Cleaning Patient-Care Equipment and Surfaces
By Erika Camardella
CONTAMINATION IN THE PATIENT ROOM, whether it be on delicate medical equipment or on sturdier surfaces such as chairs, bedrails and telephones, is the same, according to experts in environmental services (ES) and infection control.
Organisms like vancomycin-resistant Enterococci and C. difficile are common concerns, says Loretta L. Fauerbach, MS, CIC, director of infection control at Shands Hospital in Gainesville, Fla. Acinetobacter has been associated with torn mattresses that have become colonized with the organisms. Waterborne bacteria like the pseudomonads have been found on equipment that was placed near sinks.
Best Practices and Techniques
According to Jim Connors, CHESP, director of environmental and textile services at Rhode Island and Miriam Hospitals in Providence, R.I., patient rooms require the same kind of thorough cleaning that is conducted elsewhere in a hospital. All equipment in a patient room is cleaned upon discharge or transfer of a patient by ES staff, Connors says. Monitors and wires, etc. are cleaned with a cloth dampened with a hospital-approved disinfectant. Training and cleaning procedures are usually no different for departments such as intensive care units unless they have unique or specialized equipment that requires additional training.
Some high-touch areas require special attention, according to Rose Hamann, CHESP, director of environmental services and security at Blessings Hospital in Quincy, Ill. Especially during the flu season, we emphasize the bedrails and doorknobs, and other things like that, Hamann says. The room must be completely cleaned down on both sides whenever we do a discharge unit. We started using disposable wipes this year, and we have the alcohol sanitizers. In all honesty, the big infection control push is the hand-sanitizing and handwashing.
But the equipment is done by the departments, and we use an approved germicide; its not always the same one, but usually it has a hepatitis B virus (HBV) kill, and this is done when the patient is discharged, Hamann adds.
Keyboards, electric wires, IVs, and monitors are cleaned on a weekly basis, reports Fiona Nemetz, director of environmental services, safety, security and communications at Saint Josephs Hospital in Atlanta. Medical equipment in patient rooms is wiped down with a clean rag and hospital disinfectant upon each patient discharge. This procedure differs from intensive care areas where it is cleaned on a daily basis.
Hamann questions whether equipment wires are actually ever cleaned. What historically has been done by ES departments is that we clean everything but the equipment, but I know there are some places that have ES cleaning this kind of equipment now. We do wipe down the IV poles, but the IV pumps go to central supply to be disinfected between each patient. The wires that go with the pumps are done by central service. What I really question as being done and it might be an area for continued improvement is the wires of the equipment, such as in the ICU, which are always there and not taken out for cleaning.
Whose Job is it Anyway?
While many healthcare providers acknowledge that medical equipment is sometimes not touched by harried nurses nor by ES staff who are afraid to handle such delicate devices, Christine Nutty, RN, MSN, CIC, infection control practitioner at Western Baptist Hospital in Paducah, Ky. says, The department responsible for that equipment cleans it. It is either sent to the central sterile department and cleaned, or it may be cleaned by the nursing department.
I think equipment and wires play a very small role in the environmental surfaces you are in contact with in a healthcare setting, Nutty continues. I think you have to consider that everything is contaminated. Before you ever have contact with a patient you are going to clean your hands.
Bed rails have been a real issue, adds Kent L. Miller, CHESP, director of environmental services/laundry at Mercy Medical Center in Cedar Rapids, Iowa. The reason for this is the inherent problems or liability ES personnel would have to take if the rails had IV tubes, electrical wires, or other items lying over them. ES staff would feel terrible if something happened or if they inadvertently pulled something off. This happens occasionally in our long-term care division with resident collectibles. This is not potentially life-threatening, but the ES staff becomes quite concerned when they have to tackle this, says Miller. Essentially, the departments that use the equipment are responsible for cleaning the delicate medical equipment.
Hamann and Nutty also apply this rule of thumb to their hospital staff. Environmental services and the specific healthcare provider group, such as nursing staff or respiratory care staff, need to develop a clear understanding of who is going to be responsible for cleaning each surface and piece of equipment in a patient-care room or procedure room says Fauerbach. In many cases, since the equipment is so delicate and critical to patient-care, the nursing staff or respiratory care staff will assume responsibility for cleaning equipment while in use on the patient. Anyone who is responsible for cleaning equipment needs to have an understanding of the manufacturers recommendation and the types of agents that can be used to disinfect.
The Cleaning Process
When it comes down to how patient-care equipment is cleaned, Connors explains, It is cleaned with a damp cloth, never with a spray bottle or a lot of chemical solutions that could damage the equipment. In patient rooms, it is cleaned by ES staff upon patient discharge or transfer; in nursing stations or other clinical areas, equipment is cleaned by ES staff upon special request but not routinely. Nursing staff perform multiple tasks, and they do some equipment cleaning, but I dont believe ES personnel routinely clean electronic equipment unless instructed by nursing to do so.
Nutty explains the finer points of working around electronic equipment. Keyboards can be cleaned with soap and water, but they have to be totally unplugged from your system and dried, she says. And thats done by your computer services people. If you just want to disinfect in general, there are equipment covers available that you can remove and wipe. Or, you can take a cloth and spray your disinfectant on it and wipe over everything. You want to vacuum it to make sure dust isnt building up. For a thorough cleaning though, you should have your computer people take care of it. We have a bio-med engineering department that does some cleaning when they check the functioning of the equipment.
