Open Forum

Our clinic just recently adopted the 'no paper' as well. Initially met quite a bit of hesitation but after a few weeks it's no big deal. We still have paper in case a family asks. It honestly also highlighted the fact that, perhaps, we weren't cleaning as well as we could have in between patients. We've never (recently) used paper for measurements since a lot of our patients are being seen for short stature or skeletal dysplasia. We have infant length boards in both weight/measure rooms.

We are a pediatric clinic that houses Endo, and Rhem. ID, Immuno, and Plastics rotate through.

I would be interested to hear if not using exam paper is a growing practice in the nation. Can persons chime in if they are doing this also?

This is a great discussion and really speaks to the "sacred cows" we adopt in healthcare. There is no evidence to support the use of paper from an infection prevention perspective. It is purely a visual esthetic for the patient. Good Low Level Disinfection between patients and a simple visual such as a "traffic" cone will let patients know the room is disinfected and ready for them. 

We stopped exam table paper years ago after a presentation about it at the AAACN conference. We made small triangular signs that said "Exam table cleaned" - in our top languages (the sign is also wiped down) that we place on the exam tables. We also had an ID physician champion on our improvement team to help us spread the message. At the time, we occasionally checked via glo germ powder/light to see how well cleaning. It's been very successful in most clinics. (A few we have to remind / reinforce - e.g OB/GYN) via rounding. We're now starting to implement monitoring of shared equipment cleaning, including exam tables, with ATP meters that measure bioburden - give us a score. Trying to spread success.

Kathy

Do you happen to know the year this was presented at the conference? I would love to see if the information is still available. Thank you,

My colleague reminded me it was a poster around 2018.

Kathy

I was very intrigued by this question as I hate to see the table paper and, as a patient, I always wondered what the benefit was.  I asked our IC nurse this question and she answered below.  We are discussing it further as some clinics have adopted it but we don't have a formal SOP for it and the table cleaning necessary. 

APIC Text Ambulatory Basic Principles: https://text.apic.org/toc/infection-prevention-for-practice-settings-and-service-specific-patient-care-areas/ambulatory-care#book_section_757. Click or tap if you trust this link." target="_blank" rel="noopener">https://text.apic.org/toc/infection-prevention-for-practice-settings-and-service-specific-patient-care-areas/ambulatory-care#book_section_757

1. "The examination tables should be covered with disposable paper or linen that is changed between patients. More thorough cleaning and disinfection should be done if contamination is visible."

Also, referring to the Spaulding Classification (see the table below) to think this through, if there is an open wound that will touch the table, we should also be using a barrier. Knowing there are specific infections or concerns for potential infections is also an indication to use a barrier while the patient is on the exam table.  I believe the whole reason for the table paper is to eliminate the risk of missing critical thinking to prevent any unknown transmission.

Final thought: We give you the option to test this out and weigh the risks and benefits on your own, but we wanted to make sure that you were fully equipped with the knowledge to use in the new process. I would recommend developing criteria and education on when to use an additional barrier to support the best outcome. I also would recommend working with your clinical staff to learn about potential barriers or failures that can occur when not using exam table paper.