“I don’t want to know!” the trembling receptionist sitting at the keyboard stated as I walked into the office. It was obvious she was not ready to hear what needed to be said. “Not knowing does not remove the risk,” I told her.
There are places in dentistry that are obvious when it comes to risk, and there are other areas that must be studied to understand the risks. One area that has come to light in recent studies is computer keyboards in the dental setting.
Computer keyboards may seem simple and low risk when it comes to infection control, but studies in the dental setting have shown just the opposite. Computer keyboards have the potential to be contaminated with high levels of pathogenic microorganisms, and to be a possible source of cross contamination.
One study looked at the level of bacteria on keyboards. The results from this test in the clinical setting of a dental college found that 80% of computers were contaminated with potentially pathogenic bacteria. These organisms included some of your favorites. Coagulase-negative Staphylococci was found on 88% of keyboards, diptheroids on 80%, Micrococcus species on 40%, and Bacillus species on 60% of keyboards! The study also found significant levels of oxacillin resistant Staphylococcus Aureus (ORSA), oxacillin susceptible Staphylococcus Aureus (OSSA), vancomycin-susceptible Enterococcus species, Streptococci, and Aspergillus. This information and data is something we should all know.1 Keyboards can be a source of disease. They must be treated as any other possible source of disease.
It has been known for many years that computer keyboards may be a source of cross contamination in the hospital setting.2 Studies have shown that this is also an issue in the dental setting. A second study at the University of Birmingham looked closely at the possibility of cross contamination from keyboards located in both the dental clinic setting and a study area. All of the computer keyboards were contaminated with pathogenic bacteria, including Staphylococcus aureus, coagulase negative Staphylococci, gram-negative rods, and cocci. A range of gram-positive and gram-negative bacteria and Candida albicans were also found. A very important finding in this test was that these pathogens were able to survive up to TEN days in dried suspensions on the keyboard.3
Care of computers in the dental setting
So what is the protocol for caring for computer keyboards? The Birmingham study looked at several issues involving reducing the level of pathogens. The findings included:
1. The main route of bacteria transfer is direct skin contact. Hand care before computer contact is a must.
2. Other forms of contact include splashes and airborne droplets. All surfaces must be treated as possible sources of cross contamination. Cleaning, disinfection, and barrier systems are a must for computer keyboards.
3. Contamination can quickly build up on a keyboard, especially with multiple users. All users must practice hand hygiene before using the system.
No one wearing patient care gloves should be using the keyboard. Barrier protection is vital with the keyboard surface.
4. Organisms can survive for long periods in this environment and must be treated as such. C. albicans survived on surfaces for up to 10 days. The study focused on using isopropanol alcohol wipes as a method for cleaning and disinfection, which reduced the level of pathogens by 96%.
5. The more roughness, indentations, and features that facilitate soil, the more pathogens that will be present on a keyboard. Look for keyboards that are smooth or have a silicone barrier that can be removed for cleaning and washing.
The Organization for Safety and Asepsis Procedures makes the following recommendations on cleaning and disinfecting computer keyboards. Since the use of liquid chemical germicides could prove harmful to laptop computers, the proper management would be to prevent contamination. Use impervious barriers or plastic shields, or place the computer in a location that is not subject to contamination via touch or splatter.
The computer keyboard and mouse are sources of contamination and must be barrier protected or cleaned and disinfected (we are aware of one type of keyboard/mouse that is autoclavable). Dental infection control experts recommend using barrier protection to cover equipment, especially sensitive equipment, such as computer keyboards/monitors/mouse and other hard-to-clean surfaces. Reminder — barriers must be changed between patients, and surfaces only need to be cleaned and disinfected if the barrier has been compromised.
The Centers for Disease Control and Prevention’s Guidelines for Infection Control in Dental Healthcare Settings (December 2003) states: Barriers include clear plastic wrap, bags, sheets, tubing, and plastic-backed paper or other materials impervious to moisture. Because such coverings can become contaminated, they should be removed and discarded between patients, while DHCP are still gloved. After removing the barrier, examine the surface to make sure it did not become inadvertently soiled. The surface needs to be cleaned and disinfected only if contamination is evident. Otherwise, after removing gloves and performing hand hygiene, DHCP should place clean barriers on these surfaces before the next patient.
Keyboards and mouses not barrier protected should be cleaned and disinfected according to manufacturer instructions. The manufacturer should be consulted prior to disinfecting with chemical agents because the equipment warranty may be void if chemicals not approved by the manufacturer are used on the product. There are specially designed computer keyboards for use in health care settings that may be disinfected.4
“I don’t want to know!” is never going to remove the risks involved in working in the dental setting. Knowing the studies and applying the findings can help us all make an impact on cross contamination and sources of pathogen bacteria. Treating computer keyboards properly will reduce the risks.
References
1. Shakeel MA, Prashanthy PR, Irram AH, et al. Int J PHD, Vol 2, No 2 (2011).
2. Neely AN, Maley MP, Warden GD. (1999) Computer keyboards as reservoirs for Acinetobacter baumannii in a burn hospital. Clinical Infectious Diseases 29:1358–1360.
3. Sarika P, Porter K, Sammons R. Are computer keyboards a cross-infection risk in a dental clinic? J of Infection Prevention 2010 11: 206.
4. http://www.osap.org/?FAQ_Main Accessed 11/30/2011
Noel Brandon Kelsch, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists’ Association.
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