Hospital Door Handle Design and Their Contamination with Bacteria: A Real Life Observational Study. Are We Pulling against Closed Doors?

Wojgani, Hedieh; Kehsa, Catherine; Cloutman-Green, Elaine; Gray, Colin; Gant, Vanya; Klein, Nigel

doi:10.1371/journal.pone.0040171

Cited by 31 publications

(26 citation statements)

References 14 publications

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“…One recent observational study examined the number of viable bacteria found on hospital door handles of different designs in certain high traffic areas in a tertiary referral hospital in the UK. The authors found that the door handle's location, design and mode of use were all factors that affected their degree of contamination, with the traditional lever-style handles being the most highly contaminated [25].…”

Section: Discussionmentioning

confidence: 99%

Different Types of Door-Opening Motions as Contributing Factors to Containment Failures in Hospital Isolation Rooms

et al. 2013

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Hospital isolation rooms are vital for the containment (when under negative pressure) of patients with, or the protection (when under positive pressure) of patients, from airborne infectious agents. Such facilities were essential for the management of highly contagious patients during the 2003 severe acute respiratory syndrome (SARS) outbreaks and the more recent 2009 A/H1N1 influenza pandemic. Many different types of door designs are used in the construction of such isolation rooms, which may be related to the space available and affordability. Using colored food dye as a tracer, the qualitative effects of door-opening motions on the dissemination of potentially contaminated air into and out of a single isolation room were visualized and filmed using Reynolds-number-equivalent, small-scale, water-tank models fitted with programmable door-opening and moving human figure motions. Careful scaling considerations involved in the design and construction of these water-tank models enabled these results to be accurately extrapolated to the full-scale situation. Four simple types of door design were tested: variable speed single and double, sliding and hinged doors, in combination with the moving human figure. The resulting video footage was edited, synchronized and presented in a series of split-screen formats. From these experiments, it is clear that double-hinged doors pose the greatest risk of leakage into or out of the room, followed by (in order of decreasing risk) single-hinged, double-sliding and single-sliding doors. The relative effect of the moving human figure on spreading any potential contamination was greatest with the sliding doors, as the bulk airflows induced were large relative to those resulting from these door-opening motions. However, with the hinged doors, the airflows induced by these door-opening motions were significantly greater. Further experiments involving a simulated ventilated environment are required, but from these findings alone, it appears that sliding-doors are far more effective for hospital isolation room containment.

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Section: Discussionmentioning

confidence: 99%

Different Types of Door-Opening Motions as Contributing Factors to Containment Failures in Hospital Isolation Rooms

et al. 2013

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“…126 On average, a fall cost the NHS £73.33. 128 These claims cost over £3M in compensation. However, it is difficult to estimate the cost of a single claim after a fall (unitary claim).…”

Section: The Costs Associated With Fallsmentioning

confidence: 99%

“…This supports Dowdeswell et al, 8 who suggest that good infection control practices, such as access to hand washing facilities and hand hygiene, are more important factors in reducing HCAI rates than single rooms per se (cf. Wojgani et al 128 ), although compliance may be facilitated by careful design and location in a single room, along with toilets that are not shared between patients. Certainly the evidence here cannot be interpreted as providing generalisable evidence that single rooms play no part in the control of infection.…”

Section: Introductionmentioning

confidence: 99%

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Maben

Griffiths

Penfold

et al. 2015

Health Services and Delivery Research

177

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BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…The latter was most probably due to variation in cleaning practices and the frequency of touching; higher bacterial loads have been found with frequent use of, for example, door handles (Wojgani et al . ). Copper surfaces instead showed similar low <12 CFU cm −2 average bacterial counts in all facilities excluding office toilet flush buttons and retirement home floor drain lids (Table ).…”

Section: Resultsmentioning

confidence: 97%

“…However, increased bacterial counts >73 CFU cm À2 and high variability existed on reference toilet flush buttons in office and hospital, which was particularly evident for the retirement home door handle references ( Table 2). The latter was most probably due to variation in cleaning practices and the frequency of touching; higher bacterial loads have been found with frequent use of, for example, door handles (Wojgani et al 2012). Copper surfaces instead showed similar low <12 CFU cm À2 average bacterial counts in all facilities excluding office toilet flush buttons and retirement home floor drain lids ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

Copper as an antibacterial material in different facilities

Inkinen

Mäkinen

Keinänen‐Toivola

et al. 2016

Lett Appl Microbiol

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The efficiency of copper as an antimicrobial material has been noted in laboratory studies and in the hospital environment. The present study further shows that copper exerted an antibacterial effect in different facilities, i.e. in a hospital, a kindergarten, an office building and in a retirement home for the elderly. The study suggests that copper has potential use as an antibacterial material and therefore might serve as a means to lower the incidence of transmission of infectious agents from inanimate surfaces in different facilities, with everyday functions.

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Hospital Door Handle Design and Their Contamination with Bacteria: A Real Life Observational Study. Are We Pulling against Closed Doors?

Cited by 31 publications

References 14 publications

Different Types of Door-Opening Motions as Contributing Factors to Containment Failures in Hospital Isolation Rooms

Different Types of Door-Opening Motions as Contributing Factors to Containment Failures in Hospital Isolation Rooms

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Copper as an antibacterial material in different facilities

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