Where are YOU Harboring Germs and Viruses – Hygiene is Key

Author: Kelly Swails MA, CRCST, CHL, CIS, CER, ST | Senior Clinical Analyst

 Objectives:
  1. Explain the relationship between hygiene and personal safety
  2. Address considerations pertaining to workplace attire, personal belongings, and hygiene
  3. Review challenges that may impact proper hygiene and attire
Hand Hygiene

I’m sure we can all agree that handwashing is important and working in healthcare leads to multiple handwashings throughout your shift. But, what about under your fingernails and wearing nail polish. Fingernails, especially under the nail, can harbor bacteria, fungus, and yeast. A handwash without a nail brush or the quick use of hand sanitizer is most likely not cleaning under your fingernails, and the grossness that is left behind can cause illness and infection that can lead to death. Add to that the potential risk of under-the-fingernail debris finding their way into a peel pack or tray.

In sterile processing we’re told to keep nails short, don’t wear nail polish, and wash hands or use hand sanitizer, but when’s the last time you used a nail brush for your routine cleaning; especially when you leave the decontamination area. We know that gloves can have holes and our hands can be exposed to blood and bodily fluids so why aren’t we using a nail brush or washing our hands for a full 20 seconds. The first reason that comes to mind is time. We’re all in a hurry, and no one wants to waste their break time washing hands. However, that 20-second handwash has a payoff of not getting yourself and others sick, and the CDC recommends scrubbing the underside of nails with soap, water, and a nail brush every time you wash your hands.

Fingernail polish can harbor germs between the polish and fingernail. When you see chipped nail polish you have to wonder where the nail polish pieces are; they could be stuck to an instrument, or in a sterile tray or peel pack. These facts support AAMI ST79: 4.4. Yet, you still see staff members wearing fingernail polish in the sterile processing area.

Frequent handwashing can have unintended consequences. Dry skin and hangnails are not only painful but if you have open wounds or sores bacteria and other germs can enter your body and make you sick or lead to infections on your skin. So, while you’re doing what’s right and practicing good hand hygiene if you have dry, cracked skin or hangnails you may have to wear disposable gloves when assembling instruments or handling processed scopes, trays, or peel packs.

To protect ourselves and others we must practice frequent, good hand hygiene. This includes not wearing fingernail polish, washing or brushing under your fingernails, and keeping your hands well moisturized so you don’t endure dry, cracked skin and/or hangnails. The benefits of good, proper hand hygiene are astronomical, and everyone should partake.

 

Attire

Scrubs, hair covering, beard covers, shoe covers, and more. A lot goes into what we wear in sterile processing and it's important to not only have what is needed but to properly wear attire so that it protects you and prevents cross-contamination. Failure to completely cover your hair can result in hair in a sterile tray. Not removing shoe covers can result in bodily fluids being brought into sterile storage or public places. We must always be conscientious of what we’re wearing, where we’re going and is everything covered.

The facility provided scrubs are key to protection for everyone. The facility provided scrubs minimize the risk of outside environmental contaminants and debris making their way into the sterile processing area and into trays and peel packs. Removing and leaving scrubs at the facility prevents the chance of staff members bringing germs and contaminants home. Yet, there are facilities that don’t provide hospital laundered scrubs and you see staff members or vendors wearing hospital provided scrubs into and out of the facility.

Cross-contamination of pathogens via clothing is a major element in infection prevention. Wearing scrubs from home or home laundered scrubs have the potential risk of bringing dust, pet hair, human hair, food, and other contaminants into the controlled environment of sterile processing. Wearing scrubs outside of the facility and/or home leaves yourself and others open to exposure to pathogens such as MRSA, Hepatitis, C. diff, and E. coli. These pathogens can live on clothing and if you’re bringing scrubs home you could be bringing more than scrubs to you and your family.

Hair coverings vary in style and size and it seems that everyone has the style that they like. However, regardless of what is comfortable or looks good, it must be able to contain all of your hair. Personal cloth hats are common attire in sterile processing, but if they are laundered at home, they should have a hospital laundered or disposable covering placed over them. Skull type hats are common and fashionable, but can they contain all of your hair. They should probably only be worn by bald individuals that just need to contain skin shedding. Some staff members wear a hijab or burka, and hospitals should provide these with the scrubs or purchase disposable.

