Environmental Contact and Self-contact Patterns of Healthcare Workers: Implications for Infection Prevention and Control

Clin Infect Dis. 2019 Sep 13;69(Suppl 3):S178-S184. doi: 10.1093/cid/ciz558.


Background: Respiratory viruses on fomites can be transferred to sites susceptible to infection via contact by hands or other fomites.

Methods: Care for hospitalized patients with viral respiratory infections was observed in the patient room for 3-hour periods at an acute care academic medical center for over a 2 year period. One trained observer recorded the healthcare activities performed, contacts with fomites, and self-contacts made by healthcare workers (HCWs), while another observer recorded fomite contacts of patients during the encounter using predefined checklists.

Results: The surface contacted by HCWs during the majority of visits was the patient (90%). Environmental surfaces contacted by HCWs frequently during healthcare activities included the tray table (48%), bed surface (41%), bed rail (41%), computer station (37%), and intravenous pole (32%). HCWs touched their own torso and mask in 32% and 29% of the visits, respectively. HCWs' self-contacts differed significantly among HCW job roles, with providers and respiratory therapists contacting themselves significantly more times than nurses and nurse technicians (P < .05). When HCWs performed only 1 care activity, there were significant differences in the number of patient contacts and self-contacts that HCWs made during performance of multiple care activities (P < .05).

Conclusions: HCWs regularly contact environmental surfaces, patients, and themselves while providing care to patients with infectious diseases, varying among care activities and HCW job roles. These contacts may facilitate the transmission of infection to HCWs and susceptible patients.

Keywords: contact transmission; fomites; infection control; respiratory infections; self-contact.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cross Infection / prevention & control
  • Cross Infection / virology
  • Fomites / virology*
  • Hand / virology
  • Health Facility Environment*
  • Health Personnel*
  • Hospitals / statistics & numerical data
  • Humans
  • Infection Control / methods*
  • Intensive Care Units / statistics & numerical data
  • Patient Isolation
  • Patients
  • Patients' Rooms / statistics & numerical data
  • Respiratory Tract Infections / prevention & control*
  • Respiratory Tract Infections / transmission*
  • Respiratory Tract Infections / virology