This study quantifies the relationship between hand hygiene and the frequency with which healthcare workers (HCWs) touch surfaces in patient rooms. Surface contacts and hand hygiene were recorded in a single-bed UK hospital ward for six care types. Surface contacts often formed non-random patterns, but hygiene before or after patient contact depends significantly on care type (P=0.001). The likelihood of hygiene correlated with the number of surface contacts (95% confidence interval 1.1–5.8, P=0.002), but not with time spent in the room. This highlights that a potential subconscious need for hand hygiene may have developed in HCWs, which may support and help focus future hygiene education programmes

Bale, S

King, MF

Noakes, CJ

Sleigh, PA

Waters, L

White Rose Research Online

ww.sciencedirect.comJournal of Hospital Infection 94 (2016) 48e51Available online at wJournal of Hospital Infectionjournal homepage: www.elsevierheal th.com/journals / jh inShort reportRelationship between healthcare worker surfacecontacts, care type and hand hygiene: an observationalstudy in a single-bed hospital wardM-F. King a,*, C.J. Noakes a, P.A. Sleigh a, S. Bale b, L. Waters ba Institute for Public Health and Environmental Engineering, School of Civil Engineering, University of Leeds, Leeds, UKbResearch & Development Department, The Friars, Newport, UKA R T I C L E I N F OArticle history:Received 19 February 2016Accepted 5 May 2016Available online 13 May 2016Keywords:Hospital-acquired infectionHand hygieneSurface contacts* Corresponding author. Address: InstituteEnvironmental Engineering, School of Civil ELeeds, Leeds LS2 9JT, UK. Tel.: þ44 113 3432265.E-mail address: m.f.king@leeds.ac.uk (M-http://dx.doi.org/10.1016/j.jhin.2016.05.0030195-6701/ª 2016 The Authors. Published byunder the CC BY license (http://creativecomS U M M A R YThis study quantifies the relationship between hand hygiene and the frequency with whichhealthcare workers (HCWs) touch surfaces in patient rooms. Surface contacts and handhygiene were recorded in a single-bed UK hospital ward for six care types. Surface con-tacts often formed non-random patterns, but hygiene before or after patient contactdepends significantly on care type (P¼0.001). The likelihood of hygiene correlated withthe number of surface contacts (95% confidence interval 1.1e5.8, P¼0.002), but not withtime spent in the room. This highlights that a potential subconscious need for hand hy-giene may have developed in HCWs, which may support and help focus future hygieneeducation programmes.ª 2016 The Authors. Published by Elsevier Ltdon behalf of the Healthcare Infection Society. This is an open access articleunder the CC BY license (http://creativecommons.org/licenses/by/4.0/).IntroductionThe risk of acquiring nosocomial infections is a recognizedproblem in hospitals worldwide.1 Recent studies have high-lighted the importance of surface contamination and suggest acausal link to subsequent patient infection.2e4 Understandingwhich surfaces are touched by healthcare workers (HCWs) andhow this relates to hand hygiene is therefore important inassessing patient risk. This paper reports an observationalstudy to record the sequences of HCW surface contacts infor Public Health andngineering, University of31957; fax: þ44 113 343F. King).Elsevier Ltd on behalf of Themons.org/licenses/by/4.0/).single-patient rooms, and quantifies the relationships with caretype and hand hygiene frequency.MethodsThis observational study was conducted in 2012 at YsbytyAneurin Bevan, a National Health Service single-bed commu-nity hospital in Ebbw Vale, Wales, UK. The hospital opened in2010 and deals with subacute patients. The ward was staffed atall times by seven or eight nurses divided between the two‘pods’ of 16 beds, where at least two members were registerednurses (RNs), rotated in 8-h shifts. The complement of staff wascompleted by five or six auxiliary nurses (ANs) depending on theshift. One doctor made daily rounds, while a second consultantmade biweekly rounds. HCWs carried out six types of care asdescribed in Table I. The housekeeping observed was per-formed by nurses who had responsibility for cleaning high-Healthcare Infection Society. This is an open access articleTable IExamples of procedures within each care typeDirect care Housekeeping Mealtimes Medication rounds Miscellaneous Personal careBlood pressuremeasurementWeighing patientsBlood sugar saturationEquipment cleaningCleaning ‘high-touchsurfaces’Distributionof mealsDistributingmedicationInjectionsCall bell requestResponse to pressuremattress alarmsToiletingPatient changingMinor procedures (e.g.cannula insertion)M-F. King et al. / Journal of Hospital Infection 94 (2016) 48e51 49touch surfaces, such as medical equipment and near-bed sur-faces, with disposable chlorine wipes.5 Additional daily surfacecleaning by domestic staff was performed using microfibrecloths and water, and terminal cleans included bleach. Theseactivities were not included in this survey.During each care episode, the surfaces touched by the HCWand the order in which this occurred were recorded. Surfaceswere categorized following Smith et al.:6e equipment (intravenous stand, hoist, blood pressure cuff,notes/medication trolley);e patient;e near-bed (bedrail, bedding tray, TV, chair, locker);e far-bed (window, light switch, patient chart in a folder on aworkstation in the room, door handles); ande hygiene items (soap, tap, alcohol gel, sink, paper toweldispenser).Observations took place from outside the patient roomthrough a window in order to avoid disrupting