The art and importance of device and area sterilization in the wake of COVID-19

Chris Hafner, Brewster Academy
James Rafel, Geisinger

While most of us appreciate, maybe even enjoy, cleanliness, these days the art of being clean has a bigger impact than ever before. It can literally mean the difference between life and death. That’s why at Brewster Academy and Geisinger, we’re taking extra steps to ensure our sanitary conditions for our students and patients. And while we recognize the task of maintaining a germ-free environment is nearly impossible, we’re hoping the processes we put in place will help others reach a comfortable sense of cleanliness in their own environments.

At Brewster Academy, we implemented shipping and receiving guidelines that allow us to ship, receive and distribute packages without human contact.

Steps to set up a safe shipping and receiving area:

1. All deliveries are brought to a designated drop-off area.
2. Shipping personnel, equipped with proper personal protective equipment (PPE), communicate and receive any necessary signatures from delivery drivers through a receiving window.
3. Shipping personnel, still in PPE, logs and sorts the packages.
4. Shipping personnel sends emails to those with packages.
5. Packages are claimed at a separate walk-up window.

As for items destined for IT, (think of new equipment, repairs, etc.) we separate them and shift them to a designated pickup/drop-off area near the IT offices. Those who drop off the boxes also pick up outgoing packages from the same location. At this time, they also clean and sanitize the help desk area.

Steps to prepare a general repair area:

1. Set pickup and drop-off locations away from the repair or primary receiving area. This should be a location where units, both incoming and outgoing, can be transferred without human contact. For example, we pick up from the mailroom and deliver items to a designated “receiving” area by the IT help desk. Outgoing units are in the same location.
2. Set up a disinfection station. This should be a space, surface that separates incoming and outgoing boxes. Also make sure the surface can be repeatedly cleaned with disinfectants.
   1. Set up your repair area with tools needed for repair ahead of time.
   2. Wipe tools in 70% Isopropyl Alcohol, or other approved disinfectant, before and after each repair. Approved disinfectants: (70% Isopropyl Alcohol recommended), Hand Sanitizer, and boxes of non-latex gloves. Clorox or Lysol disinfectant wipes are also permitted, where applicable. (We currently use “State Ecosolution Hospital Disinfectant instead of Isopropyl Alcohol for benches, but not for computers.)
3. Employees wear approved masks at all times. This is both in and outside of all buildings, not just during the repair.

And of course the steps to make the repair are equally important as the setup. Here’s what we do to ensure everything is disinfected appropriately.

Steps to ensure a proper repair procedure:

1. Wash hands thoroughly prior to entering the office. Do not touch surfaces or door pulls until wearing gloves.
2. Put on PPE (gloves and mask, if not already worn). Use approved hand sanitizer on gloves immediately.
3. Only one technician should be in any room at a time.
4. Retrieve one shipping container at a time from the designated drop-off/pickup location.
5. Open the shipping container at the designated disinfection station, and remove the computer and any additional items sent. Cases, accessories and other items not pertinent to the repair will be left in the shipping container after being disinfected.
6. Close the container. Wipe it down with disinfectant wipes or a disposable towelette with isopropyl alcohol.
7. Store the shipping container in a designated area. The shipping materials should not go beyond this area, into repair.
8. Disinfect the computer, and any necessary accessories, at the disinfection station. Use a soft, lint-free cloth with isopropyl alcohol or disinfectant wipe, to completely wipe down and clean the entire computer. Be careful not to use too much cleaner so as to get liquid inside the computer, but enough to visibly verify that the entire unit has been wiped.
9. Change gloves, or sanitize the gloves being worn, and bring the unit to the designated repair station.
10. Reapply hand sanitizer to gloves between touching the computer, and anything other than that computer or the tools, at the repair station.
11. After the repair is complete, or it is determined that the computer needs to be sent to elevated repair, return to the sanitization station. Use hand sanitizer on gloves again before returning to the disinfection station.
12. Disinfect the computer and accessories again as done previously.
13. Wipe computer down with a non-abrasive cleaner, such as Endust for Electronics. This will clear up any streaking caused by the using any disinfectant other than Isophrphyl Alcohol).
14. Repackage in shipping materials.
15. Wipe down shipping materials with disposable wipes or towelettes with Isopropyl Alcohol and or other approved disinfectant.
16. Label and return to pre-designated drop-off/pickup spot with any documentation for shipping.
17. Change gloves between each repair. One computer, one set of gloves — no exceptions.
18. Repeat until all repairs complete.

Once repairs are complete, we notify colleagues of the items to be shipped, providing detailed shipping information. If the item that’s being shipped is a piece of technology on loan, we also ship it with a pre-paid return label. Shipping personnel then retrieve the packages, and the repair office remains closed until more repairs are needed.

Maintaining sanitary technology standards in healthcare

Living in the healthcare world, I’m very familiar with the steps needed to create and maintain a sanitary environment. That’s why it’s great to see Brewster Academy put so much thought and calculated process around properly disinfecting their devices during the repair process. Their students rely on Apple devices to complete their work. Sometimes those devices break, so having a process like Chris outlined above is critically important to ensure everyone stays safe during this unprecedented time.

Similarly, more patients than ever rely on Apple devices in the hospital. At Geisinger, staff, patients and visitors use iPads in a wide variety of clinical and non-clinical settings. From communication devices (to stay connected with family or friends while an inpatient) to a distraction for a pediatric patient (while getting prepped for a procedure), our iPads have become tools for our patients and staff. That means they must be cleaned and sanitized just like any other medical device.

While infection prevention doesn’t fall specifically in IT’s job duties, we are keenly aware as we do project plans and implementations that infection prevention and sanitization are non-negotiable for devices that go into clinical areas. The other non-negotiable is the effort to minimize asking staff to do anything that could take away from their clinical duties.

These two non-negotiable requirements helped Geisinger set the standard five years ago for cases we are still using today for patient-facing iPads. The cases had to:

• Be cleanable with healthcare industry-standard cleaning/disinfecting solutions that are normally used by staff to clean other equipment (low staff impact).
• Withstand an array of abrasive chemicals and UV lights well beyond consumer-grade cleaners (infection prevention).
• Maintain integrity to prevent damage to the iPad screen or other components (usability).
• Be cost effective without compromising the above three requirements (ROI).

During the COVID-19 crisis, we’ve used the combination of these cases, and many of the infection prevention techniques Chris outlined above, in repurposing, reconfiguring and delivering hundreds of iPads to our staff and patients around our health system. Once they arrive and are handed out, the staff do one final cleaning before they are put into production. Echoing Chris’s thoughts, while nothing can completely guarantee cleanliness across all areas and devices, we can all do our best to reduce or prevent infections.