There is likely something nastier than crumbs nestled in computer keyboards, especially those used in hospitals.
Keyboards are easily contaminated with germs, which in hospitals can take the form of antibiotic-resistant pathogens — the so-called superbugs, a study suggests.
And once they take up residence, there's almost no getting rid of them.
The electronic circuitry contained in keyboards, Blackberries, PDAs (personal data assistants) and other types of information technology make them particularly difficult to clean. The recent proliferation of these devices in hospitals poses a serious challenge for infection control.
“The difficulty with keyboards is you can't pour bleach on them. They don't work so well when you do that,” says Dr. Allison McGeer, an infection control specialist from Toronto's Mount Sinai Hospital who was asked to comment on the study.
Dr. McGeer noted another Toronto-area hospital eventually had to ditch keyboards a few years back when it was battling an outbreak of vancomycin-resistant Enterococcus, or VRE.
“We could not get the keyboards clean.”
Given the difficulty, the answer has to lie in the hands, said the lead author of the study, Dr. Gary Noskin, medical director of healthcare epidemiology and quality at Northwestern Memorial Hospital in Chicago.
“I think the key message here is that we know that keyboards can become contaminated, we know that that contamination can be transmitted from the keyboard to the hands of health-care workers,” Dr. Noskin said.
“So the best intervention would be to wash your hands (after using a computer) before you have direct contact with a patient.”
Dr. Noskin made the comments in an interview from Los Angeles, where he is presenting his findings at the annual meeting of the Society for Healthcare Epidemiology of America.
He and colleagues wanted to see whether the move to electronic medical records, which in American hospitals is bringing computers into patient rooms, posed an infection control threat.
They contaminated some keyboards with three types of bacteria, two of which are so-called superbugs: vancomycin-resistant Enterococcus (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa.
MRSA normally causes skin infections but can trigger life-threatening bloodstream infections. VRE causes urinary tract infections, bowel abscesses and infections at the entry sites of intravenous or dialysis lines. Pseudomonas aeruginosa can cause pneumonia and bloodstream infections.
All three could be picked up from the contaminated keyboards and in the cases of VRE and MRSA, the bugs were capable for surviving on keyboards for at least 24 hours. The more contact with the contaminated keyboards, the greater the likelihood of transmission of bacteria to hands.
Cleaning according to the manufacturer's recommendations — essentially soap and water — didn't make a difference, Dr. Noskin said. A hospital-grade germicide did, but regular use of such caustic solutions might take a toll.
“One of the things we don't know is how using such a strong disinfectant would impact either the plastic or the keyboard circuitry or the electronics,” he said.
“And the other thing that we didn't really study but which is also pressing is the issue of durability. These things aren't really designed to be cleaned with a germicide on a regular basis.”
Dr. McGeer said in her hospital, computers that are in patient-care areas all have plastic keyboard covers that can be removed and immersed in cleaning solutions. If they need to be thrown out, they are far cheaper to replace than an entire keyboard.
But a lot of people don't like typing with keyboard covers, Dr. Noskin said.
He suggested that while keyboards should be cleaned on a regular basis, more attention has to be paid to the cleanliness of hands — a suggestion no infection-control practitioner would argue against.
Any contact with a keyboard in a hospital setting should be followed by hand washing, Dr. Noskin said.
Bugs like VRE and MRSA aren't generally found outside hospitals, so people who share keyboards at work or home aren't likely to be at risk of running into them. But other bugs can persist on those keys, suggesting more frequent hand washing probably makes sense there, too.
“Keyboards will never be completely sterile,” Dr. Noskin said. “There are always going to be bugs there.”
