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

Abstract

Background Respiratory viruses on fomites can be transferred to sites susceptible to infection via contact by hands or other fomites. Methods Care for hospitalized patients with viral respiratory infections was observed in the patient room for 3-hour periods at an acute care academic medical center for over a 2 year period. One trained observer recorded the healthcare activities performed, contacts with fomites, and self-contacts made by healthcare workers (HCWs), while another observer recorded fomite contacts of patients during the encounter using predefined checklists. Results The surface contacted by HCWs during the majority of visits was the patient (90%). Environmental surfaces contacted by HCWs frequently during healthcare activities included the tray table (48%), bed surface (41%), bed rail (41%), computer station (37%), and intravenous pole (32%). HCWs touched their own torso and mask in 32% and 29% of the visits, respectively. HCWs’ self-contacts differed significantly among HCW job roles, with providers and respiratory therapists contacting themselves significantly more times than nurses and nurse technicians (P < .05). When HCWs performed only 1 care activity, there were significant differences in the number of patient contacts and self-contacts that HCWs made during performance of multiple care activities (P < .05). Conclusions HCWs regularly contact environmental surfaces, patients, and themselves while providing care to patients with infectious diseases, varying among care activities and HCW job roles. These contacts may facilitate the transmission of infection to HCWs and susceptible patients.

Respiratory viruses in the patient environment

“…However, >5 visits by HCWs during the 3-hour observation period was associated with virus detection in stationary air samples (OR, 5.3; 95% CI, 1.2-37.8), though most observed care activities were physical exam and other routine care activities. 9 Numerous HCW visits may indicate that the patient is relatively ill and, thus, shedding a lot of virus in the environment, but the association of numerous HCW visits with airborne virus could also reflect the fact that routine care activities introduce virus into the air.…”

“…Patient and HCW participant recruitment and consent have been described elsewhere. 9 This study was approved by the University of Illinois at Chicago Institutional Review Board (protocol no. 2015-0990).…”

“…In total, 11 patients were in intensive care units (ICUs); 18 were in the clinical decision unit; 9 were in specialty units; and 14 were in other general medical surgical units or non-ICUs. 9 Patients were grouped by infection: (1) influenza, including influenza A (n = 23) and influenza B (n = 8); (2) rhinovirus (n = 15); and (3) other (1 parainfluenza, 1 coronavirus, 3 respiratory syncytial virus, and 1 adenovirus). This grouping was selected because the viruses have characteristic environmental persistence.…”

Respiratory viruses on personal protective equipment and bodies of healthcare workers

“…Self-contacts were observed during the patient care episode and were defined as the HCW touching his or her own mask (if used), head area other than mask, torso, hand or glove, lower body, and/or personal stethoscope (if used). 10 Swabs were stored on ice until transport to the DNA Services Laboratory, where they were analyzed for the virus with which the patient had a diagnosed infection. The sample processing and analysis methodology has been reported elsewhere.…”

“…Data that were recorded on paper forms, which are available in another publication, 10 were entered in a database using double data entry (Access, Microsoft, Redmond, WA). All data analyses were performed with the R project for Statistical Computing (The R Foundation for Statistical Computing, Vienna, Austria).…”