The Most Contaminated and Most Touched Surfaces in a Patient Room

I just touched that door! What could be on it? Oh no - I also pushed that elevator button and that person just coughed!

Are these some of your common thoughts in high-traffic areas such as airports, stadiums, or healthcare facilities? Do you wonder how clean your airplane tray, movie seat arm rests, or hotel room phone are? You are not alone.

Our area of concern is health care facilities, so let's look at those in more detail. We all know that hospitals do everything they can to eliminate germs from their environment. They have infection control protocols, staff dedicated just to reducing infection, and involve every member of the staff, from housekeeping to the executives, in taking steps to protect visitors, staff, and most importantly, the vulnerable patients in their care. Despite all these efforts (which also often happen behind the scenes), we can still be wary of hospital germs. The idea of being infected by germs can be enough to even keep some people from seeking needed healthcare.

It's important to remember healthy visitors to a hospital or clinic can stay healthy with simple steps such as hand washing. (In fact, visitors' handwashing is more for the patients than for themselves.) Patients are susceptible to infection, and the germs that cause those infections are, well, everywhere. Hospitals have infection control policies, and place the highest priory on reducing hospital acquired infections. However, the "perfect storm" of high contamination plus vulnerable patients presents a significant challenge.

Let's take a look at some of the most contaminated surfaces in a hospital.

We have to start with us, human beings. We are actually always covered in bacteria, some of which can lead to infection if they break our skin barrier (read more here). Everything we touch leaves a trace of bacteria and other germs. That is why it is critical to wash our hands, and in the cases of very vulnerable patients, wear gowns, caps, and other protective gear.

What surfaces (other than us) are most contaminated in a hospital?

A number of studies have investigated the amount of MRSA, or Methycillin-Resistant Staphococcus aureus, found on objects in a typical patient room. One study combined all these studies to provide an overview of the most contaminated objects, within both endemic (everyday) and outbreak (lots of MRSA infections in a ward or hospital) settings. Here are the results:

¹ Dancer SJ et al. Lancet ID 2008;8(2):101-13

What surfaces are most touched objects in a hospital?

Now that we know which objects tend to be colonized by MRSA, let's have a look at what objects are the most touched in a hospital. One important study paved the way to defining what determines a high-touch object. Over the course of 18 months, observers noted each object in the patient room (excluding bathrooms) touched by healthcare workers during routine patient care. Data was collected for both intensive care units and general medical-surgical floors. This data was combined to create a list of objects, frequency of touch, and number of observations. The results were divided into high-touch, medium-touch, and low-touch surfaces. Here are the results:

 ² Huslage K, Rutala W A, et al. ICHE 2010;31(8):850-853

Combining these two studies, we can begin to see which objects require special attention and constant cleaning and sanitation. There are some highly contaminated surfaces, such as overbed tables, which despite being lower-touch in the ICU, are very high-touch in the general patient room. Some designs have many nooks and crannies which can be difficult to clean. They are also very close to the patient, who, as studies have shown, may not practice the same level of hand hygiene as healthcare workers. Additionally, surfaces such as bedrails, which are significantly contaminated and the #1 most touched object in both types of rooms, may only be cleaned by environmental staff (housekeeping) once per day. Knowing that MRSA alone can create an entire new generation in about 30 minutes (and 1 bacterium can become 1 billion in 10 hours), one day allows significant contamination to persist and worsen.

Armed with this information, healthcare systems and infection control specialists are developing new strategies and technologies to back up the daily cleaning routine. Keeping up with microbes and eliminating them before they can hitch a ride on the next person or surface until they find the path to transmission is a constant battle. You can also play a role by ensuring proper hand hygiene for yourself, your loved ones, and those who care for them.