Computer equipment used in patient care within a multihospital system: recommendations for cleaning and disinfection

Degree of Bacterial Contamination of Mobile Phone and Computer Keyboard Surfaces and Efficacy of Disinfection with Chlorhexidine Digluconate and Triclosan to Its Reduction

The main aim of our study was to verify the effectiveness of simple disinfection using wet wipes for reduction of microbial contamination of mobile phones and computer keyboards. Bacteriological swabs were taken before and after disinfection with disinfectant wipes with active ingredients chlorhexidine digluconate and triclosan. The incidence and type of microorganisms isolated before and after disinfection was evaluated; the difference was expressed as percentage of contamination reduction. Our results confirmed the high degree of surface contamination with bacteria, some of which are opportunistic pathogens for humans. Before the process of disinfection, on both surfaces, mobile phones, and computer keyboards, the common skin commensal bacteria like coagulase-negative staphylococci were diagnosed most frequently. On the keyboards, species of the genus Bacillus and representatives of the family Enterobacteriaceae were abundant. The potentially pathogenic species were represented by Staphylococcus aureus. Cultivation of swabs performed 5 min after disinfection and subsequent calculation of the reduction of contamination have shown that simple wiping with antibacterial wet wipe led to a significant reduction of microbial contamination of surfaces, with effect ranging from 36.8 to 100%.

Gestures for Picture Archiving and Communication Systems (PACS) operation in the operating room: Is there any standard?

Objective

Gestural interfaces allow accessing and manipulating Electronic Medical Records (EMR) in hospitals while keeping a complete sterile environment. Particularly, in the Operating Room (OR), these interfaces enable surgeons to browse Picture Archiving and Communication System (PACS) without the need of delegating functions to the surgical staff. Existing gesture based medical interfaces rely on a suboptimal and an arbitrary small set of gestures that are mapped to a few commands available in PACS software. The objective of this work is to discuss a method to determine the most suitable set of gestures based on surgeon’s acceptability. To achieve this goal, the paper introduces two key innovations: (a) a novel methodology to incorporate gestures’ semantic properties into the agreement analysis, and (b) a new agreement metric to determine the most suitable gesture set for a PACS.

Materials and methods

Three neurosurgical diagnostic tasks were conducted by nine neurosurgeons. The set of commands and gesture lexicons were determined using a Wizard of Oz paradigm. The gestures were decomposed into a set of 55 semantic properties based on the motion trajectory, orientation and pose of the surgeons’ hands and their ground truth values were manually annotated. Finally, a new agreement metric was developed, using the known Jaccard similarity to measure consensus between users over a gesture set.

Results

A set of 34 PACS commands were found to be a sufficient number of actions for PACS manipulation. In addition, it was found that there is a level of agreement of 0.29 among the surgeons over the gestures found. Two statistical tests including paired t-test and Mann Whitney Wilcoxon test were conducted between the proposed metric and the traditional agreement metric. It was found that the agreement values computed using the former metric are significantly higher (p < 0.001) for both tests.

Conclusions

This study reveals that the level of agreement among surgeons over the best gestures for PACS operation is higher than the previously reported metric (0.29 vs 0.13). This observation is based on the fact that the agreement focuses on main features of the gestures rather than the gestures themselves. The level of agreement is not very high, yet indicates a majority preference, and is better than using gestures based on authoritarian or arbitrary approaches. The methods described in this paper provide a guiding framework for the design of future gesture based PACS systems for the OR.

Bacterial Contamination of Computer and Hand Hygiene Compliance in the Emergency Department

Introduction

The aim of this study was to determine the degree and nature of bacterial contamination of computer equipment in three Korean emergency departments (ED).

Methods

Hand hygiene practices of ED doctors and nurses were observed before contact with computer equipment. Microbiological swab samples were obtained from 112 multiple-user computer keyboards and electronic mice in the ED of three teaching hospitals. Isolated organisms were identified by a clinical microbiologist using Gram stain, colony morphology, and susceptibility test.

Results

Of the 112 samples, 103 (92.0%) showed growth of organisms on culture. Thirty-eight (33.9%) pieces of computer equipment yielded multiple bacterial species. Coagulase-negative Staphylococcus was the most common microorganism isolated (85.7%). Methicillin-resistant Staphylococcus aureus was obtained from two keyboards in two hospitals (1.8%). Hand hygiene compliance was observed on 29.9% occasions. Hand hygiene compliance after patient contact (38.0%) was higher than after other environmental contact (20.7%).

Conclusions

Multiple user computer equipment in the ED may serve as reservoirs for nosocomial infection. Hand hygiene should be performed before and after using all ED equipment, including computer equipment.

Bacterial Contamination of Computer and Hand Hygiene Compliance in the Emergency Department

Introduction

The aim of this study was to determine the degree and nature of bacterial contamination of computer equipment in three Korean emergency departments (ED).