There are disposable alcohol wipes available in each patient-care area with which to clean equipment, as well as underneath each of the gurneys used to transport patients, Miller says. Infection control performs the training on this procedure to specific departments. Keyboards, electric wires, IVs and monitors are cleaned upon each discharge, while dusting of larger items, and disinfecting is done primarily on IV poles at discharge and on a daily basis if the ES staff member notices anything on them. Essentially, it is the central sterile departments responsibility to clean the IV poles as they pick them up on a daily basis from our facilitys utility rooms designated to receive dirty or contaminated items. However, nursing often needs them after each patient is done with them, so ES personnel wipe them down and ready them for distribution again. We use disposable wipes for all disinfecting, and use the rag-and-bucket method for large disinfecting jobs, such as on beds, for example.
It is also critical that ES personnel understand how to use chemical solvents properly when cleaning various pieces of medical equipment or medical furniture. You have to know what surfaces the manufacturer of the chemical approves for use because some pieces of equipment have vinyl components; some disinfectants will cause them to turn milky-looking or and make the rubberized areas harden, Nutty advises. Make sure you ask the manufacturer the right questions when you get the equipment in for cleaning. When Ive talked with some of the manufacturers, one of the first things we have to find out is whether the disinfectant we use in our hospital is safe for that product.
Proper chemical handling also raises issues related to the wearing of appropriate personal protective equipment (PPE) by ES personnel while performing their cleaning duties. ES staff is trained to use standard precautions and to follow instructions on isolation room signs, Connors says. They have access to gowns, face shields, etc., when needed and are trained in their use and when to use them. Medical equipment is generally removed from the room when any heavy cleaning is done that might splash water or chemicals on them, if they cant be removed and cleaning is being done above them then they are covered to protect them. Nemetz says her staff wears goggles, masks, protective clothing and gloves while the medical equipment is covered with plastic covers or garbage bags during the cleaning process.
Education of ES Personnel
It is essential for infection control practitioners to work closely with ES managers and staff to ensure that ES personnel understand the methods and means of transmission of disease and how to prevent it by thorough cleaning techniques. We do a pretty extensive training on how infections spread, how cross-contamination occurs, the concern about airborne transmission, and to clean off any object that was in the room before you use it someplace else, Hamann says. We really stress the need to clean the doorknob, the bedrail, the handrails, and the arms of the patient chairs. There is more emphasis lately on the infection control and the training for ES staff. We also do Internet learning and we have an online learning system in the hospital; staff must complete a set number of modules within a years time.
Nemetz says her ES personnel receive extensive training on bloodborne pathogens, standard precautions, TB fit-testing, and isolation practices, among others. The initial training is done during their orientation and then follow-up training is conducted at a minimum annually but typically on a more frequent basis in monthly departmental meetings, she says.
Proper training is especially important given the large numbers of immuno-compromised patients in todays healthcare facilities. Hospitalized patients are at higher risk than ever, whether they are considered immuno-compromised or not, Fauerbach says. Many nursing care units have dedicated equipment that can stay with a patient for the length of hospitalization to make it easier for the staff and safer for the patient. This practice is particularly true for our immuno-compromised patients who have a solid organ transplant, a bone marrow transplant, or who are undergoing chemotherapy.
According to Nutty, There are a lot of conditions that decrease the immunity, so it is really important that every piece of equipment is disinfected before it is brought into any patient room.
Ultimately, it is everyones responsibility to prevent disease transmission, and ES personnel are no exception. Cross-contamination has been identified as a potential cause of infection in some outbreaks, especially with organisms that can survive in the environment for a long time, Fauerbach says, But it is critical to remember that healthcare workers can interrupt transmission from the environment by good hand hygiene before touching a patient or their equipment. Thus it is important not to just blame the environment but to evaluate patient-care practices and the adherence to those practices that can minimize the risk.
Orkin and ASHES Partner to Promote Healthier Pest Control in Healthcare Facilities
ATLANTA In response to a growing movement in healthcare toward hazardous- chemical reduction, Atlanta-based pest control company Orkin, Inc. and the American Society for Healthcare Environmental Services (ASHES) of the American Hospital Association are launching a partnership that will promote more effective and environmentally friendly pest control practices in healthcare settings.
Minimizing pesticide use through integrated pest management (IPM) is part of our educational focus this year, says ASHES executive director Patti Costello. We are pleased to be working with an industry leader like Orkin to guide healthcare providers toward improved pest control practices.
The partnership kicks off with the release of Integrated Pest Management, the first in a series of ASHES recommended practice documents. Co-authored by certified entomologists from Orkin and Western Pest Services, which was acquired by Orkin in 2004, the new recommended practice is a complete how-to guide to implementing and maintaining an effective IPM program in a healthcare facility. It is available for pre-market order at www.ashes.org.
Pest control programs too often rely on chemicals, and ignore the reasons why the pests are there, said Zia Siddiqi, PhD, Orkins director of quality assurance and co-author of the practice document. IPM programs address the root causes of pest problems as well as the symptoms, so healthcare facilities can reduce their pesticide use and have fewer pest issues at the same time.
ASHES and Orkin are also working together to publish educational articles about the new practice for its members and others. The educational effort will culminate with two educational breakout sessions at the ASHES annual conference in September, featuring panelists from Orkin, Western Pest Services and The IPM Institute of North America.
Orkins commitment to IPM is evidenced by its latest service offering, Gold Medal Protection for Health Care, a comprehensive program consistent with the ASHES IPM recommendation and the recommendations of Hospitals for a Healthy Environment (H2E). More information on Gold Medal Protection for Health Care can be found on the Web at www.orkin.com/commercial.
IPM is an environmentally responsible approach to pest management that combines multiple pest management options versus relying on pesticides alone. It is the method recommended by the Centers for Disease Control and Prevention (CDC), the U.S. Environmental Protection Agency (EPA), H2E, ASHES and many others.