Becker's Clinical Quality & Infection Control

Executive Briefing: Mobile Equipment Disinfection 18 Sponsored by: Implementing and Sustaining Best Practices in Mobile Equipment Disinfection A pproximately 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, evidencebased 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 infectioncausing 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

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