New study finds IT can play a key role in infection prevention
In April 2017, UC Irvine Medical Center reported 10 newborns in one of its neonatal intensive care units tested positive for methicillin-resistant Staphylococcus aureus, or MRSA. While none of the infants died, the medical center was unable to locate the source of the infection, according to the Los Angeles Times, and subsequently required staff and visitors to undergo vigorous infection prevention measures.
“Staff and family members must also wear gowns and gloves while visiting the babies,” the story explained, “and take other precautions such as placing cellphones in plastic bags.”
The LA Times report highlights a weak link in contemporary infection prevention. Although mobile phones, tablets, laptops and other computing devices are now ubiquitous in hospitals, standards for cleaning and disinfecting them have lagged, according to a new HIMSS Media survey of 213 healthcare providers and clinicians.
Among the highlights of the survey, Creating a Patient-Safe Technology Environment:
- Forty-three percent of the survey respondents said they had no guidelines for sanitizing technology products at their organization, a figure that jumped to 60 percent for hospitals with 100 or fewer beds.
- More than half of the respondents rated the risk of infection to patients and caregivers from improperly sanitized technology products as “minimal.”
- Computer keyboards and laptops were of greatest concern to respondents, with 71 percent perceiving them as most prone to carrying infections in clinical settings. Another 55 percent included smartphones in the same threat category.
These results are surprising, because research has consistently shown that computing devices and peripherals are likely sources of healthcare-associated infections (HAIs). Beginning with a 2009 article published in the Annals of Clinical Microbiology and Antimicrobials, and frequently replicated since, data reveal that between 90 and 100 percent of mobile IT devices, keyboards and laptops swabbed in hospital environments carry a variety of bacteria including Staphylococcus aureus, as well as coliforms, molds and yeasts.
Neglected vectors of infection
Despite having meaningful infection prevention protocols for medical devices, the same careful consideration has not been given to IT devices. Hospitals are only now recognizing that “many, many things within the patient environment could be a vector to spread infections,” said Erin Sparnon, engineering manager for the Health Devices Group at the non-profit ECRI Institute. “The struggle they have right now is determining how to safely clean and disinfect devices that may not have been designed to be routinely cleaned and disinfected.”
In a 2013 article in the American Journal of Infection Control, Sparnon and three co-authors noted the lack of disinfection guidelines for Wi-Fi-enabled tablets and smartphones. The simple “wipe with a soft cloth” advice might remove dirt, but it did nothing to kill germs.
To counter the lack of manufacturer guidance, Sparnon and her co-authors advocated “commonsense” practices to reduce infection risks, such as sanitizing hands before touching personal devices and banning mobile devices from patient care areas.
While these options may be better than doing nothing (which, the HIMSS Media study suggests, may be the more common course of action), the risks remain substantial. The Centers for Disease Control and Prevention identified nearly 1.7 million cases of HAIs in U.S hospitals, resulting in about 99,000 deaths and an overall cost of $30 billion. Preventing HAIs can be measured in lives as well as dollars, especially in a value-based care environment.
Awareness is key
“Raising awareness with IT staff is important for both infection control and disinfection,” Sparnon said. “Both of these procedures are needed if you’re going to put equipment in a patient care area. Whether it’s doctors, nurses, patients or their families, they need to be able to use that equipment without elevating the risk of infection for their patients.”
ECRI Institute encourages infection prevention specialists and risk managers to include IT and clinical engineering teams in infection prevention policymaking, Sparnon said, adding that “it may be more feasible to ask IT to collaborate during the policymaking process rather than serve as IP (infection prevention) champions themselves.”
Janet King, senior director, market insights at HIMSS Analytics, said the new survey bears out Sparnon’s view that greater collaboration with IT correlates with better policies.
“The existence of sanitization guidelines is more widespread among organizations where the IT department is very involved in purchasing products,” King said. “A full 76 percent of those respondents with highly involved IT organizations report they do have sanitization guidelines in place versus just 53 percent at organizations where IT plays a lesser role in guiding those product purchases.”
King also noted that among respondents with highly involved IT departments, the percent who feel patients are at moderate to high risk of getting sick from improperly sanitized technology drops to 29 percent from 43 percent overall.
For its part, the IT department should consult with infection prevention specialists when planning to buy and deploy new technologies. “The challenge is to phase out legacy equipment that can’t handle disinfection and cleaning,” said Jim Davis, a senior infection prevention analyst at ECRI Institute and a co-author of the 2013 article. “That can be expensive.”
 Creating a Patient-Safe Technology Environment: a HIMSS Custom Research Report, HIMSS Media (Prepared for HP, October 2017).
 Fatma Ulger, Saban Esen, Ahmet Dilek, Keramettin Yanik, Murat Gunaydin and Hakan Leblebicioglu, “Are we aware how contaminated our mobile phones with nosocomial pathogens?” Annals of Clinical Microbiology and Antimicrobials, (2009) 8:7.
 Mary Lou Manning, James Davis, Erin Sparnon, Raylene M. Ballard, “iPads, droids, and bugs: Infection prevention for mobile handheld devices at the point of care,” American Journal of Infection Control.; 41, No. 11 (2013):1073-1076.