Little Touches Do Mean So Much

Healthcare workers generally underestimate the role of environmental surfaces in the transmission of infection, and compliance with hand hygiene following contact with the environment is generally lower than following direct patient contact. To reduce the risk of onward transmission, healthcare workers must identify the need to wash hands with specific tasks or events. Studies have demonstrated that whereas the majority of hand-hygiene opportunities occur after contact with a patient’s surroundings, these opportunities are also those most commonly missed (i.e. are associated with the lowest levels of compliance).

The aim of this investigation was to observe the movement of staff in critical care and general wards and, with a view to focus hand-hygiene training, to determine the routes most commonly traveled and the surfaces most frequently touched together with associated hand-hygiene compliance. The results of this study demonstrate how the movement patterns of staff differ in critical care and general wards. In the ICU, the one-nurse-per-bed policy reduced staff movement between bed spaces. In the gastrointestinal ward, movement from patient to patient or from bed to bed was more frequent.

In critical care, the majority of movement occurred within the bed space. The bedside computer and equipment trolley were the surfaces most commonly touched, often immediately after patient contact. In the general ward, movement between bed spaces was more common and observed hand hygiene ranged from 25% to 33%. Regardless of ward type, observed hand-hygiene compliance when touching the patient immediately on entering an isolation room was less than 30%.

Healthcare workers must be made aware that bacterial spread can occur even during activities of perceived low risk. Education and intervention programs should focus on the potential contamination of ward computers, case notes and door handles.