up to 25% of hospital keyboards carry MRSA

[Hurricane]

http://news.bbc.co.uk/1/hi/health/6107892.stm

I'm going to go wash my hands now.

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[deleted87716]

These keyboards are similar to the ones described in the article.

 

[treesap]

I read this study not too long ago on a similar topic.

The worst offending fomites were doctors cell phones and pagers. They go off while you're in the room and you touch them with gloves on, before washing your hands, etc. They grew all sorts of nasty bugs, MRSA included.

Before I read this article, I had never wiped down my pager (its had a few close call with the toilet too). Now I have another reason to curse when the thing goes off...I have to touch it too!

 

[secretwave101]

Why is this even interesting?

S. aureus is a cutaneous organism. Some of it is resistant to some of the -cillins. Who cares?

Wash your hands anyway.

 

[Hurricane]

Dude who peed in your cheerios?

Anyway, the keyboards in our hospital are disgusting. The MRSA news just lends more objective data to confim my qualitative label of "disgusting."

It could be worse I suppose. I used to work in a lab where the radiation saftey inspectors confisgated the keyboard to our common computer because it was radioactive. Because some ******* lab tech kept checking her email between experiments without removing her gloves.

 

[Faebinder]

This would be interesting if a study was done to compare that to the colonies found in regular home keyboards showing that home keyboards has less MRSA on it than hospital keyboards + that the hospital keyboards are more capable of transfering this MRSA to your hands...

In otherwords.... wash your hands... we aint getting rid of keyboards until they make disposable ones or ones you can dip in acid and they come out fine.



Thanks for the study link though... I will never look at my office keyboard the same way again.

 

[toxic-megacolon]

Why is this even interesting?

S. aureus is a cutaneous organism. Some of it is resistant to some of the -cillins. Who cares?

Because this cutaneous organism can cause nasty infections in patients given the right environment. Moreover, It is resistant to standard antibiotics which buy the organism more time while people realize that Diclox or Ancef aren't working. AND... If they become resisent to your "backup" antiobiotics, you're kind of screwed. I'm actually a big fan of starting people immediatly on Vanc/Linezolid/Daptomycin, etc. rather than futz around with the penicllins, but still resistence to those second line drugs and the patient is in a world of hurt.

That's why people care.

 

[f_w]

When it comes to spreading MRSA around, nothing beats stetoscopes worn around the neck.

 

[secretwave101]

Sorry to sound like a jerk on that last post. Got schooled recently by a nurse for not wearing a face-mask with a patient who "HAD MRSA!!!", even though I was just talking to her. Felt like thoughtless rule-following to me. Guess I'm still feelin' the grrrrrr

Anyway, I feel that the much bigger issue here is that RESISTANCE is spreading. As long as people sneeze and have hands, we'll have Staph on things we use every day (evolution appears to be moving real slow here). What is of concern is that the org's on those keyboards are significantly tougher than they used to be.

 

[f_w]

Sorry to sound like a jerk on that last post. Got schooled recently by a nurse for not wearing a face-mask with a patient who "HAD MRSA!!!", even though I was just talking to her. Felt like thoughtless rule-following to me. Guess I'm still feelin' the grrrrrr

I don't know what kind of infection control protocols your hospital has, but last I know MRSA is typically a contact precaution type bug. No need for a face mask here.

 

[secretwave101]

AGREED!! It was insane.

A few years back, I guess most hospitals used gowns and masks for MRSA. The stupidity of this has become clear to most hospitals recently, but it hasn't gotten through on all the floors of our hospital. So, the precautions - silly and expensive in the first place - are spottily enforced.

Drives me nuts. Still, I'm managing to be nice about it everywhere but at SDN.

 

[Tired]

MRSA is so last year.

Come to the military hospitals, where all we talk about anymore is acinetobacter. MRSA is for old ladies and cardiac patients. Acinetobacter kills Marines.

 

[Hurricane]

MRSA is so last year.

Come to the military hospitals, where all we talk about anymore is acinetobacter. MRSA is for old ladies and cardiac patients. Acinetobacter kills Marines.

I bet it can't kill Chuck Norris.

 

[Tired]

I bet it can't kill Chuck Norris.

Chuck Norris was Delta Force, which is Army. So yes, it can easily kill Chuck Norris.

The Devil Dogs are way tougher than the "Be All You Can Be" boys. Always bet on the Marines in a fight.

(Navy bias, sorry)

 

[Smurfette]

Well, if you want to know something really scary...if all health care workers had nasal cultures today, a good 50% would be MRSA positive. And nearly 100% will be positive in the future or have been at some time in the past, but most clear the infection without ever knowing it (assuming they're relatively healthy). So the 25% keyboard infection is nothing compared to the people themselves.

