title: Examining the association between surface bioburden and frequently touched sites in intensive care.
abstract: BACKGROUND
  Critical care patients are at increased risk of infection. Near-patient surfaces act as reservoirs of microbial soil, which may contain pathogens.
  
  
  OBJECTIVE
  To correlate soil levels with hand-touch frequency of near-patient sites in an intensive care unit (ICU).
  
  
  METHODS
  Five sites around each bed in a 10-bed ICU were screened for total microbial soil (cfu/cm2) and Staphylococcus aureus every month for 10 months. Selected sites were infusion pump and cardiac monitor, left and right bedrails, and bed table. Ten 1 h covert audits of hand-touch frequency of these sites were performed in order to provide an average hand-touch count, which was modelled against soil levels obtained from microbiological screening.
  
  
  RESULTS
  Seven of 10 staphylococci were found in conjunction with gross contamination of a specific site (P=0.005) and the same proportion from three most frequently touched sites (bedrails and bed table). There was a linear association between four sites demonstrating gross microbial contamination (>12 cfu/cm2) and mean number of hand-touch counts (P=0.08). The bed table was handled most but was not the most contaminated site. We suspected that customary placement of alcohol gel containers on bed tables may have reduced microbiological yield. Removing the gel container from one table confirmed its inhibitory effect on microbial contamination after rescreening (19% vs 50% >12 cfu/cm2: P=0.007).
  
  
  CONCLUSIONS
  Surface bioburden at near-patient sites in ICU is associated with hand-contact frequencies by staff and visitors. This supports the need for targeted hygienic cleaning in a high-risk healthcare environment.
authors.affiliation: Department of Anaesthesia, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK.
authors.forename: C E
authors.initials: CE
authors.lastname: Adams
authors.affiliation: Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK.
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.affiliation: Department of Anaesthesia, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK.
authors.forename: V
authors.initials: V
authors.lastname: Watson
authors.affiliation: Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK; Health Protection Scotland, Glasgow, UK; International Prevention Research Institute, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Robertson
authors.affiliation: Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK; School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK. Electronic address: stephanie.dancer@lanarkshire.scot.nhs.uk.
authors.forename: S J
authors.initials: SJ
authors.lastname: Dancer
mesh_terms: D001419:Bacteria / Q000302:isolation & purification*; D015169:Colony Count, Microbial; D003422:Critical Care; D004783:Environmental Microbiology; D006801:Humans; D010865:Pilot Projects; D013499:Surface Properties
keywords: Hand-touch sites; Healthcare environment; Hospital cleaning; Intensive care unit; Microbial reservoirs