Clinical practice management
Case studies in clinical practice management
Keeping Clean in the Reading Room: An Initiative to Improve Workstation Hygiene

https://doi.org/10.1016/j.jacr.2019.05.049Get rights and content

Introduction

Nosocomial infections have long been recognized as a contributor to hospital morbidity and mortality as well as overall health care costs, with subsequent adoption of hand hygiene and cleaning practices as a primary defense of the spread of infection within hospitals 1, 2, 3. Traditionally, the main focus of these initiatives has centered on areas of high traffic and high patient contact, such as the emergency department, inpatient floors, or intensive care unit. However, with the advent of modern and portable technologies and the ubiquity of computer systems throughout hospitals, lower traffic areas such as the radiology department are gaining increased attention for their possible role in nosocomial infection 4, 5.

Environmental surfaces play an important role in transmission of health care–associated pathogens to susceptible patients 5, 6, 7. A recent university study demonstrated contamination of hospital keyboards by at least two micro-organisms before disinfection, with over 50% of computers growing pathogenic organisms [7]. Hartmann et al in Germany found higher contamination rates of computer user interfaces (keyboard and mouse) when compared with other fomites in the intensive care unit setting, potentially serving as an overlooked reservoir for disease transmission [6]. Several radiology-specific studies have demonstrated bacterial con‐tamination of equipment, such as portable radiography plates, ultrasound probes [8], and automatic CT injectors for CT 9, 10. Significant surface bacterial contamination is experienced at radiology workstations [11]. A recent study assessing workstation contamination found that reading room stations have higher bacterial colonization counts than nearby restroom toilet seats and doorknobs [12]. At the same time, these and other similar studies have demonstrated that environmental cleaning or disinfecting effectively reduces surface contamination rates, and thus patient colonization and infection, and is relatively inexpensive 5, 7, 12.

A compounding variable is one of physicians working while sick, termed “presenteeism” 13, 14. A survey at a meeting of American College of Physicians found that over half of resident physicians admitted to the act of working while ill during the academic year [14]. A related cross-sectional study by Szymczak et al determined that over 80% of attending physicians and advanced practice clinicians had worked while ill in the past year, with the majority (over 95%) ascribing to the notion that working while sick puts patients at risk [13]. The majority of participants in both studies attributed the practice of presenteeism to a sense of obligation to colleagues and to patient care.

Unfortunately, many radiologists forgo hand and workstation hygiene, which may be due to existing culture and lack of education, inaccessible supplies, or the reasoning that patient contact is minimal. However, given the combined factors of workstation contamination, frequently shared workstations, presenteeism in the physician workforce, and working in close quarters with technologists and other health care personnel, there is significant potential to improve health care outcomes by improving workstation cleaning practices.

We investigated whether workstation hygiene could be improved through a series of low-cost interventions by assessing workstation hygiene habits before and after installation of hand sanitizing and disinfectant facilities within the reading rooms and subsequent educational interventions. By installing sanitizing stations and educating radiologists about workstation hygiene, we proved simple interventions significantly improve environmental cleaning.

Section snippets

What Was Done

At the start of our study, we initiated monitoring of workstation cleaning at our tertiary care academic institution. Our population consisted of 34 radiology residents, 9 fellows, and 26 faculty who used these reading rooms on a rotating basis. Before any intervention, cleaning supplies and hand-sanitizing stations were not routinely present or stocked in any of the reading rooms. A baseline evaluation was performed on 32 frequently used workstations distributed over nine reading rooms to

Outcomes

Workstations were evaluated for both evidence of cleaning as well as completeness of cleaning (ie, how many of the five marked sites showed evidence of cleaning). At baseline, 24 workstations were sampled with 13% of the workstations showing evidence of cleaning. However, cleaning of these stations was incomplete, with only 8% of the sites marked showing evidence of cleaning. After the installation of the sanitizing stations and before educational initiatives, there was minimal improvement; 23

Acknowledgments

Many thanks to Dr Emily Sickbert Bennet and Jason Smith for the assistance with study design and to Thad Benefield for his assistance with data analysis.

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The authors state that they have no conflict of interest related to the material discussed in this article.

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