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Background: Recent studies suggest that contaminated environmental surfaces may be an important source of contamination of healthcare workers' hands with healthcare-associated pathogens.
Objective: To examine the frequency of contact with environmental surfaces in patients' rooms by healthcare workers, and to test the hypothesis that compliance with hand hygiene is significantly lower after contact with environmental surfaces without direct patient contact versus after contact with patients.
Methods: We performed a 1-month prospective observational study of hand hygiene compliance by healthcare workers in a VA hospital. The frequencies of contact with patients, patients and environmental surfaces, or surfaces only were determined. Rates of compliance with hand hygiene were compared for interactions involving contact with patients with or without concurrent contact with environmental surfaces versus contact with surfaces only.
Results: Of 168 observations, 72 (43%) involved direct contact with patients, 36 (21%) with the patient and the environment, and 60 (36%) with the environment only. The most commonly touched surfaces were the bed rail and bedside table. Rates of hand hygiene were significantly lower after contact with environmental surfaces only versus after contact with patients with no environmental contact (P =0.03) (Figure). There was no significant difference in the rates of compliance for physicians, nurses, and other providers.
Conclusions: Healthcare workers contacted environmental surfaces during more than half of patient interactions. Compliance with hand hygiene was significantly lower after contact with environmental sites with no direct patient interaction than after contact with patients with no environmental contact. There is a need for education of healthcare workers about the importance of contaminated environmental surfaces as a source for transmission of pathogens.
