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

Smith, S.J. and Young, V. and Robertson, Christopher and Dancer, S.J. (2012) Where do hands go? An audit of sequential hand-touch events on a hospital ward. Journal of Hospital Infection, 80 (3). pp. 206-2011. ISSN 0195-6701

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Abstract

Reservoirs of pathogens could establish themselves at forgotten sites on a ward, posing a continued risk for transmission to patients via unwashed hands. To track potential spread of organisms between surfaces and patients, and to gaina greater understanding into transmission pathways of pathogens during patient care. 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. 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): 35.6e58.8] than during 20 winter periods (7%; 95% CI: 3.2e14.4; 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: 0.94e16.0); P ¼ 0.059] and sites beside the patient (OR: 6.76; 95% CI: 1.40e65.77; P ¼ 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. Hand-hygiene compliance remains poor during covert observation; understanding the most frequent interactions between hands and surfaces could target sites for cleaning.