Control, 39(7), 602-604.

 

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