Healthcare Hygiene magazine January 2020 | Page 24

Almost all
99.2 %
of hospital staff
smartphones
were
contaminated
with potential
pathogens, and
bacterial colony
forming units
(CFUs) were
significantly
higher on hospital
phones than in
the control group.
24
laborious and is subject to low compliance, as
demonstrated by some studies. Another strategy
is to regularly disinfect equipment. Several studies
have shown that good hygiene reduces keyboard
contamination.”
Another reservoir is the use of smartphones
in the clinical environment, highlighting the need
to consider infection control policies to mitigate
the potential risks associated with the increased
use of these devices.
Simmonds, et al. (2019) sought to charac-
terize the quantity and diversity of microbial
contamination of hospital staff smartphones
using culture-dependent and culture-independent
methods; to determine the prevalence of antibiot-
ic-resistant potential pathogens; and to compare
microbial communities of hospital staff and control
group phones. The researchers swabbed the
smartphones of 250 hospital staff and 191 control
group participants and determined the antibiotic
resistance profile of Staphylococcus aureus and
Enterococcus isolates was determined. Swabs were
pooled into groups according to the hospital area
staff worked in, and DNA was extracted.
Almost all (99.2 percent) of hospital staff
smartphones were contaminated with potential
pathogens, and bacterial colony forming units
(CFUs) were significantly higher on hospital
phones than in the control group. MRSA and VRE
were only detected on hospital mobile phones.
Meta-barcoding revealed a far greater abundance
of Gram-negative contaminants, and much greater
diversity, than culture-based methods.
In their review, Kanamori, et al. (2017) say the
main cause of healthcare-associated outbreaks
was inappropriate disinfection practice for shared
items: “Other reviews also noted that medical
equipment used in noncritical settings rarely had
cleaning protocol and may be involved in frequent
transfer of pathogens compared to critical settings,
suggesting the need for appropriate cleaning
and disinfection protocols for patient care items
commonly used in daily practice. Cleaning must
precede high-level disinfection or sterilization
of any reused patient care items. Thus, assuring
disinfectants for noncritical medical equipment in
addition to improving thoroughness of cleaning
and disinfection practice is imperative in terms of
infection prevention.”
They add, “Any patient-care items used in
healthcare settings can be contaminated with
a healthcare-associated pathogen and are a
potential fomite, but outbreaks via these fomites
can be prevented or minimized by adhering
to current recommendations for cleaning and
disinfection of devices and surfaces. Although
the trend in healthcare-associated outbreaks
via a fomite may be affected by reporting bias,
sharing lessons learned from outbreaks and
accumulation of practical evidence would help
improve infection prevention for each fomite. It
is important for healthcare personnel to recognize
the increasing role of patient-care items as a
fomite and adhere to prevention strategies for
fomite-associated outbreaks based on current
guidelines and the literature.”
While fomites are ubiquitous in the healthcare
environment, their omnipresence may make
them more easily ignored as they fade into
the background.
“Although fomite-mediated spread of
pathogens has been illustrated in numerous
clinically relevant instances and is a well-defined
phenomenon, there are various questions that
remain,” says the University of Nebraska Medical
Center’s Mark Rupp. “All healthcare providers
should be aware of this route of dissemination
and means to prevent such spread. However,
as medical care has become more complex and
technologically oriented, an increasing array of
potential fomites have been introduced into
medical care.”
As we have seen, some researchers say empha-
sis should be placed on high-touch, near-patient
objects and surfaces only. “Potential fomites that
pose the greatest risk are those that are more
likely to harbor large numbers of pathogens, are
difficult to clean/disinfect, come into contact with
a patient’s bloodstream or mucus membranes, or
are found in conjunction with particularly high risk
patients,” Rupp says. “So, for example, a blood
pressure cuff in an ambulatory clinic caring for
largely healthy patients should be cleaned between
patients with a low-level disinfectant. However, it
generally comes into contact only with a patient’s
intact skin (or sometimes I’ve seen clinics where
they measure blood pressure through a patient’s
shirt sleeve – so in some instances it may be in
contact with clothing) and, in a clinic caring for
largely healthy persons, the risk is fairly low that
a dangerous pathogen is going to be transferred
from one person to another and result in invasive
disease. Conversely, for example, an ultrasound
probe used in a NICU to establish vascular access
may deliver pathogens in close proximity to the
vascular system – in the presence of a foreign
body (IV) - in a very vulnerable population (neo-
nate). It is thus imperative that the ultrasound
probe and machine be appropriately cleaned
between patients.”
Considering the degree of contamination of
the environment by specific pathogens is a key
factor when examining the role fomites play in
infection transmission.
“In a perfect world, all potential fomites would
be appropriately cleaned and disinfected after use
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