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Door handles and particularly washroom door handles are a well-documented source of cross contamination.
It is a simple fact, not everybody washes their hands after using the toilet.
Indeed, studies have shown that washing and drying your hands in an improper manner, can be even more harmful than not washing them at all, resulting in door handles becoming contaminated more easily with microbes commonly associated with washrooms, which in turn creates a source of contamination for Clean Hands and Clean Hands, as we all know, are essential for maintaining good standards in any Healthcare Facility, for protecting the vulnerable and avoiding the socioeconomic impact of Hospital Acquired Infections.
It is therefore important to ensure that unavoidable commonly touched surfaces, such as door handles, are constantly sanitised, in order to help prevent the contamination of clean hands and support any strategy designed to limit avoidable pathogen transmission.
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The purpose of the trial is twofold:
A. To demonstrate the level of contamination, if any, on a number of commonly touched door handles in the hospital.
B. To demonstrate the efficacy of the Handliser System on contaminated door handles in a hospital.
To ensure we complied with best practice, for the purpose of this trial, it was agreed to engage the use of Nordia Hygicult TPC contact slides, a means recommended for such testing by Infection Control Specialist Dr. Stephanie Dancer, NHS. Lanarkshire, Scotland.
Twelve doors on two different levels in the hospital, the A&E Dept. and Men’s Ward 8, were selected for inclusion in the trial.
1. The inside handle of the entrance door to the isolation room in A&E
2. The inside handle of the toilet in the isolation room.
3. The inside handle of the Sluice room door in A&E
4. The outside handle of the Sluice room door in A&E
5. The inside handle of the Sluice room door in Ward 8.
6. The outside handle of the Sluice room door in Ward 8.
7. The outside handle (ward side) on the exit door to the toilet in 2nd Men’s ward.
8. The inside handle (toilet side) on the exit door to the toilet in 2nd Men’s ward.
9. The outside handle (ward side) on the exit door to the toilet in 1st Men’s ward.
10. The inside handle (toilet side) on the exit door to the toilet in 1st Men’s ward
11. The inside handle on the toilet door in isolation room ward 8.
12. The inside handle on the entrance door to the isolation room in ward 8.
Before commencing the trial, the system was introduced where possible to staff on the ground in both areas, so as to gain their support and to give them an understanding of what it was about and how it worked and to alleviate any concerns that can surround the introduction of any new product into the work place.
The system gained huge approval amongst staff and was spoken about positively throughout the course of the trial, demonstrating staff support for a system that can help reduce infections without interfering with normal day to day workflow.
Prior to the installation of the Handliser door units, all handles on the assigned doors were monitored for microbial contamination, using the Hygicult Contact Slides, to test the various parts of each handle, top, bottom, front and back.
All the handles were swabbed and the swabs subsequently incubated at 31-33° C for 48 hours to highlight microbial growth and provide a base line for comparison purposes. (Nov. 3rd H/H 1.)
The Handles were further tested on November 8th, 10th, 14th and 20th and all swabs again incubated for 48 hours.
Included in the swabbing on Nov. 10th (H/H.3) were two randomly selected high use handles, namely the Ladies and Gents toilet door handles in the main reception area.
Again, throughout the course of swabbing on Nov.14th (H/H.4) two more handles were randomly selected in a Staff toilet and Patient toilet for comparison purposes, so as to give an indication of the efficacy of the Handliser units.
Swabbing of the door handles was completed one week later on Nov. 20th (H/H.5) as the trial drew to a close.
Upon completion of the trial, the swabs were all grouped and documented along with all data collected and forwarded to Trinity College Dublin for analysis. The results are seen here with typical examples of swabs from each test.
The analytic report by Dr. Ronnie Russell of Trinity College Dublin in section 2 of this report, outlines how the handles, prior to installation of the Handle Hygiene units, harboured considerable contamination, with a range of Bacteria, Yeast and Fungi, sufficient to ensure that any clean hand that touched them was vulnerable to ontamination.
Some of the bacterial colonies found on the handles included species of Staphylococcal,
Klebsiella, Micrococcus, Prevotella, Bacillus, Stenotrophomonas and Pseudomonas all of
which pose a risk to any Healthcare Environment and its occupants.
Dr. Russell’s report also clearly demonstrates the effect of the Handliser Sanitising System on such contaminated door handles, reducing the “Colony Forming Units” from an average of 49 cfu’s per swab on the original baseline, to an average of just 1 cfu and then levelling at an average 2.2 cfu’s on each of the swabs subsequent to the introduction of the Handliser system, with a guide for even greater reduction.
Our study concluded that in hospitals, door handles are a potential source for the transfer of bacterial and fungal pathogens on to the hands of health care workers, patients and visitors alike, in turn promoting the transmission of germs throughout that cause HAI’s.
Hospitals by their very nature are susceptible to germs and cross contamination exasperates this problem, because there is simply no single hard and fast way to eliminate it.
It is only through multipronged strategies that success can be achieved. Systems such as Handliser play an important part in any multipronged approach, by addressing the problem of contaminated door handles. The system not only cleans handles, but it keeps them clean permanently, preventing them from being a source of cross contamination, while at the same time transferring traces of sanitiser onto the hands of people who use them, helping keep Clean Hands Clean while Disrupting the Chain of Infection.