Infection Control Today

FEB 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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32 ICT January/February 2019 rooms across a unit, and they need time to properly clean and disinfect equipment before it enters the next patient's room. ICT: Mobile technology consists of electronics that can be damaged in the cleaning and disinfection process; what do you advise healthcare professionals to look out for? JD: There are ways to help clinicians do the right thing when it comes to mobile devices; we are always balancing how to clean and disinfect a particular device when it is not technically considered a medical device, like a smartphone or a tablet. When you talk to a manufacturer such as Apple, they say just use a damp cloth, but there are no instructions for use (IFU) for these devices in the healthcare setting. An ECRI engineer and I wrote an article that addressed this in lieu of formal recommendations. Some solutions are as simple as putting a smartphone or tablet into a Ziploc-type bag if you must bring it into an isolation room — it's essentially PPE for your phone. When you are done in that room, remove it like a pair of gloves and throw it away, then and wipe your device off and wash your hands. People do use alcohol pads on their phone, but that can be problematic. The idea is to reduce contamination and limit whatever potential bioburden could get deposited on the mobile device by putting a layer between it and the environment. Recently I have seen some covers that people are using on their phones, but over time, disinfectants may degrade that cover; if that happens, they throw it out and buy a new cover. I think there needs to be ownership — if it is your device, then you need to be responsible and do the right thing by diligently cleaning and disinfecting it. AS: We at ECRI are very interested in infection-re- duction technologies, and one of the technologies that I have evaluated are countertop UV-emitting disinfection devices. The way they work is they generate UV-C, which is not native to Earth, so when bacteria encounter it, they are damaged irreparably and cannot replicate. So, that effectively kills them. We looked at fve models of these devices and I am currently evaluating a sixth device. It is important that, as Jim was saying, to properly protect your phone, because in the case of UV-C, it is known to degrade materials. Say you have a black phone and you expose it to UV-C just like any type of ultraviolet light; it will become grey over time, and white will become yellow over time. So, you must take proper precautions to protect your mobile devices and having a cover over your phone is key. JD: UV-C is a disinfection technology, it's not a cleaning technology, so at some point you will still need to wipe down your phone or tablet before you put it in one of those disinfection devices. Whether you use a wipe containing a quat or a UVC-generating device, you must remember that there is a distinct difference between cleaning, which is removal of soil, and disinfection, which is killing bugs. ICT: What risk do contaminated devices pose to patients? JD: It's very hard to tie infections to particular devices. Some manufacturers claim you will reduce your HAI rates if you use XYZ in a patient room, but there are so many variables that come into play. You must consider how well that room and the objects in it were cleaned, whether some kind of wipe was used with a mechanical action in combination with a disinfectant, and then was UV-C used as an adjunct? Real-world scenarios are diffcult because humans are involved here; one worker may do something a little differently that might make all the difference. When it comes to mobile devices like a phone or tablet, we are not putting it on a patient, for the most part. Having said that, given that apps are becoming much more mature and are able to sense and detect conditions of the human body, who knows what the future may hold. Currently I am not putting my personal phone on someone's skin; I am touching the patient and then touching my phone and then potentially touching the next patient — but I should be doing hand hygiene, wearing gloves, and wiping off my phone and using a Ziploc bag if I am in an isolation room. The risk there probably isn't as signifcant as most people would assign to it. However, if we talk about a blood pressure cuff moving from patient to patient applied to their skin, that could be a vector, of course, and there have been studies to document that. Now, if a piece of equipment goes into a patient's mucous membrane, and it is used as a multiple-patient device like an ERCP scope and you don't clean and disinfect it properly, there is documented transmission of disease and potentially death. So, we must be specifc about what devices we are talking about and where they fall according to the Spaulding classifcation and the relative risk assigned to these classifcations. ICT: How can barriers to compliance be broken so that healthcare personnel can always do the right thing? JD: As we look at this, sounds simple but it's not. There is pressure for rapid bed turnover and if a piece of equipment is needed and it takes 25 minutes to do a good job, you must look at those human factors-related issues. Also, does the facility provide the right tools needed to do proper cleaning and disinfection? And are healthcare personnel using appropriate cleaning products and techniques for whatever was in that room last, whether it was CRE or C. diff, for example. I think it is multi-factorial. I've done some consults where facilities have conducted time studies where instead of turning things over in 25 minutes, it takes much longer when you clean and disinfect properly and thoroughly. I think people are realizing that disinfection is paramount, it's a mission-critical task around which processes and workfows should be arranged so that it is performed correctly. Institutions must make it easy for healthcare workers to do the right thing all of the time, not making it hard for them to do their jobs. AS: I would like to expand on what Jim said by emphasizing that it is a team effort; it's everyone working together and always trying to do the right thing for the next patient. I was an artifcial heart engineer and during training I remember we were expected to clean and disinfect our intra-aortic balloon pump consoles; our trainer told me always clean and disinfect it like your family member is going to be using it next. Our workfow was such that cleaning and disinfection was supported, so that I had the time to devote to proper technique. So, Ò I was an artifcial heart engineer and during training I remember we were expected to clean and disinfect our intra-aortic balloon pump consoles; our trainer told me always clean and disinfect it like your family member is going to be using it next. — Amanda Sivek, PhD

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