Hand-touch contact assessment of high-touch and mutual-touch surfaces among healthcare workers, patients, and visitors

J Hosp Infect. 2015 Jul;90(3):220-5. doi: 10.1016/j.jhin.2014.12.024. Epub 2015 Mar 7.


Background: Unlike direct contact with patients' body, hand hygiene practice is often neglected by healthcare workers (HCWs) and visitors after contact with patients' environment. Contact with hospital environmental items may increase risk of pathogen transmission.

Aim: To enumerate the number of hand-touch contacts by patients, HCWs and visitors with any hospital environmental items.

Methods: All contact-episodes between person and item were recorded by direct observation in a six-bed cubicle of acute wards for 33 working days. High-touch and mutual-touch items with high contact frequencies by HCWs, patients, and visitors were analysed.

Findings: In total, 1107 person-episodes with 6144 contact-episodes were observed in 66 observation hours (average: 16.8 person-episodes and 93.1 contact-episodes per hour). Eight of the top 10 high-touch items, including bedside rails, bedside tables, patients' bodies, patients' files, linen, bed curtains, bed frames, and lockers were mutually touched by HCWs, patients, and visitors. Bedside rails topped the list with 13.6 contact-episodes per hour (mean), followed by bedside tables (12.3 contact-episodes per hour). Using patients' body contacts as a reference, it was found that medical staff and nursing staff contacted bedside tables [rate ratio (RR): 1.741, 1.427, respectively] and patients' files (RR: 1.358, 1.324, respectively) more than patients' bodies, and nursing staff also contacted bedside rails (RR: 1.490) more than patients' bodies.

Conclusion: Patients' surroundings may be links in the transmission of nosocomial infections because many are frequently touched and mutually contacted by HCWs, patients, and visitors. Therefore, the focus of hand hygiene education, environmental disinfection, and other system changes should be enhanced with respect to high-touch and mutual-touch items.

Keywords: Disinfection; Environment; Hand hygiene; High-touch; Mutual-touch.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross Infection / epidemiology
  • Cross Infection / microbiology*
  • Cross Infection / prevention & control
  • Cross Infection / transmission*
  • Hand Disinfection / methods*
  • Hand Hygiene / standards*
  • Health Facility Environment / standards
  • Hospitals
  • Humans
  • Infection Control / methods
  • Infectious Disease Transmission, Professional-to-Patient / prevention & control
  • Infectious Disease Transmission, Professional-to-Patient / statistics & numerical data
  • Intensive Care Units / standards
  • Nursing Staff / education
  • Personnel, Hospital / education*
  • Poisson Distribution
  • Skin / microbiology*
  • Touch / physiology*
  • Visitors to Patients / education*