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

J Hosp Infect. 2012 Mar;80(3):206-11. doi: 10.1016/j.jhin.2011.12.007. Epub 2012 Jan 30.


Background: Reservoirs of pathogens could establish themselves at forgotten sites on a ward, posing a continued risk for transmission to patients via unwashed hands.

Aim: To track potential spread of organisms between surfaces and patients, and to gain a greater understanding into transmission pathways of pathogens during patient care.

Methods: Hand-touch activities were audited covertly for 40 × 30 min sessions during summer and winter, and included hand hygiene on entry; contact with near-patient sites; patient contact; contact with clinical equipment; hand hygiene on exit; and contact with sites outside the room.

Findings: There were 104 entries overall: 77 clinical staff (59 nurses; 18 doctors), 21 domestic staff, one pharmacist and five relatives. Hand-hygiene compliance among clinical staff before and after entry was 25% (38/154), with higher compliance during 20 summer periods [47%; 95% confidence interval (CI): 35.6-58.8] than during 20 winter periods (7%; 95% CI: 3.2-14.4; P < 0.0001). More than half of the staff (58%; 45/77) touched the patient. Staff were more likely to clean their hands prior to contact with a patient [odds ratio (OR): 3.44; 95% CI: 0.94-16.0); P = 0.059] and sites beside the patient (OR: 6.76; 95% CI: 1.40-65.77; P = 0.0067). Nearly half (48%; 37/77) handled patient notes and 25% touched the bed. Most frequently handled equipment inside the room were intravenous drip (30%) and blood pressure stand (13%), and computer (26%), notes trolley (23%) and telephone (21%) outside the room.

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

MeSH terms

  • Cross Infection / prevention & control
  • Cross Infection / transmission
  • Guideline Adherence
  • Hand Disinfection / methods
  • Hand Disinfection / standards*
  • Hand* / microbiology
  • Humans
  • Hygiene / standards
  • Infectious Disease Transmission, Professional-to-Patient*
  • Medical Audit*
  • Patients' Rooms*
  • Personnel, Hospital*
  • Touch