Where do hands go? An audit of sequential hand-touch events on a hospital ward

Smith, S.; Young, Victoria Solveig; Robertson, Christopher; Dancer, S.J.

doi:10.1016/j.jhin.2011.12.007

Cited by 61 publications

(56 citation statements)

References 26 publications

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“…These items are likely to benefit from enhanced cleaning, including disinfection (123,129). High-touch sites or surfaces can be identified through direct observation or environmental screening using fluorescent or other markers (130).…”

Section: Critical Surfacesmentioning

confidence: 99%

“…Cleaning and disinfection should be focused on routine decontamination of high-risk surfaces, i.e., the sites more likely to harbor pathogens and thus facilitating transmission (43,237,239). Removing pathogens from handles, switches, buttons, knobs, and other frequently touched (and often forgotten) sites is more likely to have an impact on patient transmission than cleaning inaccessible surfaces such as high shelves, ledges, or ceilings or low-touch surfaces such as walls and window panes (130). Thoughtful construction of a specification to prioritize the highest-risk sites should also obviate the confusion over who cleans what and how often an item or surface should be cleaned (133,136,140,271).…”

Section: Current Unanswered Questionsmentioning

confidence: 99%

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Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

2014

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SUMMARY There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Gram-negative bacilli, norovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the value of physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence on the role of antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens.

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Section: Critical Surfacesmentioning

confidence: 99%

Section: Current Unanswered Questionsmentioning

confidence: 99%

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

2014

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“…At least five modes of infection transmission may occur at any given time within the hospital environment: direct contact [2], indirect contact [3], common vehicle [4], droplet [5] and pure airborne sub-micron particle transport [6]. For some infections like tuberculosis, which are exclusively transmitted through susceptible subjects inhaling the bacteria, the airborne route of transfer is relatively well documented [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

An Effective Surrogate Tracer Technique for S. aureus Bioaerosols in a Mechanically Ventilated Hospital Room Replica Using Dilute Aqueous Lithium Chloride

et al. 2017

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Finding a non-pathogenic surrogate aerosol that represents the deposition of typical bioaerosols in healthcare settings is beneficial from the perspective of hospital facility testing, general infection control and outbreak analysis. This study considers aerosolization of dilute aqueous lithium chloride (LiCl) and sodium chloride (NaCl) solutions as surrogate tracers capable of representing Staphylococcus aureus bioaerosol deposition on surfaces in mechanically ventilated rooms. Tests were conducted in a biological test chamber set up as a replica hospital single patient room. Petri dishes on surfaces were used to collect the Li, Na and S. aureus aerosols separately after release. Biological samples were analyzed using cultivation techniques on solid media, and flame atomic absorption spectroscopy was used to measure Li and Na atom concentrations. Spatial deposition distribution of Li tracer correlated well with S. aureus aerosols (96% of pairs within a 95% confidence interval). In the patient hospital room replica, results show that the most contaminated areas were on surfaces 2 m away from the source. This indicates that the room's airflow patterns play a significant role in bioaerosol transport. NaCl proved not to be sensitive to spatial deposition patterns. LiCl as a surrogate tracer for bioaerosol deposition was most reliable as it was robust to outliers, sensitive to spatial heterogeneity and found to require less replicates than the S. aureus counterpart to be in good spatial agreement with biological results.

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“…[7][8][9][10] Several studies have reported high rates of fecal coliforms on child care provider hands, suggesting the need to study hand contact events in child care facilities. [11][12][13] Audits of the frequency of hand contact events have been performed in health care settings, 14,15 but no published study has quantified child care provider hand contacts. The purpose of this study was to determine the frequency surfaces were touched by child care providers to identify surfaces that should be cleaned and sanitized.…”

mentioning

confidence: 99%

An observational study of frequency of provider hand contacts in child care facilities in North Carolina and South Carolina

Fraser

Wohlgenant

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et al. 2015

American Journal of Infection Control

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Where do hands go? An audit of sequential hand-touch events on a hospital ward

Abstract: Hand-hygiene compliance remains poor during covert observation; understanding the most frequent interactions between hands and surfaces could target sites for cleaning.

Cited by 61 publications

References 26 publications

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

An Effective Surrogate Tracer Technique for S. aureus Bioaerosols in a Mechanically Ventilated Hospital Room Replica Using Dilute Aqueous Lithium Chloride

An observational study of frequency of provider hand contacts in child care facilities in North Carolina and South Carolina

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