Where do hands go? An audit of sequential hand-touch events on a hospital ward.
BACKGROUND
Reservoirs of pathogens could establish themselves at forgotten sites on a ward, posing a continued risk for transmission to patients via unwashed hands.


OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
Hand-hygiene compliance remains poor during covert observation; understanding the most frequent interactions between hands and surfaces could target sites for cleaning.
Department of Surgery, Hairmyres Hospital, Lanarkshire, UK.
S J
SJ
Smith
V
V
Young
C
C
Robertson
S J
SJ
Dancer
D003428:Cross Infection / Q000517:prevention & control / Q000635:transmission; D019983:Guideline Adherence; D006225:Hand / Q000382:microbiology; D006235:Hand Disinfection / Q000379:methods / Q000592:standards*; D006801:Humans; D006920:Hygiene / Q000592:standards; D017757:Infectious Disease Transmission, Professional-to-Patient; D008485:Medical Audit; D010362:Patients' Rooms; D010564:Personnel, Hospital; D014110:Touch