We all know the surfaces in our facilities that are the most touched, right? Overbed tables, bed rails, door handles, keyboards. But your facility may have a unique program or provide a unique service that introduces a novel high-touch surface that might not make the typical "top ten" list. In a recent study, a team sampled high-touch surfaces only to reveal that their CPR manikins ranked as one of the top two most-touched, and therefore most-contaminated surfaces in their hospital! Due to an extra emphasis on CPR training at their facility, their CPR manikins were in constant rotation for training and assessment, making them idea reservoirs for bacterial contamination. In today's post, we will present what surfaces might go overlooked at your facility, and how you can take steps to identify other forgotten surfaces that could lead to germ transmission.
Here are some surfaces that you may not consider as harboring disease-causing pathogens, but in fact provide a reservoir that could lead to healthcare-acquired infections.
1. Workstations on Wheels (WOWs): Workstations on Wheels (WOWs) and Computers on Wheels (COWs) are becoming mainstays in today's hospitals. These mobile workstations roll into and out of patient rooms, sometimes following the patient and sometimes following the user/healthcare worker. Either way, these are high-touch surfaces that are often not sufficiently disinfected. Check out this poster presentation from 2020 that details how the handle/arm proved to be the most contaminated.
2. Breakrooms and break areas: Many high-touch surfaces abound in a break room, from fridge handles and knobs to coffee machine buttons and chair backs. These areas are potential germ reservoirs and should be disinfected frequently. This study captures just how contaminated those surfaces can be, especially the coffee maker!
3. Shared office supplies (clipboards, charts, staplers, etc): When was the last time you disinfected your stapler? How often are chart clipboards wiped down? These high-touch surfaces can be the last item touched before a healthcare worker touches a patient, so if they are not disinfected, then the focus should be on hand hygiene immediately after use! Here's a study on contaminated patient charts.
4. Communication equipment, including pneumatic delivery systems and phones: Desk phones, cell phones, and delivery systems are just a few high-touch surfaces that may be overlooked as germ reservoirs. And don't forget buttons: Call buttons, touch screens, and walk-talkie buttons are all places where germs can survive a very long time. Here's a study on worker cell phones and another study about contamination of desk phones.
5. Keyboards and buttons on not just computer, but medication dispensing machines: Buttons are everywhere! You may not be able to keep track of them all, so emphasis on hand hygiene after use is critical. This is just one of many studies about keyboard contamination.
How can you go about identifying overlooked surfaces that may require extra disinfection at your facility?
1. Consider initiatives that have associated technology or accessories. Are you going out into the community to do on-site screenings? These programs often require medical bags and carts that are touched by hundreds of people per month. Do you have touchscreens to help in wayfinding or to entertain patients in waiting rooms or treatment rooms? These screens must be wiped down frequently, not just during routine cleaning.
2. Consider your unique demographic and community. Do you see many families with children? If so, make sure their play areas and changing rooms are well-stocked with hand sanitizer and are disinfected regularly. Facilities that serve a higher proportion of elderly individuals should keep their immunocompromised status in mind as well.
3. New technologies that require unusual supplies: Maybe a new piece of equipment comes with a dispenser, or a storage case, or other high-touch item that is not yet on a cleaning protocol list. Make sure environmental services is informed about the new surfaces so that they become integrated into checklists.
4. Elevator buttons and escalator railings may get lots of use in your facility. As a result, their cleaning and disinfection schedule might not match the hospital down the street that has different usage.
5. Shared wheelchairs and other shared equipment is often not sufficiently disinfected, especially if it is in heavy circulation. Wheelchairs wheels come into direct contact with floors, often the dirtiest surface in a hospital. Walkers, physical therapy equipment, and exercise equipment can often have padded surfaces that are more difficult to clean, requiring additional attention to hand hygiene.
6. Outreach clinics, such as community vaccination events or screenings often use shared sign up clipboards, pens and tables. While these events cater to community rather than inpatient clients, they are opportunities for germs to spread. If the outreach clinics target an immunocompromised population, such as individuals with COPD or diabetes, extra care will be needed.
7. Outreach classes and training sessions: If your facility offers preventative care classes or training seminars, you will need to evaluate the spaces and equipment used by participants. If they share equipment with the hospital, they will need to be disinfected before and after events.
What are some high-touch surfaces in your facility that may be unique to your programs or demographics? Share them in the comments below - you may help a colleague spot an overlooked surface!