Methods

Hand hygiene practices of ED doctors and nurses were observed before contact with computer equipment. Microbiological swab samples were obtained from 112 multiple-user computer keyboards and electronic mice in the ED of three teaching hospitals. Isolated organisms were identified by a clinical microbiologist using Gram stain, colony morphology, and susceptibility test.

Results

Of the 112 samples, 103 (92.0%) showed growth of organisms on culture. Thirty-eight (33.9%) pieces of computer equipment yielded multiple bacterial species. Coagulase-negative Staphylococcus was the most common microorganism isolated (85.7%). Methicillin-resistant Staphylococcus aureus was obtained from two keyboards in two hospitals (1.8%). Hand hygiene compliance was observed on 29.9% occasions. Hand hygiene compliance after patient contact (38.0%) was higher than after other environmental contact (20.7%).

Conclusions

Multiple user computer equipment in the ED may serve as reservoirs for nosocomial infection. Hand hygiene should be performed before and after using all ED equipment, including computer equipment. (Hong Kong j.emerg.med. 2012;19:387-393)

Evaluating Isolation Behaviors by Nurses Using Mobile Computer Workstations at the Bedside

This secondary analysis from a larger mixed methods study with a sequential explanatory design investigates the clinical challenges for nurses providing patient care, in an airborne and contact isolation room, while using a computer on wheels for medication administration in a simulated setting. Registered nurses, who regularly work in clinical care at the patient bedside, were recruited as study participants in the simulation and debriefing experience. A live volunteer acted as the standardized patient who needed assessment and intravenous pain medication. The simulation was video recorded in a typical hospital room to observe participating nurses conducting patient care in an airborne and contact isolation situation. Participants then reviewed their performance with study personnel in a formal, audio-recorded debriefing. Isolation behaviors were scored by an expert panel, and the debriefing sessions were analyzed. Considerable variation was found in behaviors related to using a computer on wheels while caring for a patient in isolation. Currently, no nursing care guidelines exist on the use of computers on wheels in an airborne and contact isolation room. Specific education is needed on nursing care processes for the proper disinfection of computers on wheels and the reduction of the potential for disease transmission from environmental contamination.

Bacterial contamination of computer touch screens

The goal of this study was to determine the occurrence of opportunistic bacterial pathogens on the surfaces of computer touch screens used in hospitals and grocery stores. Opportunistic pathogenic bacteria were isolated on touch screens in hospitals; Clostridium difficile and vancomycin-resistant Enterococcus and in grocery stores; methicillin-resistant Staphylococcus aureus. Enteric bacteria were more common on grocery store touch screens than on hospital computer touch screens.

Effectiveness of stringent decontamination of computer input devices in the era of electronic medical records and bedside computing: a randomized controlled trial

Bedside computing may lead to increased hospital-acquired infections mediated by computer input devices handled immediately after patient contact. We compared 2 decontamination methods in 2 types of wards. We found high baseline contamination rates, which decreased following decontamination, but the rates remained unacceptably high. Decontamination was more effective in intensive care units compared with medical wards and when using alcohol-based impregnated wipes compared with quaternary ammonium-based impregnated wipes.

[Bacterial contamination of mobile phones shared in hospital wards and the consciousness and behavior of nurses about biological cleanliness]

OBJECTIVES

The purpose of this study was to clarify the contamination of mobile phones shared in hospital wards and its relationship with the consciousness and behavior of nurses about biological cleanliness.

METHODS

Samples from mobile phones were cultured to detect viable bacteria (n=110) and Staphylococcus aureus (n=54). A questionnaire survey was conducted on 110 nurses carrying mobile phones on the day of sampling.

RESULTS

Viable bacteria were detected on 79.1% of the mobile phones, whereas S. aureus was detected on 68.6%. All the nurses were aware of hand washing with water or alcohol after regular work, but 33.6% of the nurses were not conscious of hand washing with water or alcohol after using a mobile phone. There was a significant positive relationship between the frequency of using mobile phones and the number of hand washings with water or alcohol. A significant negative relationship was found between the detection of viable bacteria and the number of hand washings with alcohol. The results of logistic regression analysis showed that the detection of viable bacteria was related significantly with the number of hand washings with alcohol (Odds ratio, 0.350; 95%CI, 0.143-0.857) and that the detection of S. aureus was related significantly with the frequency of using mobile phones (Odds ratio, 0.183; 95%CI, 0.036-0.933).

CONCLUSIONS

It is important to be conscious of the fact that mobile phones shared in hospital wards are easily contaminated. Because hand washing with water or alcohol prevents the contamination of the mobile phones, nurses should take standard precautions after using mobile phones.

Do protective lead garments harbor harmful bacteria?

