The potential role of the environment in contributing to the transmission of multidrug-resistant organisms (MDROs) has been widely reported.1 Yet, the scope of environmental services cleaning procedures in patient rooms is usually limited to basic areas such as the floor, bathroom, and night stands. Who is responsible for cleaning items like the computer keyboard and mouse, monitors, point-of-care testing equipment, stethoscopes, blood pressure equipment, thermometers, ventilators, IV pumps, commodes, and doorknobs?
Stand outside a patient room and take visual inventory of the supplies and medical equipment. There are many possible reservoirs in every patient room. In addition to the equipment in the room, there can be smartphones and tablets that are brought in and out of rooms, from one patient to the next.
Have you made a list of everything in a room that should be cleaned and who is responsible for cleaning the items on the list? When one facility had an increase of C. difficile in a unit, infection prevention, nursing, respiratory, and environmental services met and developed a list that was three pages long. Not all of the items were cleaned routinely, nor was it known who was responsible for cleaning all of the equipment on the list. A special report in Infection Control Today examined keyboards as fomites in cross contamination of pathogens.2 In this report, multiple studies found contamination of computer equipment in the healthcare setting.
Incontinent patients and those with draining wounds can increase the bioburden of pathogens in a room. With C. difficile, the room can quickly become contaminated and the spores can linger for a long time. The Centers for Disease Control and Prevention recommend that cleaning and disinfecting frequently touched surfaces (e.g., bedrails, bedside commodes, bathroom fixtures in the patient's room, doorknobs) and equipment in the immediate vicinity of the patient should be done for patients in Contact Precautions (patients with an MDRO will be in Contact Precautions).3 Does your facility clean the room of a patient with an MDRO more than once a day?
Which departments are responsible for cleaning patient rooms in your facility?
- Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006. MDRO Prevention and Control. Healthcare Infection Control Practices Advisory Committee (HICPAC). Retrieved from the internet October 23, 2015. http://www.cdc.gov/hicpac/mdro/mdro_4.html
- Pyrek KM. Cross-Contamination Prevention: Addressing Keyboards as Fomites. Infection Control Today. May 2014. Retrieved from the internet October 23, 2015. http://www.infectioncontroltoday.com/reports/2014/05/cross-contamination-prevention.aspx
- Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006. Prevention of transmission of Multidrug Resistant Organisms. Healthcare Infection Control Practices Advisory Committee (HICPAC). Retrieved from the internet October 23, 2015. http://www.cdc.gov/hicpac/mdro/mdro_5.html