Beard covers can be challenging but are very necessary. Many are one size fits all and many of these do not contain all the facial hair. Add to that having to wear a mask and they can become uncomfortable. I’ve seen individuals wear an ortho hood to cover a full beard but if it’s not tucked in facial hair can still land in trays or on surfaces. Whether wearing a beard cover or ortho hood it is imperative to wear something that covers and secures all facial hair.

The primary source of bacteria and dust in the air comes from human skin. A human walking for one minute will release 1,000 skin particles and those particles need to land somewhere. That somewhere can be in a tray, on a scope, or inside opened wrap. We know that sterilization will inhibit bacterial growth, but it is debris and, therefore, a foreign body.

It is imperative for facilities and staff members to be responsible and minimize the risk of contaminants entering the sterile processing area. If policies and procedures are created, implemented, enforced, and maintained an environment that protects individuals and minimizes cross-contamination opportunities can be created and sustained.

 

Personal Belonging – Cell Phones

Cell phones are in the sterile processing area. They may stay in your pocket or your facility’s policy may say they can’t be used in the department, but should they be on our person or in the department. It seems everyone these days has a cell phone and it's always within arm’s reach. FOMO (fear of missing out) is a real phenomenon and 69% of millennials suffer from FOMO. Millennials have grown up with cell phones and don’t know what life is like without “communication at your fingertips.” Many other generations have joined the FOMO and won’t be without their cell phone. Cell phones harbor pathogens and can be distracting, but sometimes they’re needed in the workplace. If you need to know what an instrument is, and your computers have blocked internet searches, how will you easily locate the information you need? We used to search through catalogs but now those are even online, so you may need your phone.

If a cell phone is in the department it should be cleaned and disinfected, but how do you clean every crevice without damaging your phone. Most phones have a case, is anyone removing the case and cleaning both pieces on a daily or routine basis. The National Institute of Health (NIH) performed a study on cell phones in the workplace and the results confirmed that disease-producing pathogens such as MRSA are present and put us at risk of illness and disease. To protect individuals and minimize cross-contamination when handling sterile items cell phones should not be allowed in the department, or if they are, they should be cleaned and disinfected on a regular basis. In addition to this, you should probably practice hand hygiene every time you touch your phone.

 

Food and Drink

Food and drink are typically not allowed but there are those coworkers who have candy or chips in their pocket. Some facilities allow bottled water at the assembly workstation. Regardless of what is allowed and what others are doing, food and drink should not be in the sterile processing area. Eating in the department makes you susceptible to pathogens that are on your hands or airborne contaminants can land in open packages in your pocket. In addition to this food, particles can affect sterilization if they’re transferred to an instrument. When you drink from a water bottle your bacteria enters the bottle. If the bottle spills it can contaminate the work surface and you most likely won’t know where the splash made contact. To comply with AAMI ST79 Standards food and drink should be limited to unrestricted areas.

 

Conclusion

Studies have confirmed that disease and illness are transmitted by many means, and one common mode of transmission in humans. While we can’t all live and work in a bubble, we must do our part to minimize the risk to our patients, coworkers, and ourselves. Simple steps like proper and frequent hand hygiene are the first, and most important steps, to minimizing the risks associated with disease and illness transmission. Doing your part is not only for your safety – it’s for your coworkers, family, and everyone you encounter.

Resources:

25+ Powerful FOMO Statistics to Skyrocket Sales (2020). January 3, 2020. https://optinmonster.com/fomo-statistics/

ANSI/AAMI ST79, Comprehensive guide to steam sterilization and sterility assurance in health care facilities. 2017

AST Guidelines for Best Practices for Laundering Scrub Attire. April 14, 2017. https://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/Standard%20Laundering%20Scrub%20Attire.pdf

Laundry and textile hygiene in healthcare and beyond. July 1, 2019. http://microbialcell.com/researcharticles/2019a-bockmuehl-microbial-cell/

Role of healthcare apparel and other healthcare textiles in the transmission of pathogens: a review of the literature. March 31, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7132459/

Study of bacterial flora associated with mobile phones of healthcare workers and non-healthcare workers. June 9, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719508/

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