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Hand touches on the surfaces of a healthcare waiting area

2020; Elsevier BV; Volume: 105; Issue: 2 Linguagem: Inglês

10.1016/j.jhin.2020.04.042

1532-2939

Yandi Andri Yatmo, Paramita Atmodiwirjo, Mochammad Mirza Yusuf Harahap,

Dental Research and COVID-19

The COVID-19 pandemic has triggered an urgency to prevent the rapid transmission of diseases. Environmental surfaces play a role in the transmission of diseases through physical contact with users [[1]Otter J.A. Yezli S. Salkeld J.A.G. French G.L. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings.Am J Infect Control. 2013; 41: S6-S11Abstract Full Text Full Text PDF PubMed Scopus (345) Google Scholar]. Pathogens could persist on surfaces for certain periods [[2]Kampf G. Todt D. Pfaender S. Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents.J Hosp Infect. 2020; 104: 246-251Abstract Full Text Full Text PDF PubMed Scopus (2495) Google Scholar], and transmission of diseases could occur when hands of users touch a contaminated surface. It is necessary to pay attention to environmental surfaces in public areas, especially high-touch surfaces [[3]Huslage K. Rutala W.A. Sickbert-Bennett E. Weber D.J. A Quantitative approach to defining "high-touch" surfaces in hospitals.Infect Control Hosp Epidemiol. 2010; 31: 850-853Crossref PubMed Scopus (167) Google Scholar] that tend to be touched mutually by different users [[4]Cheng V.C.C. Chau P.H. Lee W.M. Ho S.K. Lee D.W. So S.Y. et al.Hand-touch contact assessment of high-touch and mutual-touch surfaces among healthcare workers, patients, and visitors.J Hosp Infect. 2015; 90: 220-225Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar]. Only a few studies have been conducted in public areas of healthcare facilities [[5]Wang Y.L. Chen W.C. Chen Y.Y. Tseng S.H. Chien L.J. Wu H.S. et al.Bacterial contamination on surfaces of public areas in hospitals.J Hosp Infect. 2010; 74: 195-196Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar], despite the high potential for disease transmission in these areas due to the higher possibility of surfaces being mutually touched by many users. Previous studies on healthcare surfaces indicated the abilities of different surface materials to retain and transmit pathogens [[2]Kampf G. Todt D. Pfaender S. Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents.J Hosp Infect. 2020; 104: 246-251Abstract Full Text Full Text PDF PubMed Scopus (2495) Google Scholar,[6]Lankford M.G. Collins S. Youngberg L. Rooney D.M. Warren J.R. Noskin G.A. Assessment of materials commonly utilized in health care: Implications for bacterial survival and transmission.Am J Infect Control. 2006; 34: 258-263Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar]. In practice, surface materials are applied on to objects in particular shapes and sizes, yet most studies only consider the types of surface materials generally; only a few studies addressed other aspects of surface design [[7]Ellis O. Godwin H. David M. Morse D.J. Humphries R. Uslan D.Z. How to better monitor and clean irregular surfaces in operating rooms: Insights gained by using both ATP luminescence and RODAC assays.Am J Infect Control. 2018; 46: 906-912Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar]. Most objects are three-dimensional with surfaces on several sides and different types of materials. Such three-dimensionality presents different possibilities of touch occurrences, but these were rarely considered when studying high-touch objects in the healthcare environment. This study explores the occurrences of hand touches in a healthcare waiting area, by identifying where exactly the touches occurred on object surfaces. In this study, the occurrences of hand touches were observed on 26 object surfaces consisting of doors, chairs, and horizontal working surfaces in a waiting area of a 'puskesmas', a type of healthcare facility in Indonesia. The location of each touch on the surface was noted, along with the types of user (adult, child, or staff) and the related activities. Each object was observed during a 2-h period, resulting in a total of 1340 hand touches (723 by adults, 312 by children, and 305 by staff). The data from the observation were mapped into surface touch maps for each object. The results indicate that there are certain parts of object surfaces most likely to be touched by the users, and this seems to relate to the users' activities (Figure 1). The door surface areas most likely to be touched were the door handles and their surrounding areas, the door panels, the door frames, the side of the door panels, and the nearby wall. These touches occurred when the users opened or closed the door, leaned on or stood near the door, and when the children played around the door. The waiting chair surface areas most likely to be touched were the front edge of the seat, the area between connected seats, the top surface of the armrest, and the edge of the backrest. These touches occurred when the users sat, stood up from sitting position, or when the children played near the chairs. Touches on horizontal working surfaces mostly occurred on the top side, around the edge of both sides of the surfaces. These touches occurred during the healthcare service activities, such as during the measurement of patient blood pressure or when the staff wrote on the medical cards or handed them to the patient. The hand touches on surfaces also seemed to be related to some other aspects. Different patterns of touch were found on the closed and opened doors. The touches on the closed doors tend to be concentrated around the door handles and extended to the wall area near the handle. Meanwhile, the touches on the doors that remained open were found not only around the door handles but also on the whole door panel surfaces. For horizontal working surfaces, most touches were observed on the top side around the edge of the surface; however, when the surfaces are higher, touches were also found on the side surface. The position of the object in relation to other objects could also trigger particular hand touches. Touches on the backrest edge were observed on the front row chairs when the users from the back row used the backrest as a support to stand up from a sitting position. The upper parts of the surfaces were touched by adults, while the lower parts were touched by children. The children tend to move around extensively while waiting, so their touches were found on many surfaces, sometimes on unusual spots. During a pandemic, reducing the risk of disease transmission could be supported by minimizing mutual touches on environmental surfaces in public areas. This study indicates that there are particular areas of surfaces on which hand touches most likely occurred. Various aspects of surfaces should be considered in the design of objects and the application of surface materials to minimize the transmission of disease. The findings could also inform the procedures for environmental surface cleaning [[8]Han J.H. Sullivan N. Leas B.F. Pegues D.A. Kaczmarek J.L. Umscheid C.A. Cleaning hospital room surfaces to prevent health care–associated infections: A technical brief.Ann Intern Med. 2015; 163: 598-607Crossref PubMed Scopus (136) Google Scholar], by paying more attention to particular parts of surfaces. None declared. The study was funded by the Ministry of Research, Technology, and Higher Education of the Republic of Indonesia through PDUPT Research Grant.