Researchers Define 'High-Touch' Surfaces in Hospitals

A team of researchers from the Department of Hospital Epidemiology at UNC Health Care and the Division of Infectious Diseases at the University of North Carolina, Chapel Hill, has tried to better determine what constitutes high-touch surfaces in hospitals related to contaminated environmental surfaces; their research was published in the August 2010 issue of Infection Control and Hospital Epidemiology.

The researchers acknowledge the emphasis that has been placed on the role that inanimate objects in the immediate vicinity of a patient play in the transmission of nosocomial pathogens. They point to the recommendations made by the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Centers for Disease Control and Prevention (CDC) to clean and disinfect high touch surfaces more frequently than minimal touch surfaces; however, they say that no one has quantitatively assessed the frequency of healthcare worker contact with different room surfaces.   

Kirk Huslage, RN, BSN, MSPH; William A. Rutala, PhD, MPH; Emily Sickbert Bennett, PhD; and David J. Weber, MD, MPH observed 50 interactions between healthcare workers and patients in five intensive care units (ICUs) and on seven medical/surgical floors at the University of North Carolina hospitals in Chapel Hill, N.C. to determine the definition of hightouch surfaces based on frequency of contact. Five surfaces were defined as hightouch surfaces: bed rails, bed surface, supply cart, overbed table and intravenous pump. The study was conducted over an 18month period from 2008 to 2009. 

Huslage, et al. (2010) reports that an effort was made to include an equal amount of rooms with and without contact precautions within each type of setting. The average number of contacts per surface per interaction was observed to determine hightouch, mediumtouch, and lowtouch surfaces on the basis of the average frequency of contact for each type of setting. The researchers report that 1,490 surface contacts were recorded during the observation period, with ICUs accounting for 1,109 (74.4 percent) surface contacts and the medical/surgical floors accounting for 381 (25.6 percent) surfaces. High-touch surfaces in the ICU were the bed rail, the bed surface, and the supply cart, defined as sustaining more than three contacts per interaction, and these three surfaces accounted for 40.2 percent of the contacts recorded in the ICUs. High-touch surfaces on the medical/surgical floors were the bed rail, the overbed table, the intravenous pump, and the bed surface, defined as sustaining more than one contact per interaction; these four surfaces accounted for 48.6 percent of the contacts recorded. The researchers report that there were 11 medium-touch surfaces and 14 low-touch surfaces in the ICUs, and seven medium-touch surfaces and 13 low-touch surfaces on the medical/surgical floors. 

Huslage, et al. (2010) concludes, Our data demonstrated that, in the ICU and on the medical/surgical floor, hightouch and mediumtouch surfaces were in the immediate vicinity of the patient. This finding becomes a primary concern when considering how to target room disinfection practices. Ideally, all surfaces should be disinfected regardless of the frequency of contact, but fewer than 50 percent of surfaces are cleaned during a terminal cleaning. Hospital protocols for room cleaning and disinfection should focus on environmental service personnel training, use of checklists, and/or monitoring of those surfaces that have the highest frequency of contact with healthcare workers hands, to minimize the potential for hand contamination, as well as direct transmission to patients. Thus, in the ICU, it is critical that bed rails, bed surfaces, and supply carts be adequately cleaned and disinfected. Furthermore, studies of the effectiveness of room disinfection should focus on evaluating disinfection of these surfaces. Room decontamination protocols used in hospitals should take into account both our data on the frequency with which healthcare workers touch certain surfaces and data on the concentration and type of microbial pathogens found on specific environmental surfaces. Although it is desirable that all environmental surfaces be routinely disinfected, other surfaces that are likely not heavily contaminated or frequently touched, such as thermostats, may not warrant as much concern. However, at terminal cleaning, all environmental surfaces should be disinfected.

Reference: Huslage K, Rutala WA, SickbertBennett E and Weber DJ. A Quantitative Approach to Defining High-Touch Surfaces in Hospitals. Infect Control Hosp Epidemiol 2010;31:850-853.