“First-person view” of pathogen transmission and hand hygiene – use of a new head-mounted video capture and coding tool

Abstract

BackgroundHealthcare workers’ hands are the foremost means of pathogen transmission in healthcare, but detailed hand trajectories have been insufficiently researched so far. We developed and applied a new method to systematically document hand-to-surface exposures (HSE) to delineate true hand transmission pathways in real-life healthcare settings.MethodsA head-mounted camera and commercial coding software were used to capture ten active care episodes by eight nurses and two physicians and code HSE type and duration using a hierarchical coding scheme. We identified HSE sequences of particular relevance to infectious risks for patients based on the WHO ‘Five Moments for Hand Hygiene’. The study took place in a trauma intensive care unit in a 900-bed university hospital in Switzerland.ResultsOverall, the ten videos totaled 296.5 min and featured eight nurses and two physicians. A total of 4222 HSE were identified (1 HSE every 4.2 s), which concerned bare (79%) and gloved (21%) hands. The HSE inside the patient zone (n = 1775; 42%) included mobile objects (33%), immobile surfaces (5%), and patient intact skin (4%), while HSE outside the patient zone (n = 1953; 46%) included HCW’s own body (10%), mobile objects (28%), and immobile surfaces (8%). A further 494 (12%) events involved patient critical sites. Sequential analysis revealed 291 HSE transitions from outside to inside patient zone, i.e. “colonization events”, and 217 from any surface to critical sites, i.e. “infection events”. Hand hygiene occurred 97 times, 14 (5% adherence) times at colonization events and three (1% adherence) times at infection events. On average, hand rubbing lasted 13 ± 9 s.ConclusionsThe abundance of HSE underscores the central role of hands in the spread of potential pathogens while hand hygiene occurred rarely at potential colonization and infection events. Our approach produced a valid video and coding instrument for in-depth analysis of hand trajectories during active patient care that may help to design more efficient prevention schemes.

Silica nanoparticles with encapsulated DNA (SPED) – a novel surrogate tracer for microbial transmission in healthcare

“…The scenario featured 13 experimentally pre-defined hand-to-surface exposures, of which 10 were fomites and 3 were patient skin. The sites were chosen according to our observational experience in healthcare settings as being habitual [8]. We marked swabbing areas of 1x3cm on each of the 13 sites.…”

“…Healthcare workers’ (HCW) hands play a key role in transmission of pathogens through bi-directional exchange of microbes between hands and surfaces, [ 4 , 5 ] especially considering that hand hygiene performance is commonly substandard in almost all healthcare settings despite widely accepted concepts and guidelines [ 6 , 7 ]. A recent head-camera-aided study uncovered that many more opportunities for microbe transmission might exist in acute healthcare than anticipated based on more traditional hand hygiene observation methods [ 8 – 10 ]. Tracing events leading to microbial transmission, however, is difficult, especially using living microorganisms.…”

Community-acquired in name only: A cluster of carbapenem-resistantAcinetobacter baumanniiin a burn intensive care unit and beyond

“…10,11 This investigation has revealed insights into the challenges facing healthcare facilities in ensuring that the built environment and PME are adequately cleaned and disinfected to reduce the risk of transmission. Given the frequency with which healthcare workers interact with the patient, the patient's environment, and PME, 12,13 as well as known failures in hand hygiene [14][15][16] and use of personal protective equipment, [17][18][19] there are many opportunities and potential pathways for transmission. The process for bed and mattress cleaning and disinfection is estimated to take an hour.…”

Silica nanoparticles with encapsulated DNA (SPED) – a novel surrogate tracer for microbial transmission in healthcare

“…The sites were chosen according to our observational experience in healthcare settings as being habitual. (8) We marked swabbing areas of 1x3cm on each of the 13 sites. The sites and both hands and ngers of the HCW were swabbed prior to every simulation to demonstrate they were free of SPED.…”

“…(6, 7) A recent headcamera-aided study uncovered that many more opportunities for microbe transmission might exist in acute healthcare than anticipated based on more traditional hand hygiene observation methods. (8)(9)(10) Tracing events leading to microbial transmission, however, is di cult, especially using living microorganisms. Surrogate tracers may therefore provide a safer and easier means to increase our understanding of transmission pathways.…”