Editor’s note: Richard Duszak, Jr. MD, a radiologist at Emory University School of Medicine in Atlanta, is the first radiologist to author a peer-review journal-published article expressing concern about sanitation and the diagnostic radiology workstation workspace. He has championed awareness of the need to disinfect electronic devices used by radiologists, technologists and staff. To read another article on this subject, click here.
AR: In February 2014, the Journal of the American College of Radiology published your article, “Bacterial Contamination of Radiologist Workstations: Results of a Pilot Study.” This was the first article about this subject directed specifically to radiologists published in a peer-reviewed journal. What feedback did you receive from JACR readers?
RD: First of all, readership was not just limited to JACR subscribers. When the article was published online ahead of print in July 2013, almost every online daily or weekly radiology publication wrote about our research. What we discovered was not revolutionary. Research reinforcing the need to sanitize computers, mobile tablets, and smartphones has been published for years. What I think jolted readers was the fact that we determined in our limited sampling that toilet seats and toilet doorknobs had fewer bacteria than reading workstations and the equipment — dictation systems, telephones, and desk workspace.
Since this was only a single institutional pilot study, I’ve been surprised at the amount of comments and feedback I have received — and continue to receive — from practicing radiologists all across the country. A number of individuals have shared with me their personal pet peeves that radiologist workstations are often messy and/or dirty. For a variety of reasons, they have been considered “off limits” for hospital housekeeping staff.
Some radiologists have used our work as evidence to support a variety of initiatives, such as those which we recommend in the article. We encourage radiologists to consider the cleanliness of their work environments - with potential radiologist, staff, and patient health safety implications - and make available antiseptic wipes to do quick workstation “wipe overs” before beginning work.
AR: Do you think that the impact of the article may have stimulated improvements in workstation area hygiene by radiologists?
RD: I don’t have any hard evidence to support this, but anecdotally my impression is that our work has stimulated a variety of workstation hygiene initiatives in hospital radiology departments and by private radiology practices in their imaging centers. When I am attending conferences and professional meetings, radiologists approach me and say, “Hey, aren’t you the workstation bacteria guy?” (not necessarily a title I would have intentionally aspired to) or “Your article really made our practice think about workplace hygiene differently.”
AR: Do you know, anecdotally , of rules put into place or campaigns to increase awareness in reading room areas?
RD: I’m not aware of any hard rules, policies, or campaigns at any practices, but I have heard about a number of radiologists who have shared this article with their partners. I know of many practices that have implemented initiatives to make antiseptic wipes readily and easily available in their reading rooms, implemented initiatives to make antiseptic wipes readily and easily available in their reading rooms. I think those practices have learned the lessons of hand and device hygiene elsewhere within the hospitals where they work. We need to enable systems to make all of this easy, just like having antiseptic hand pumps readily available at every patient access point within our health systems.
AR: There is a dearth of literature on the cleaning of technologists’ PACS workstations and modality consoles. Do you think that keeping these free of contamination is being addressed, along with keeping the tables, imaging plates, and mammography equipment sanitized?
RD: It’s not something I’ve personally looked at, so I think it would be more appropriate to address this question to administrators of radiology departments, to supervisors of technologists, or maybe even the professional societies that represent them. I would like to think that modality consoles and their workspaces would ideally be cleaned with the consistency of modality and patient tables.
With regard to workstations and the consoles on the radiologists’ side of things, I can offer some more thoughts. Our team took on this pilot project largely because we didn’t see the attention to workspace hygiene getting the attention in radiology as it has gotten in a lot of other healthcare domains.
Our colleagues in emergency and critical care medicine, surgery, and anesthesiology have all paid much more attention to this subject. In our pilot project, we only looked at microbial colonization, and did not look downstream at pathogenicity in the study. However, I think that my frequent “your dictation microphone has more bacteria than a toilet seat” message has evoked a pretty emotional reaction in some folks. Hopefully, either we or others will find the resources to be able to take this to the next step, specifically conduct workplace hygiene initiatives to make our work environments safer for us, our staff, and our patients, as many of us intuitively believe.
AR: You are a member of the faculty at the Emory School of Medicine in Atlanta and working in the hospitals of Emory Healthcare. Based on your observations, are radiologists sanitizing adequately?
RD: We have dozens of reading rooms in our multi-hospital health system, and do not have a formal system-wide policy. Anecdotally, though, there are a number of “neat freak champions” like me who have worked with our reading room coordinators to help gradually increase radiologist awareness. At the hospital where I most frequently work, I must admit that a few radiologists initially laughed at me when I went through my one-minute workstation wipe-down ritual on my clinical days. Now, at that site, it’s become pretty routine for many of my colleagues.
AR: What are your hopes for future research in this area?
RD: Doing this type of work on a multi-institutional basis—looking at microbial pathogenicity in a more sophisticated manner, as well as looking at downstream measures of success, such as radiologist sick days or the like—would be immensely resource intensive. [But] it was gratifying to learn of the Ottawa Hospital’s quality improvement project and the impact it had on modifying the culture in the radiology department there. Perhaps our collective efforts will stimulate additional research at teaching hospitals. Minimizing the risk of infection in hospital environments is of paramount importance. Radiologists and administrators need to be aware that disinfection needs to extend beyond just imaging suites and into the reading rooms. The more that is published the better!
Radiology workstation cleanliness: A conversation with Dr. Richard Duszak, Jr.. Appl Radiol.
Cynthia E. Keen is a freelance writer based in Sanibel Island, Florida.