Clean Workstation Initiative Alters Perceptions, Lowers Infection Risk

Although previous research has shown that anesthesia workstations and equipment often are sources of hospital-acquired infections, cleaning up their proverbial act may come from something as simple as a standardized system to increase workstation turnover. Indeed, a Massachusetts General Hospital study has found that implementing such a system improves providers’ perception of workstation cleanliness and their use of alcohol-based hand sanitizer.

“Despite diligent cleaning of anesthesia workstations between cases, it is intuitive that minimizing the amount of workspace contamination would potentially reduce cross-contamination and make our operating rooms [ORs] safer for patients,” said T. Anthony Anderson, MD, PhD, instructor in anesthesia at Harvard Medical School, Boston.

The investigators began the undertaking by surveying the institution’s providers and technicians, an exercise aimed at gauging both their perception of workstation cleanliness and interest in adopting a standardized turnover; positive feedback led to the design of the turnover system, dubbed the Clean Workstation Initiative.

“We spent a lot of time gauging openness through surveys,” Dr. Anderson explained. “We also viewed it as a way to get people ready to accept the idea of change. A fair percentage of the department staff didn’t think the cleanliness was optimized and there could be things done to change it.

“Initially we identified some areas of potential cross-contamination,” Dr. Anderson said. “As part of that, we labeled them as either ‘dirty’—surfaces that come in contact with patients or used supplies—or ‘clean’, meaning they have no contact with the patient or used supplies.” The anesthesia machine tray and OR bed were both labeled dirty, whereas the anesthesia cart and top of the anesthesia machine were dubbed clean.

As part of the protocol, an anesthesia technician discarded all items left on the tray after the case. The tray was then wiped down, a clean towel placed on its surface, and a card left on the tray with the technician’s name and pager number to signify turnover completion. In addition to this turnover process, alcohol-based hand sanitizer dispensers were installed on, or immediately adjacent to, the anesthesia carts within the anesthesia workstations. Brackets for premoistened disinfectant wipes and “emergency drug” syringes also were designed, built and tested in a subset of 10 ORs.

“We actually spoke with the OR engineering unit and had them build prototypes of a clamp that connected the hand sanitizer to the anesthesia carts,” said Dr. Anderson, who is presenting his findings here at the 2014 annual meeting of the American Society of Anesthesiologists (abstract A2182). “We also spoke with departmental leadership on numerous occasions to gather financial and conceptual support.” Gaining this support was critical to the program’s success, he added.

Equally important was promoting departmental awareness among all providers and technicians, an undertaking addressed through a variety of communication methods, including information sessions, emails and reminders viewed on hallway LCD screens. To assess provider attitude toward the initiative, a second survey was administered six months after the rollout.

Results from 99 surveys revealed that 89.9% of respondents were willing to adopt a new standardized turnover procedure. Using a scale ranging from 1 (“poor”) t o 5 (“excellent”), 78.2% of respondents rated workstation cleanliness at 4 or 5 after the initiative’s rollout compared with only 39.1% before, and 21.7% of respondents rated cleanliness at 5 after rollout compared with only 10.0% before. Finally, although 24.6% of respondents rated cleanliness at 1 or 2 before the initiative, none did so after.

Respondents’ reported use of hand sanitizer during every case showed a similar boost, increasing from 59.4% before the initiative to 72.5% after. And although 5.8% of respondents reported never using hand sanitizer before the initiative, this fell to 1.4% after the initiative was implemented.

Although the turnover process improved perception of workstation cleanliness and increased the use of alcohol-based hand sanitizer, Dr. Anderson recognized that further research is necessary to investigate any possible connection between the initiative and rates of hospital-acquired infections.

“For all our success, it’s important to note that the initiative requires constant upkeep, energy and attention in order to prevent backsliding of the process,” he said. “I’m hoping it’s going to become routine in our practice and everyone will be used to it. I still think we are a couple of years away from that.”