Top-Rated Infection Prevention Questions from PDI’s First Reddit AMA

Author: Caitlin Stowe MPH, CPH, CIC, CPHQ, VA-BC

Amidst the chaos of the COVID-19 pandemic, healthcare workers are among those in most danger of getting infected. For them, it can be challenging to stay up-to-date on infection prevention best practices while providing the best level of care possible to their patients. Instead of leaving healthcare workers to find answers on their own, we recently joined Reddit’s r/medicine community, a leading medical professional subreddit community home to over 300K members, to participate in an “Ask Me Anything” (AMA). This AMA gave healthcare workers a chance to ask questions directly to our expert infection preventionists and get answers from them in real-time.

Our infection preventionists, James Clayton, Director of Laboratory Sciences at PDI and Caitlin Stowe, Clinical Affairs Research Manager, spent two hours answering nearly fifty questions from doctors, nurses, medical students, technicians, paramedics, and EMTs about how to keep their work environments safe from everyday healthcare pathogens in addition to coronavirus for their patients and themselves. Here, we narrowed down the list to the five most popular questions. With the virus surging again in the United States, we think their advice is more important than ever.

1.“If you were asked to redesign a hospital or healthcare system and had free reign, what few key things would you do first to improve infection control at the patient/ward level, and at the systems level?”

At the patient/ward level, I would first ensure there are sinks in every patient room. Second, I would work with nursing and other clinicians to design the patient room so that the flow of patient care makes it easy to provide care in a logical way that makes following infection control practices easy. This can be accomplished by ensuring:

• The hand hygiene products are within easy reach of the patient zone
• The surface disinfection products are attached to the pieces of equipment that need to be cleaned and disinfected
• There’s enough space for you to don and doff PPE effectively
• The sharps containers are in the right spot, same with the glove holders.

The goal is to make it easier for the care providers to give safe and effective care.

In the unit or ward level, I would ensure that the alcohol hand sanitizer is in places where it is most used, and the flow of the unit is set up so that nurses and care providers have easy access at all times.

At the systems level, I think having easily cleanable surfaces (minimize fabric, wood, other hard to clean materials) is key for a hospital. Carpet and water features should be avoided because they are more difficult to maintain and can harbor potentially infectious organisms. – Caitlin Stowe

2. “Surgeon here. (FYI, we call the purple wipes ‘anti-baby wipes’ because they have a giant ‘do not use on babies’ picture on it). From what my hospital is telling us, during intubation of a COVID-19 positive patient, aerosolization can spread up to 27ft. We’ve been closing the rooms down afterwards for decontamination.  Anything specific we should be aware of? I also have a P95 respirator. Any recommendations for sterilizing/decontaminating?”

The recommendation is to follow your facility protocol for cleaning/disinfecting the room to get it ready to reopen. Make sure you’re cleaning all of the surfaces thoroughly and allowing the contact time of the product to be observed. For your respirator, definitely follow the manufacturer’s IFUs on the types of disinfectants and how you should clean and disinfect. As always, check with your infection prevention team if you have any questions. – Caitlin Stowe

3. Electronics and infection control. Tablets, computer-on-wheels, keyboards in outpatient offices. What scares you guys and any recommendations on best practices for cleaning?

Unfortunately a lot of these surfaces get overlooked as non-critical or low touch surfaces, when in fact every surface is critical when managing infection control in the environment, especially during this pandemic. Each ‘device’ has its own unique needs and best solutions. For sensitive touch screens for example, 70% IPA is recommended whereas WOWs with their various materials can be cleaned and disinfected using hospital grade disinfectants in wipe, spray, or mist format. In terms of regularity, that is a tough question to answer. We know that organisms can return in a matter of hours after disinfection, so regular treatments or the use of a continuously active disinfectant is what I would recommend. – James Clayton

4. Can you state definitively what each PDI container color wipe (red, gray, purple) can/cannot be used on? I hear conflicting things from everyone. (Electronics, surfaces, equipment etc.)

 This is a tricky question because it depends on the device manufacturer IFU, which we always recommend you follow if possible. PDI does have a compatibility website where you can look up specific pieces of equipment and what wipe is appropriate to use. Some facilities choose to follow their own protocols and products for cleaning/disinfection, but they do so at their own risk. – Caitlin Stowe

5. Other than staring intently and constantly re-wiping as I see it dry, what’s the best way of ensuring appropriate wet times?

 It’s a question that I have been passionately exploring. It is just not realistic for anyone to watch disinfectants dry and discern between wet, semi-wet, drying and dry, especially when you consider all the types of surfaces and their topography. The regulations bound us to maintain a wet contact time, however emerging science is challenging that notion. An opinion piece by Drs. Rutala and Weber suggested that it was the ‘treatment’ time that mattered, i.e. wet and dry time. The authors suggested as long as the disinfectant is left undisturbed for the contact time, the efficacy could be assured. Data generated by West et. al found that common disinfectant wipes were as effective within ~2 minutes as they were after several. They concluded that there was no additional bactericidal activity once the disinfectant had dried. – James Clayton

What We Learned from This Process

Healthcare workers don’t have it easy. It’s impossible for them to follow social distancing rules during their work shifts; meanwhile, many come in contact with potential SARS-CoV-2 carriers. Despite this, they show remarkable resilience. While tending to patients is their utmost priority, they still see keeping their environment clean as a critical component of healthcare. The questions we received also reaffirmed that disinfection is not a simple nor straightforward process.

We were happy to provide a level of personalized expertise that can be difficult to obtain during this unprecedented turmoil. Through this process, we sought to offer our help as a means to remind the medical community of our commitment to them as a trusted source of knowledge, through this pandemic and beyond.