Oh, and you're forgetting a top fomite carrier---men's ties. Afterall, few men clean their ties on a regular basis, and it's not uncommon to see a male MD bend down over a patient and see the tie brush against the patient.

 

[Tired]

Well, if you want to know something really scary...if all health care workers had nasal cultures today, a good 50% would be MRSA positive. And nearly 100% will be positive in the future or have been at some time in the past, but most clear the infection without ever knowing it (assuming they're relatively healthy). So the 25% keyboard infection is nothing compared to the people themselves.

Oh, and you're forgetting a top fomite carrier---men's ties. Afterall, few men clean their ties on a regular basis, and it's not uncommon to see a male MD bend down over a patient and see the tie brush against the patient.

Where are you getting a 50% nasal carriage rate from?

 

[Bertelman]

Oh, and you're forgetting a top fomite carrier---men's ties. Afterall, few men clean their ties on a regular basis, and it's not uncommon to see a male MD bend down over a patient and see the tie brush against the patient.

BS BS BS.

This is top 3 in my SDN pet peeve. Brush against the patient- gasp! What about the white coat everybody wears? Or the stethoscope? Or your nasty shoes! I am still waiting for someone to guide me to an article that shows a tie, or any other article of clothing, which was directly responsible for transmission of an infection.

 

[Smurfette]

Frankly, the stethoscope, shoes and white coat are obvious sources of contamination. But people think to clean those (though probably not often enough). Things like ties, PDAs, pagers, etc. are things many people never think about as getting nasty and gross.

I never said it officially was proven to transmit an infection to a patient, I said it's a carrier....as in if you swab and culture ties, all sorts of bugs grown out on it. Do an internet search, there are quite a few studies out there. PDAs, ties, shoes, white coats as vectors. The most recent study re: neckties was in 2004 by Bronx hospital.

Anyhow, here are some journal articles that address the debate about neckties/clothing.
J Hosp Infect. 2001 May;48(1):81-2
BMJ - 25-FEB-2006; 332(7539): 442

 

[Bertelman]

From BMJ: Dr Spencer said that although there was “no direct evidence” of a link between levels of dirtiness in hospitals and levels of infection, greater cleanliness in hospital wards might encourage greater pride and commitment to personal hygiene and good practices of infection control.

J Hops Infect: Carriage of S. aureus on the hands and nares is thought to be the most important means of hospital-related spread. However many articles of clothing and equipment have been identified as vectors of harmful organisms including pens, tourniquets and stethoscopes. Although small (and non-published, I might add) our study has shown the necktie to be likewise capable of prompt acquisition of potentially pathogenic bacteria.


Not exactly compelling evidence to ban the tie. I'm not trying to pick a fight here, I just don't like it when the tie is thrown out as some vogue new way to reduce hospital infection. It is probably one of 20 things we carry with us every day which harbor bacteria. Somehow, when it is proposed as a fomite, people (not necessarily smurfette) get this aha! moment and believe it should be outlawed in the hospital. When was the last time you cleaned a single piece of your diagnostic equipment, except maybe your stethoscope, unless it was visibly contaminated. You say you don't take your equipment with you to the hospital? Then when was the last time the ward's otoscope was cleaned? Probably the last millenium. I just think we should start at the top of the list of potential sources of infection, and for me, the necktie is somewhere south of #50.

As the BMJ article points out, handwashing alone is the most effective way to reduce this threat. So let's just get people to wash their hands instead of grasping for straws.

 

[Tired]

And I'm still waiting to hear where the 50% MRSA nasal carriage rate came from.

I'm starting to get the impression someone just went to a lecture by an Infection Control Nurse from a community hospital . . .

 

[f_w]

MRSA in my snot has far less of a potential to contaminate patients than MRSA on the phone receiver, door knob or computer keyboard. It is easier to remember to wash your hands after you blow your nose than it is to wash your hands every time you touch a door knob (it never fails, everyone gets all dressed up to go into a contact-precaution room, but on the way out someone will open the door with his gloved hands....).

As for the other 'fomites'
Shoes: I don't care what dog-poop bacteria live on the soles of my shoes, the only time I could imagine my foot to come in contact with a patient would be during the reduction of a anterior-inferior shoulder dislocation (if done the more medieval way, and even then you would take off your shoe...).
Stethoscope: Yes, your stethoscope is a perfect way to spread the joy around. It comes in contact with the skin flora of different patients, you will touch it right after you touch a patient, it often enough lives around peoples necks (which are favourite culture locations for MRSA). And no, wiping the diaphragm with an alcohol wipe won't make all evil bugs go away, they still live along the tubing and the ear pieces which you touched after you touched the patient ('back in the old country', we had stethoscopes physically attached to the incubators in the neonatal unit, use of your personal stethoscope was prohibited).
Ties: I don't wear one, but that is more an out of fear from strangulation rather than an infection control issue. Even if I did, I don't think I would drag it through patients MRSA or VRE laden excretions and then drag it through the next patients wound. I think the tie mania has more to do with the fact that the infection control gestapo is usually female.

