San Diego—A new initiative by a community health system is addressing a source of OR contamination that many physicians may underappreciate or fail to recognize: cellphones.
As a result of the study, clinicians found that adherence to various elements of a phone use protocol produced a sustained reduction in contamination of the ORs.
“We focus on infection control in medication preparation, hand hygiene and other areas in our clinical practice. But nobody talks about how we bring our devices in and out of operating rooms, particularly phones,” said Benjamin Houseman, MD, PhD, the residency program director at Memorial Healthcare System, in Hollywood, Fla.
Given the lack of standardized approaches to phone hygiene in the community-based anesthesiology group, Dr. Houseman and his colleagues set out to both assess current phone use practices and test a practical approach to improving phone hygiene in the perioperative environment.
The process began with a survey that obtained clinicians’ practice patterns regarding daily phone use, particular cleaning. The survey comprised these statements:
- After making or receiving a call, I perform hand hygiene.
- Before making or receiving a call, I remove gloves or perform hand hygiene.
- I have a designated space for my phone in the OR.
- I clean my phone between cases.
- I clean my phone before the first case.
Results of the survey indicated a significant need for improvement, which prompted the researchers to create a protocol for phone infection control. The protocol consisted of five behaviors:
- Sanitize the phone at the beginning of a shift and place it in a clean plastic bag.
- Upon entering the OR, sanitize the bag and place the phone in a designated area.
- When using the phone, remove used gloves or the outer layer of gloves.
- Following phone use, perform hand hygiene (or gel gloves), and wipe the bag and return it to the designated area.
- Sanitize the bag before leaving the room.
“During COVID, we started using bags around our phones for infection control reasons,” Dr. Houseman said. “So, part of this project was born during our COVID practices, because we were deathly afraid of the coronavirus.”
Presenting at the 2022 annual meeting of the American Society of Anesthesiologists (abstract Q2116), Dr. Houseman reported that clinician responses to the five survey questions improved dramatically one month after implementation of the protocol, a change that was largely maintained six months later.
“There’s always going to be a little bit of backsliding compared to the beginning when people are very attentive and excited,” Dr. Houseman noted. “So, it’s about making sure people have that muscle memory and are still doing a good job of paying attention to the protocol.”
In light of their success, the researchers encouraged their peers to consider implementing similar programs at their institutions.
“I think people are very aware of infection control in our workplaces, particularly with regard to hand hygiene,” Dr. Houseman said. “But then they’ll go and pick up their phone and forget to clean their hands again, or forget to clean their phone. So, they’re inadvertently sabotaging themselves without even knowing it or thinking about it.”
For Nikolaus Gravenstein, MD, the Jerome H. Modell, MD, professor of anesthesiology and professor of neurosurgery and periodontology at the University of Florida College of Medicine, in Gainesville, the initiative should help institutions begin to address the contamination risk posed by telephones in the OR, as his previous research has shown. In a 2018 study (J Am Coll Surg 2018;226[6]:1117-1121), Dr. Gravenstein and his colleagues cultured 18 OR phones with Glo Germ, an ultraviolet light–enhanced particle powder sized to mimic bacteria. Next, the phones were held with a sterile, disposable OR towel covering a sterile surgical glove, and the gloves were cultured to determine whether bacteria had transmitted from the phone through the towel.
It was found that the powder readily transmitted through the towel to the gloves, with a median of 10 colony-forming units on the 17 evaluable cultured telephones. Of these 17 samples, 47% had transmission from the telephone to the glove, leading the researchers to conclude that sterile, disposable OR towels do not provide an effective barrier between the bacteria present on OR telephones and sterile gloves.
“We also know that cellphones have been shown to often have more germs on them than toilet seats,” Dr. Gravenstein added.
Drs. Gravenstein and Houseman reported no relevant financial disclosures.
This article is from the September 2022 print issue.