Interaction of healthcare worker hands and portable medical equipment: a sequence analysis to show potential transmission opportunities

Abstract

BackgroundWhile research has demonstrated the importance of a clean health care environment, there is a lack of research on the role portable medical equipment (PME) play in the transmission cycle of healthcare-acquired infections (HAIs). This study investigated the patterns and sequence of contact events among health care workers, patients, surfaces, and medical equipment in a hospital environment.MethodsResearch staff observed patient care events over six different 24 h periods on six different hospital units. Each encounter was recorded as a sequence of events and analyzed using sequence analysis and visually represented by network plots. In addition, a point prevalence microbial sample was taken from the computer on wheels (COW).ResultsThe most touched items during patient care was the individual patient (850), bedrail (375), bed-surface (302), and bed side Table (223). Three of the top ten most common subsequences included touching PME and the patient: computer on wheels ➔ patient (62 of 274 total sequences, 22.6%, contained this sequence), patient ➔ COW (20.4%), and patient ➔ IV pump (16.1%). The network plots revealed large interconnectedness among objects in the room, the patient, PME, and the healthcare worker.ConclusionsOur results demonstrated that PME such as COW and IV pump were two of the most highly-touched items during patient care. Even with proper hand sanitization and personal protective equipment, this sequence analysis reveals the potential for contamination from the patient and environment, to a vector such as portable medical equipment, and ultimately to another patient in the hospital.Electronic supplementary materialThe online version of this article (10.1186/s12879-017-2895-6) contains supplementary material, which is available to authorized users.

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

“…We found that the patient was the most commonly touched surface, contacted in 91% of the visits, which is consistent with the work of others [8,9,12,13]. Bed surfaces, bed rail, IV pole, computer station, and tray table were among the most highly touched fomites by both HCWs and patients in this study, which is consistent with the work of others [8,9]. The median contact rate on all fomites by HCWs was 37.8 contacts per hour, which is lower than the 93.1 contacts per hour reported by Cheng et al [9].…”

“…Overall, these data indicate that HCWs contact surfaces similarly when providing routine care to patients with viral respiratory infections and other infectious diseases. We found that the patient was the most commonly touched surface, contacted in 91% of the visits, which is consistent with the work of others [8,9,12,13]. Bed surfaces, bed rail, IV pole, computer station, and tray table were among the most highly touched fomites by both HCWs and patients in this study, which is consistent with the work of others [8,9].…”

“…At the hospital in which this study was conducted, the policy is that reusable medical equipment is disinfected between patients, but cleaning behaviors and efficacy was not observed in this study. Jinadatha et al [8] Non Self-contact could transfer infectious pathogens from HCWs' gloved or bare hands to their PPE, clothing, and skin. To our knowledge, self-contact patterns of HCWs during patient encounters have not been previously explored.…”

“…Environmental surfaces in the hospital have been found to be contaminated with influenza viruses and SARS-CoV, including the hospital bed, bedside table, and television remote control [5][6][7]. Previous work found that patient bodies, bed surfaces, and bedside tables were among the most frequently touched surfaces by HCWs and patients [8,9]. Thus, contact with these surfaces may put HCWs at risk of infection or of transmitting the pathogens to other susceptible patients and workers.…”

Pulsed xenon ultraviolet and non-thermal atmospheric plasma treatments are effective for the disinfection of air in hospital blood sampling rooms

“…The effect of manual cleaning is variable and cleaning is often incomplete even after an intervention to improve cleaning methods [5]. Medical devices used by multiple patients are often inadequately cleaned by manual measures [6]. Therefore automated cleaning systems, such as pulsed xenon ultraviolet (PX-UV), are innovations designed to disinfect hospital environments of different settings, such as wards [7][8][9][10][11], burns units [12], milk feed preparation rooms [13], operation rooms [14,15], surgical sites [16,17], nursing homes [18], long-term acute care facilities [19], isolation rooms [20], and community hospitals [21,22].…”