 

[Hurricane]

I just don't like it when the tie is thrown out as some vogue new way to reduce hospital infection. It is probably one of 20 things we carry with us every day which harbor bacteria. Somehow, when it is proposed as a fomite, people (not necessarily smurfette) get this aha! moment and believe it should be outlawed in the hospital.

I'm just guessing here, but could this possibly be because deep down people would like a reason to not have to wear ties to work every day? I'm just a chick, so I dunno, but if I were a guy I can't imagine I'd enjoy tying a useless piece of cloth around my neck every day. FWIW they do look dapper

But yeah, ditto on the stethoscopes. I wish I could autoclave mine. The contact isolation rooms are supposed to have a disposable one that's just for that room though. Although I rarely see docs use it. The nurses do though.

 

[Tired]

As for the other 'fomites'
Shoes: I don't care what dog-poop bacteria live on the soles of my shoes, the only time I could imagine my foot to come in contact with a patient would be during the reduction of a anterior-inferior shoulder dislocation (if done the more medieval way, and even then you would take off your shoe...).

What do you think about the argument that bacteria on shoes can aerosolize and potentially cause infection by that route? I've had a number of surgeons ride me for moving my feet around too much during cases.

 

[f_w]

What do you think about the argument that bacteria on shoes can aerosolize and potentially cause infection by that route? I've had a number of surgeons ride me for moving my feet around too much during cases.

The same surgeons 'aerosolized' tons of their respiratory tract bugs by chewing you out blowing them past their masks (surgeons ride medstudents just because they can. some of the things told with this authoritative surgical voice are just pulled out of some body orifice of the respective individual).

I am not aware of a study that correlates foot movement with infectious outcome, but I am sure someone in italy has done that study at some point in the past. I'll gladly stand corrected on this one, maybe dog-poo on your shoes does create a problem.

Airconditioning in proper ORs is supposed to be designed in a way that you have a flow of air from the top of the room to the bottom. While this is not quite the same as in a proper laminar flow cleanroom (like the ones that integrated circuits are produced in), I don't think that whatever happens at the OR floor has a great influence on what is going on in the field. If we want to cut down on that source, how about reducing the number of times/case that some rotator tech runs through the room looking for some dohicky that is missing in OR 'X' or the number of times that the surgeon answers phonecalls speaking into a phone held to his ear by the CRNA ?

 

[Bertelman]

I'm just guessing here, but could this possibly be because deep down people would like a reason to not have to wear ties to work every day? I'm just a chick, so I dunno, but if I were a guy I can't imagine I'd enjoy tying a useless piece of cloth around my neck every day. FWIW they do look dapper

ding! ding! ding!

 

[Tired]

The same surgeons 'aerosolized' tons of their respiratory tract bugs by chewing you out blowing them past their masks (surgeons ride medstudents just because they can. some of the things told with this authoritative surgical voice are just pulled out of some body orifice of the respective individual).

I am not aware of a study that correlates foot movement with infectious outcome, but I am sure someone in italy has done that study at some point in the past. I'll gladly stand corrected on this one, maybe dog-poo on your shoes does create a problem.

Airconditioning in proper ORs is supposed to be designed in a way that you have a flow of air from the top of the room to the bottom. While this is not quite the same as in a proper laminar flow cleanroom (like the ones that integrated circuits are produced in), I don't think that whatever happens at the OR floor has a great influence on what is going on in the field. If we want to cut down on that source, how about reducing the number of times/case that some rotator tech runs through the room looking for some dohicky that is missing in OR 'X' or the number of times that the surgeon answers phonecalls speaking into a phone held to his ear by the CRNA ?

Interesting. Thanks for confirming my suspicions.

 

[DOctorJay]

there are laser keyboards available now, wonder how long it'll take to make it into the hospitals. basically a laser picture of a complete keyboard is projected onto any hard surface (except for glass I'm assuming) and it somehow registers your tapping on the surface for input. you can always wipe off the surface much easier than cleaning a nasty keyboard.

http://www.sforh.com/keyboards/virtual-keyboard.html

 

[Wizard of Oz]

And I'm still waiting to hear where the 50% MRSA nasal carriage rate came from.

I'm starting to get the impression someone just went to a lecture by an Infection Control Nurse from a community hospital . . .

Having worked as a clinical microbiologist for several hospitals, I've never seen anyone do this sort of study. I'm with Tired. Source, please?

As the BMJ article points out, handwashing alone is the most effective way to reduce this threat. So let's just get people to wash their hands instead of grasping for straws.

So true.

-Wiz, MP,M(ASCP), a$$-kicking microbiologist and MRSA warrior.