This study attempted to identify and characterize bacteria present on shared-use protective lead shielding garments worn in the operating room. Those worn at the authors' institution were collected and swabbed in designated 5×5-cm areas. Swabs were sent to the clinical laboratory for bacterial isolation and identification. All isolates were identified using standard microbiological methods. Isolates then underwent antimicrobial susceptibility testing as per standard hospital procedures. Of 182 total collected swabs, bacteria were isolated on only 5 (2.7%) samples. Coagulase-negative Staphylococci was identified on 3 samples and the remaining 2 grew coagulase-negative Staphylococci and gram-positive rods. The collection sites for these isolates were the lead apron, midline, bottom outer surface (n=3), thyroid shield midline, inner surface (n=1), and skirt midline, bottom inner surface (n=1). Of the collected samples, 98.3% were negative for bacterial growth. The remaining isolates were consistent with common skin flora. No multi-drug resistant organisms were identified on any garments. Standard cleaning procedures at the institution are an effective way to prevent growth of bacteria on shared-use protective lead shielding garments worn in the operating room.

Are computer keyboards a cross-infection risk in a dental clinic?

Computers in dental surgeries located within the patient treatment room could potentially pose a risk of cross-infection of patients and operators. The aims of this investigation were to determine the degree of contamination of computer keyboards located in clinics and study rooms in a teaching dental hospital, to determine the survival time of micro-organisms on keyboards and to compare the efficiency of two common disinfectants in disinfecting keyboards. All keyboards were found to be contaminated with a variety of micro-organisms including Staphylococcus aureus, coagulasenegative staphylococci, Gram-negative rods and cocci. A range of Gram-positive and -negative bacteria and Candida albicans were able to survive up to 10 days in dried suspensions on computer keys. Seventy per cent isopropanol wipes proved effective in reducing the numbers of viable test organisms on keys by at least 96% and reducing contamination of keyboards in routine use. The data suggest that computers in dental study areas and clinics act as reservoirs of potentially pathogenic organisms including S. aureus and should be regularly disinfected to reduce the risk of cross-infection.

Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii on computer interface surfaces of hospital wards and association with clinical isolates

Background

Computer keyboards and mice are potential reservoirs of nosocomial pathogens, but routine disinfection for non-water-proof computer devices is a problem. With better hand hygiene compliance of health-care workers (HCWs), the impact of these potential sources of contamination on clinical infection needs to be clarified.

Methods

This study was conducted in a 1600-bed medical center of southern Taiwan with 47 wards and 282 computers. With education and monitoring program of hand hygiene for HCWs, the average compliance rate was 74% before our surveillance. We investigated the association of methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Acinetobacter baumannii, three leading hospital-acquired pathogens, from ward computer keyboards, mice and from clinical isolates in non-outbreak period by pulsed field gel electrophoresis and antibiogram.

Results

Our results revealed a 17.4% (49/282) contamination rate of these computer devices by S. aureus, Acinetobacter spp. or Pseudomonas spp. The contamination rates of MRSA and A. baumannii in the ward computers were 1.1% and 4.3%, respectively. No P. aeruginosa was isolated. All isolates from computers and clinical specimens at the same ward showed different pulsotypes. However, A. baumannii isolates on two ward computers had the same pulsotype.

Conclusion

With good hand hygiene compliance, we found relatively low contamination rates of MRSA, P. aeruginosa and A. baumannii on ward computer interface, and without further contribution to nosocomial infection. Our results suggested no necessity of routine culture surveillance in non-outbreak situation.

Microbial contamination of computer keyboards in a university setting

The keyboards of multiple-user (student) and single-user (staff) computers located on a university campus were sampled to assess microbial contamination. The average number of microorganisms present on multiple-user computer keyboards was significantly greater than on single-user keyboards, and the number of keyboards harboring potential pathogens was also greater for multiple-user computers. It is recommended that regular cleaning and disinfection of computers be used to reduce the microbial load, especially for multiple-user workstations.

A Review of the Research Literature on Evidence-Based Healthcare Design

Objective:

This report surveys and evaluates the scientific research on evidence-based healthcare design and extracts its implications for designing better and safer hospitals.

Background:

It builds on a literature review conducted by researchers in 2004.

Methods:

Research teams conducted a new and more exhaustive search for rigorous empirical studies that link the design of hospital physical environments with healthcare outcomes. The review followed a two-step process, including an extensive search for existing literature and a screening of each identified study for the relevance and quality of evidence.

Results:

This review found a growing body of rigorous studies to guide healthcare design, especially with respect to reducing the frequency of hospital-acquired infections. Results are organized according to three general types of outcomes: patient safety, other patient outcomes, and staff outcomes. The findings further support the importance of improving outcomes for a range of design characteristics or interventions, including single-bed rooms rather than multibed rooms, effective ventilation systems, a good acoustic environment, nature distractions and daylight, appropriate lighting, better ergonomic design, acuity-adaptable rooms, and improved floor layouts and work settings. Directions for future research are also identified.

Conclusions:

The state of knowledge of evidence-based healthcare design has grown rapidly in recent years. The evidence indicates that well-designed physical settings play an important role in making hospitals safer and more healing for patients, and better places for staff to work.