The following article was originally published in Preventing Infection in Ambulatory Care, the quarterly e-publication from the Association for Professionals in Infection Control and Epidemiology (APIC). To learn more about receiving this resource and joining APIC, visit www.apic.org/ambulatorynewsletter. To learn more about APIC, visit www.apic.org.
While technology can help to provide better and safer patient care, hardware used can be involved in the transmission of infection between staff and patients.
Computer hardware, especially keyboards, can be contaminated with microorganisms when touched by contaminated hands. Clostridium difficile can survive on inanimate surfaces for months. Gram positive bacteria, including vancomycin-resistant enterococcus (VRE) and methicillin-resistant staphylococcus aureus (MRSA) can survive days to months on dry surfaces. Many gram-negative species, such as E. coli and P. aeruginosa can also survive for months on equipment. All it takes is one provider who is over-worked and in a hurry. Computer access without proper hand hygiene can deposit organisms on the keyboard for the next provider. Recent studies support this, showing that keyboards can become significant reservoirs for organisms because of the increased use of computers in patient care areas.
This is why hand hygiene is critically important after touching surfaces that may be contaminated and before contact with another patient or with the environment. Unfortunately, hand hygiene compliance across the U. S. is about 40% and multi-drug resistant organisms are on the rise in the community and in hospitals and clinics.
Computer cleaning guidelines have been developed which can help reduce the risk of transmission of organisms. A keyboard/mouse cover can be one strategy used. Covers are easily removed and disinfected with a low or intermediate-level hospital approved disinfectant. Also washable/sealed keyboards may be employed. Rutala's studies indicate that keyboards can be as easily disinfected with or without covers using 5 seconds of friction and a wide range of low level disinfectant solutions. Gloves should not be worn during computer use. And hand hygiene should be performed before using the computer. Keyboards and mice need to be disinfected daily or when visibly soiled or contaminated with blood.
11 Infection Prevention and Control Guidelines for Computers in Patient Care Areas
• Use waterless alcohol degermer for non-soiled hands; soap and water for soiled hands prior to computer use, and prior to touching patients.
• No gloves should be worn during computer use.
• Hands must be de-germed after accessing the computer, before touching patients in multi-bed rooms.
• Roving computers must be cleaned before moving to another patient room.
• Clean/disinfect computer surfaces including keyboards using germicidal wipe containing a hospital disinfectant by wiping surface with friction for 5 seconds once a day and when soiled.
• Keyboards in patient rooms should be cleaned and disinfected with same process as the other horizontal surfaces and equipment in the patient room, i.e. at least daily and when soiled.
• Touch-screen computer monitors should be cleaned and disinfected with same process as the other horizontal surfaces and equipment in the patient’s room, i.e., at least daily and when soiled.
• Non-touch screen monitors should be cleaned per manufacturer’s instruction and/or when visibly soiled.
• Whenever possible install computer at least 3 feet from sink.
• Splashguard can be used between computer and sink and should be made of clear plastic that can be cleaned using disinfectant products compatible with the plastic.
• Splashguard should be cleaned with same frequency and process as all other horizontal surfaces in the patient care environment, i.e., daily and when soiled.
References
1. Rutala W, et al. "Computer keyboards: bacterial contaimination, ef 1. ficacy and compatibility of disinfectants". ICHE-2005-161.
2. Neely AN, Sittig DF. "Basic microbiologic and infection control information to reduce the potential transmission of pathogens to patients via computer hardware". J Am Med Inform Assoc. 2002 Sep- Oct;9(5):500-8.
3. Coia JE, Masterton RG. "Computer keyboards as a risk for nosocomial infection". Am J Infec Control. 2001 Oct;29(5):345.
4. Schultz M, et al. "Bacterial contamination of computer keyboards in a teaching hospital". Infect Control Hosp Epidemiol. 2003 Apr;24(4):302-3.
5. Bures S, et al. "Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit". Am J Infec Control. 2000 Dec;28(6):465-471.
6. Neely AN, et al, "Dealing with contaminated computer keyboards and microbial survival". Am J Infec Control, 2001, Apr;29(2):131-132.
7. Hartman B, et al "Computer keyboard and mouse as a reservoir of pathogens in an intensive care unit. J Clin Monit Comput. 2004 Feb;18(1):7-12.
8. Singh D, et al, "Bacterial contamination of hospital pagers". Infect Control Hosp Epidemiol. 2002 May;23(5):274-6.
9. Devine J, et al. "Is methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals a surrogate marker for nosocomial MRSA transmission and handwashing compliance?" J Hosp Infect. 2001 May;48(1):72-5.
10. Denton M, et al. "Role of environmental cleaning in controlling an outbreak of Acinetobacter baumannii on a neurosurgical intensive care unit". J Hosp Infect. 2004 Feb;56(2):106-10.
11. Boyce JM, et al. "Environmental contamination due to methicillinresistant Staphylococcus aureus; possible infection control implications". Infect Control Hosp Epidemiol. 1997 Sep:18(9):622-7.
12. Neely AN, "Computer equipment used in patient care within a multi-hospital system: Recommendations for cleaning and disinfection". Am J Infec Control, 2005 May;33(4)233-7.
13. Ivey JC, et al. "Fungal contamination related to personal computer devices installed in a hospital intensive care unit". Am Soc Microbiol Abstras 2001:L-I:469.
14. Hassoun A, et al. "Colonization of personal digital assistants carried by health care professionals". Infect Control Hosp Epidemiol 2003:24:302-3.
15. Man GS, et al. "Bacterial contamination of ward-based computer terminals". J Hosp Infect 2002;24:302-3
Read more from APIC:
- Basics of Cleaning, Disinfection and Sterilization of Instruments
- APIC Updates MRSA Elimination Guide
- A Measure of Safety: Preventing Infection During Medication Administration