Following on from an assessment of high touch areas in acute patient areas comes a new study that has examined which surfaces in an operating theatre are the most frequently touched and additionally assessed the level of contamination of these surfaces (as was done for acute areas).
In the first phase of the study, direct observation of three procedures from each of 7 surgical categories was undertaken. Importantly the authors included both inpatient and day-case surgery. The total number of touches for each surface was calculated and then the top five high-touch surfaces were quantified. In the second phase of the study, the top five surfaces were cultured both before the fist case of the day and after the patient had left the theatre and before cleaning. As a control surface, they additionally cultured one area that was deemed to be ‘low touch’ from the first phase (the top of operating light, chosen for consistency as this was an immovable object and that area was unlikely to be touched during a procedure).
The top five high-touch areas were determined to be:
1. Anaesthesia computer mouse
2. Theatre table (OR Bed)
3. Nurse computer mouse
4. Theatre door
5. Anaesthesia medical cart
The mean number of touches per case (with more than five touches) were as follows:
The Anaesthesia mouse was a clear ‘winner’ in that it was touched 1,313 times, on average over 30 times per ‘case’. This was 30% more often than the second placed item. Lack of hand hygiene by anaesthetists has previously been highlighted as a risk in earlier work.
When compared with the control area (which had a zero median growth), all surfaces with the exception of the theatre table demonstrated more contamination, with the greatest contamination being noted on the computer mice and keyboards with the greatest contamination being noted on the nurse keyboard. The authors suggest that this is the case because multiple persons access the nurse computer.
The authors concluded that an enhanced cleaning protocol for these high touch surfaces be created by a multi-disciplinary team. Of course, this will only be possible if the design of the items in question (mice and keyboards) enables them to be effectively cleaned.
We talk often about the ‘antibiotic pipeline’, but as the pipeline slows to a trickle, the ‘disinfectant pipeline’ is made even more important. Prof Jean-Yves Maillard from Cardiff University recently gave a talk at the HIS Spring Meeting scanning the horizon for new disinfectants. Prof Maillard began with highlighting the emerging challenge that biofilms present to effective disinfection of dry hospital surfaces. Whilst traditionally associated with wet environments, biofilms have recently been discovered on dry hospital surfaces. The entire disinfection process, from product develop through to delivery at the point of use, has been configured without the knowledge that biofilms are present. This means that disinfectants have not been formulated with anti-biofilm activity in mind, standard laboratory tests and based on killing bacteria in a planktonic growth phase, and that the mode of usage of disinfectants has not been developed in a way that addresses the presence of biofilms. Gama and Cardiff University are collaborating to develop some disinfectant formulations with anti-biofilm activity in mind. Prof Maillard also discussed some other approaches to developing disinfectants, for example, exploring synergies between ‘green’ disinfectants, chiefly hydrogen peroxide and peracetic acid combinations. Finally, Prof Maillard gave a word of warning against disinfectants with a residual activity claim. The level of residual activity is likely to be low level, and whilst this may be useful in the short term, it will promote sub-lethal exposure and the development of reduced susceptibility.