Creating a culture of sanitation in workstation environments
Safety is essential in radiology. Quality assurance programs are rigorous and vigilance ongoing. They should be. Excessive radiation exposure is hazardous to patients and to staff.
And so are bacterial infections. Yet are quality assurance efforts in radiology departments to prevent microbial transfer as vigorous? In 2014, a pilot study investigating bacterial contamination of a sampling of diagnostic workstations at two hospitals revealed that the workstations had a significantly higher level of bacteria than the toilet seats and doorknobs of nearby rest rooms.
Do radiologists practice hand hygiene protocols and disinfection? Should radiology workstation disinfection merit a Practice Quality Improvement Project, and can outcomes be maintained? The experiences of the Department of Medical Imaging at the Ottawa Hospital in Ontario are illustrative.
Radiology resident Jeffrey S. Quon, MD, launched the project, a two-part study to investigate workstation disinfection rates and hand hygiene habits of radiologists and residents and to subsequently assess the impact of an education and awareness campaign. No protocols mandating workstation disinfection by their users exist at Ottawa Hospital, neither when the study began nor today. Radiologists have sole discretion with respect to whether they disinfect their workstation and dictation space.
Dr. Quon distributed an email survey to all radiology staff, fellows and residents. It was designed to assess:
- the frequency at which a radiologist disinfected the workstations he used (ranging from never, to “x” times per week, to daily) over the course of a month;
- the items being disinfected: keyboard, mouse, dictaphone, dictation system, surface of workstation table, telephone;
- whether cold or flu prevalence increased frequency of disinfection;
- the availability and proximity of disinfectant wipes and hand sanitizers;
- hand sanitation and food consumption practices at diagnostic workstations.
Survey recipients were subsequently sent an educational presentation describing risk of bacterial contamination of workstations, the method to sanitize, and the importance of using a hand sanitizer before and after workstation use. A second survey sent six weeks later polled hand sanitation and workstation disinfection practices over another month-long period to gauge the impact of the educational campaign.
The initial survey generated a 76% response rate. All but two of the 84 respondents ate food and/or drank a beverage while reporting studies. Twenty never had disinfected a workstation, whereas 22 disinfected at least some items in the workstation environment each time they used it. After the educational campaign and the installation of campaign placards, only nine still did not disinfect, and daily disinfection increased by two survey responders. The remainder of radiologists and residents reported that they disinfected more frequently. The number of items that were disinfected also increased.
Improvements in hand hygiene were not as dramatic. About half of the respondents reported they washed their hands before and/or after using the workstation and dictation equipment, and this did not change.
Of particular note was the fact that no respondent had ever received any instruction on methods of sanitizing workstation spaces until they were emailed the presentation by the authors. Dr. Quon, now an abdominal imaging fellow at Brigham & Women’s Hospital in Boston, told Applied Radiology that he believes it would be beneficial for any newcomer to the radiology department to be educated in the benefits of workstation disinfection and hand hygiene. “Although hand hygiene is a staple of working in any hospital, it is often forgotten in radiology as we rarely interact with patients. With regards to workstation disinfection, this is a topic that is probably not stressed enough in all areas of the hospital,” he said.
Cc-author John G. Ryan, MD, the director of fellowship training in radiology, told Applied Radiology that the Practice Quality Improvement Project triggered a greater awareness and a culture change among the radiologists. He said, “At least 80% of the staff and trainees follow department disinfection and hygiene recommendations. The radiologists and residents have become very proactive in station hygiene and almost all members begin the day with a station disinfection. It has become an ingrained aspect of our work day for most members.”
Use of disinfecting wipes have not damaged the equipment. Dr. Ryan told Applied Radiology that over the three years since the study was conducted, microphones, telephones, keyboards, desks and chairs show no staining, bleaching, or evident wear due to the disinfection processes.
Richard Duszak, Jr., MD, principal investigator of the 2014 study, noted that with the exception of portable chest radiographic plates and CT power injectors, microbial colonization in radiology departments has received little attention. “Simple, rapid, and inexpensive disinfection techniques nearly completely eradicate workstation bacterial contamination…But as with many quality improvement initiatives, addressing workstation microbial contamination will require a cultural change for radiologists.”
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REFERENCES
- Duszak R, Lanier B, Tubbs JA, et al. Bacterial Contamination of Radiologist Workstations: Results of a Pilot Study. J Am Coll Radiol 2014 11: 176-179.
- Quon JS, Dilauro M, Ryan JG. Disinfection of the Radiologist Workstation and Radiologist Hand Hygiene: A Single Institution Practice Quality Improvement Project. Can Assoc Radiol J. Published online April 7, 2017.