Computer tablets can carry entertainment to residents, helping them create connections with their caregivers and the world around them.
But they also can carry germs, including surface-clinging bacteria that can live for weeks if not properly treated.
That’s one reason Linked-Senior is proactive about offering handling and cleaning advice to its clients even after getting out of the device-supply business.
“Technology, the more mobile it is, the more likely it is to keep people active and engaged,” says LinkedSenior founder Charles de Vilmorin. “But any device that is in a common area, any screen that’s going to be touched, it needs protection.”
Tablets can seem like a lifesaver if they help residents feel less lonely during building-wide isolation periods. Such devices also are increasingly pushing into patient rooms for activities such as music therapy or memory exercises.
Meanwhile, point-of-care workstations with electronic health records access or medication management tablets often roll down shared hallways and into and out of patient rooms. Other handheld electronics — ranging from nurse call pagers to smartphone cameras used for pressure wound monitoring to residents’ own phones and tablets — are inescapable in modern nursing homes.
Danger may be lurking on every stylus, keypad or touchscreen.
“We know from numerous clinical studies across the globe that healthcare workers’ mobile handheld devices are frequently contaminated with healthcare-associated pathogens,” says Rosie Lyles, M.D., director of clinical affairs for Medline. “Mobile phones, which we often carry in our pocket and hold with clean or dirty hands, can lead to potential risks, such as noise, distractions, loss of concentration, data safety, disturbance of patient privacy, and transfer of microorganisms possibly leading to nosocomial infections.”
Healthcare-associated infections remain a leading, high-cost problem for providers, and hand-washing compliance rates are less than ideal. Handheld phones, Lyles points out, are rarely cleaned after handling and may transmit microorganisms after contact with a patient to become the source of bacterial cross-contamination.
It’s clear someone needs to take responsibility for mobile device disinfection as part of an overall infection control plan, including monitoring where the items roam.
“This type of equipment is patient care equipment and needs to be considered in a facility’s protocol,” says Joan Hebden, RN, infection prevention consultant for APIC Consulting. “In light of a high prevalence of pathogenic bacteria in long-term care settings, it is something that should not be overlooked.”
Hebden said mobile electronic devices should be addressed in policy as would any other reusable equipment — such as IV poles, wheelchairs or blood pressure cuffs — or any electronic device mounted in a resident’s room.
A single contaminated device could allow the flu, C. diff, MRSA or worse to fly through a facility.
“Alarmingly, there are quite a number of papers that have found gram-negative bacteria are highly prevalent, and they are shown to live a long time on surfaces,” Hebden says. “Anyone who touches it, their hands become contaminated. Then you have the issue of contact transmission occurring.”
Among the device-lurking dangers nursing homes should be concerned about: cipro-resistant Acinetobacter, a pathogen commonly associated with healthcare-acquired infections.
This time of year, prospective clients are more likely to raise the question of how to safely sanitize electronics because flu is top of mind, de Vilmorin says.
But establishing a policy that sets cleaning expectations, assigns responsibility and monitors for compliance can help keep devices from contributing to disease outbreak year round.
Every few months, it seems, a new study reveals a different weak spot in the industry’s infection control procedures. Past studies have hit on stethoscopes, blood pressure cuffs, chalkboard frames, and the markers and erasers used on whiteboards.
“I’m not sure people are surprised by it or that they don’t have time to address it,” says Nick Haralambis, RN, senior healthcare product manager for HD Supply. “It’s been drilled into our heads that everything is dirty. It’s just a matter of diligence.”
Haralambis recommends the Centers for Disease Control and Prevention’s Clean Hands Count for Safe Healthcare campaign. It’s a reminder that proper handling of all other equipment begins with consistent, thorough hand-washing efforts.
Like the frequently missed nooks and crannies of our hands, Haralambis says providers should monitor the cleanliness of high-touch but low visibility items.
“Siderails on beds, head and footboards, medical carts, lifts and even wheelchairs and geri chairs: These are things that are touched time and time again, but are they ever cleaned?” he asks.
Talking back to dirt
Manufacturers can suggest treatment solutions that protect investment in devices, whether that means using slightly more expensive impregnated wipes or stocking up on protective sleeves.
Some steps are more effective than others. Hebden says keyboard covers, though easily wiped down, quickly fell out of favor because they reduce users’ tactile sensation. Likewise, antimicrobial coatings may not provide the protection technology pros think they do.
Ask whether products making antimicrobial claims contain E.Coli– and MRSA-killing copper, such as MicroGuard. The company’s copper alloys have shown a 99.9% kill rate against six infection-causing bacteria, including MRSA and VRE.
Rugged tablets designed for healthcare often feature an anti-microbial housing that lasts longer than coatings. Other touchscreens made for healthcare settings are designed to stand up to antimicrobial cleaners.
During outbreaks, de Vilmorin also has seen his long-term care clients opt for disposable sleeves, such as the iBarrier, that completely seal a tablet to limit germ transmission while in use by a resident. The sleeve is replaced each time the device is used.
Gloves also can be part of the solution when touching most screens — but only if employees remember to change them.
Another important question is when to clean. Mobile devices carried by clinical staff — or those shared over a whole day by multiple shifts — may be easy to miss.
Cleaning responsibility, frequency and monitoring duties all should be determined by a team that ideally includes environmental services, clinical staff and the building’s infection preventionist, Hebden advises.
Creating a catalog, checking it often for lapses and monitoring with ATP or fluorescent light testing can help ensure efficacy.
No matter the product, operators need to be sure active ingredients address any known viral or bacterial culprits, and follow the appropriate application time to ensure a complete kill. Vendors such as HD Supply and Clorox provide clients with kill times for various products, and they can help develop comprehensive standard operating practices.
While terminal room cleanings provide a good opportunity for thorough sanitation, the presence of long-term patients, some of whom may not leave their room for long periods, is a challenge in skilled nursing.
Clorox Healthcare recently announced its Total 360 System, which delivers an electrostatic spray throughout a patient room and can be safely used with some electronics, according to internal testing.
“Electronics are tricky. The water in most disinfectants can be too much for them,” says Katherine Velez, Ph.D., Clorox senior scientist. “But the Total 360 creates a thin, even coating on surfaces.”
Users shouldn’t apply the spray directly to a monitor or other screens, but can stand up to four feet away and use a gentle sweeping motion over an entire room. The negative charge in the spray will make it seek out surfaces “like a target missile.”
“You get the assurance that you’re covering everything, even anything that’s oddly shaped,” Velez says.
Clorox also has introduced a new alcohol-free wipe, the Versa-
Sure, that is compatible with a broad array of hard, non-porous surfaces because it doesn’t leave corrosive residue. Still, the manufacturer suggests checking with individual electronic makers to see if products are compatible.
Cleaning mobile health devices with alcohol or bleach-based wipes would reduce pathogens, Lyle says, but those same disinfectants or abrasive materials may destroy screens.
She suggests facilities develop an iPBundle, first advanced by Mary Lou Manning at Jefferson College of Nursing in 2013, that promotes infection prevention and recognizes the need to preserve electronic resources meant for resident and clinical use.