Keyboards latest culprit in hospital infections

Experts say physicians are not cleaning their hands as often as they should.

By Damon Adams — Posted May 2, 2005

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First it was neckties. Now it's computer keyboards that have been identified as nesting grounds for germs that could be spread to patients.

A new study says potentially harmful bacteria can survive on computer keyboards and keyboard covers up to 24 hours, a threat to hospital patients as more institutions implement electronic systems and bring technology to patients' bedsides.

The findings come on top of research showing that white coats, stethoscopes, pens and even neckties are among germ carriers in a doctor's everyday world.

Physicians say the computer keyboard discoveries are another reminder that doctors should be mindful of what they might take with them when they see their next patient.

"We touch a lot of things and don't consciously think about the effect of touching things and what we carry around," said Lawrence Brandt, MD, chief of gastroenterology at Montefiore Medical Center in Bronx, N.Y.

In the new study, Gary A. Noskin, MD, and his colleagues studied three types of bacteria commonly found in hospital environments: vancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa. They contaminated computer keyboards and keyboard covers with the bacteria and examined the germs' ability to survive on both surfaces.

Researchers found that VRE and MRSA could survive up to 24 hours after being put on keyboards and covers. PSAE was found to live up to an hour on keyboards and up to five minutes on covers, according to study findings presented at the annual meeting of the Society for Healthcare Epidemiology of America held in Los Angeles in April.

The research also showed that after any contact with the keyboards, gloved and ungloved hands frequently became contaminated. Not surprisingly, the more contact hands made with contaminated keyboards, the more likely bacteria were transmitted.

Disinfectants can help prevent germs from spreading. A disinfectant that remained on a keyboard for 10 minutes before cleaning was more effective than one that was supposed to be removed after five minutes, according to the study.

But old-fashioned hand washing is still seen as one of the best defenses against spreading germs.

"The key message is that after contact with the computer keyboard, you must wash your hands. The simple measure of hand washing is the single most effective way to prevent transmission of bacteria in the hospital," said Dr. Noskin, medical director of health care epidemiology and quality at Northwestern Memorial Hospital in Chicago.

Hand washing often neglected

Sounds simple, but infectious disease experts say many physicians do a poor job of cleaning their hands often enough. A study in the July 6, 2004, Annals of Internal Medicine found that doctors at a hospital in Switzerland cleaned their hands 57% of the times they should have.

Lax hand washing among doctors has prompted some groups to encourage better cleaning.

In October 2002, the Centers for Disease Control and Prevention released new hand hygiene guidelines that advised using alcohol-based hand rubs to protect patients. The CDC stressed the guidelines as it found that each year about 2 million U.S. patients are infected in hospitals and about 90,000 die as a result.

In addition, the AMA endorses four principles of hand awareness for all people: Wash your hands when they are dirty and before eating; don't cough into your hands; don't sneeze into your hands; and don't put your fingers into your eyes, nose or mouth.

Raising awareness

Philip Tierno, PhD, author of The Secret Life of Germs, has looked at computer keyboards and found that they can be home to bacteria. He said doctors need to be more aware that keyboards, neckties and stethoscopes can be launching pads for bacteria to go from doctors to patients.

"People just don't stop and think of the mechanisms involved in transferring organisms," said Dr. Tierno, director of clinical microbiology and diagnostic immunology at New York University Medical Center.

Leonard Mermel, DO, president of the Society for Healthcare Epidemiology of America, said computer keyboards in office practices also could harbor bacteria. With keyboard use increasing in health care settings, he said, hospitals and practices should review keyboard cleaning policies.

"Bugs are becoming more and more resistant. We are running out of antibiotic options for some germs. As our options become more limited, prevention of transmission becomes more and more important," said Dr. Mermel, professor of medicine at Brown Medical School and medical director of the Dept. of Infection Control at Rhode Island Hospital.

At least one physician wonders if some researchers have gone too far in culturing bacteria on everything from pens to handhelds.

James J. Rahal, MD, was co-author of a Queens, N.Y., study on bacteria and neckties, but he said the bacteria were common and not considered dangerous.

"It's being overdone, frankly. Everybody seems to be culturing everything," said Dr. Rahal, director of the infectious diseases section at New York Hospital Medical Center of Queens. "You can find bacteria everywhere. We don't have a sterile environment. We never will."

But most physicians see the studies as providing useful information that should nudge physicians to take more notice of what they touch and greater care of cleansing their hands.

"[Doctors should] realize that we may infect other things," said Matthew Hall, MD, a staff physician and an infectious disease specialist at Marshfield (Wis.) Clinic.

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Menacing microbes

A new study found three species of potentially harmful bacteria can survive for long periods on computer keyboards and keyboard covers. The bacteria can produce a variety of infections.

  • Methicillin-resistant Staphylococcus aureus: Skin rash, boils, blisters, toxic shock syndrome and other types of infection
  • Vancomycin-resistant Enterococcus faecium: Complicated abdominal infections, skin infections, urinary tract infections and bloodstream infections
  • Pseudomonas aeruginosa: Pneumonia, urinary tract and bloodstream infections

Source: Society for Healthcare Epidemiology of America

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Where germs lurk

Studies of health care settings that harbor bacteria reveal the need for vigilance in hygiene.

Neckties: Researchers sampled 42 neckties worn by doctors, physician assistants and medical students at New York Hospital Medical Center of Queens. They also looked at 10 ties donned by hospital security personnel. The study found that about half of the neckties of clinicians carried potential pathogens. The odds of a clinician's tie carrying germs were eight times greater than those for a security worker's tie. The findings were presented May 24, 2004, at the general meeting of the American Society for Microbiology (link).

Hands: Study authors found doctors at a Swiss hospital adhered to hand hygiene guidelines 57% of the time. Physicians cleaned their hands most often when a hand-rub solution was available. They did not wash their hands as frequently when they had busy workloads. The findings were published in the July 6, 2004, Annals of Internal Medicine (link), in pdf.

Computer keyboards: A Chicago physician and his colleagues found that three potentially harmful bacteria survived for prolonged periods on computer keyboards and keyboard covers. Since transmission is possible from the environment to the patient, gloved and ungloved hands must be disinfected after contact with keyboards and keyboard covers, the study said. Researchers presented their findings at the Society for Healthcare Epidemiology of America's annual meeting held April 11 in Los Angeles (link).

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