the care; in allcases, data were only recorded where there was a clear line ofsight. Each observation period began when a HCW entered apatient room, and concluded once they left the room at theend of the care episode. Interruptions in a care episode (i.e.leaving the room) occurred on a small number of occasions, andwere recorded as an integral part. The majority of care activ-ities observed involved a single HCW; however, if more thanone HCW was present, both sets of surface contacts wererecorded as separate episodes. Hand hygiene was recordedeach time it occurred, with the observation noting the type ofantisepsis (soap and water or alcohol gel) and whether or notgloves were worn. Separate hand antisepsis events wererecorded if the HCW donned gloves and also washed their00.20.40.60.81Direct care Housekeeping MealtimesCaLikelihood of hand hygieneFigure 1. Likelihood of hand hygiene plotted against surface contact ccontacts; black bars, 11 to 15 contacts; striped bars, more than 15 cohands. In total, 431 care episodes were observed over 8-h pe-riods during two visits of three and four days by one observer.Ward occupancy was 100%; however, data were not recordedon specific patients or rooms.ResultsHand hygieneCare type influenced the choice of hand antisepsis(P¼0.0003), with personal care being dominated by hand-washing with soap and water (60% handwashing, 43% alcoholgel). For all other care types, the choice of antisepsis methodwas almost equal between soap and water or alcohol gel.Gloves were only worn for a small number of care episodes(6%); antisepsis before donning gloves and after their removaloccurred on 50% of occasions.RNs and ANs were involved in 47% and 41% of observations,respectively. On average, ANs performed hand hygiene 17%more often than RNs in equivalent care types (54% vs 37%). ANsperformed hand hygiene on 51% of occasions for proceduralcare, such as direct care, compared with 27% for RNs. However,in care types with a higher level of variability, such as miscel-laneous or personal care, this trend was reversed (30% vs 40%and 62% vs 80%, respectively).The likelihood of any type of hand antisepsis following careincreased proportionally with the number of surface contacts(Figure 1). Strong positive correlation by means of logisticregression upheld this observation in all cases [odds ratio (OR)1.5, 95% confidence interval (CI) 1.1e5.8; P¼0.002]. However,time spent in the room did not correlate with number of sur-face contacts or hand hygiene.Medication Miscellaneous Personal carere typeount. Light grey bars, one to five contacts; dark grey bars, six to 10ntacts.109876543210Surface contact countEquipment Hygiene items Patient Near-bed Far-bedFigure 2. Surface contacts for direct care (grey bars) and personal care (black bars). Error bars show one standard deviation either sideof the mean.M-F. King et al. / Journal of Hospital Infection 94 (2016) 48e5150Influence of patient contact on hand hygieneHand hygiene before patient contact occurred on 0e62% ofoccasions (direct care 1%, N¼1/197; housekeeping 11%, N¼2/17; mealtimes 0%, N¼0/21; medication rounds 10%, N¼11/111;miscellaneous care 1.5%, N¼1/72; personal care 62%, N¼8/13).The likelihood of hand antisepsis after patient contact was onlysignificant in the cases of direct care (OR 3.8, 95% CI 2.1e7.1;P¼0.001) and personal care (OR 3.8, 95% CI 0.1e7.8; P¼0.03),with likelihood of hygiene following contact of 73% and 80%,respectively. In all other care types, the likelihood of handhygiene was close to 50%. For all care types where antisepsisoccurred after patient contact, HCWs preferred handwashingwith soap and water to alcohol gel (P¼0.0003).Surface contact sequencesSurface contacts during direct care show a regular non-random (Pw0.04) pattern of movement. Medication roundsexhibit peaks for near-bed and far-bed surface contacts due tonurses always touching the workstation and patient notes (onthe workstation). Near-bed surfaces and medical equipmentfall into the category of ‘high-touch surfaces’ and werecleaned by HCWs, but the patient’s chart and workstationwhich were touched in almost every care episode were nevercleaned by HCWs. Surface contact sequences tended to be lessordered in personal care or housekeeping, both exhibiting ahigher number of contacts during an episode. Although thelikelihood of hand hygiene increased with contacts (Figure 1),it was under 50% for housekeeping, which may allow for a widerspread of pathogens.Figure 2 shows average surface contact counts for directcare and personal care. It can be seen that near-bed surfacesdominated in personal care, followed by patient contacts andfar-bed surfaces. However, equipment was touched morefrequently during direct care. On average, it was found thateven if hand hygiene occurred, the patient was often touchedagain before the HCW left the room.Discussion and conclusionThis observational study investigated the relationship be-tween surface contacts, patient contact and hand hygiene. TheHawthorne effect7 is known to improve hygiene compliance, sothis report is probably a best-case scenario. The studymeasured surface contacts and frequency of hand hygiene, butdid not measure the effectiveness of hand hygiene or whetheror not HCWs were compliant. The results suggest the following.e The likelihood of hand hygiene increased with surfacecontacts for all care types. A subconscious need for handhygiene may have developed, possibly as a result of HCWhygiene education programmes.e No correlation was found between the time spent in theroom by HCWs and the likelihood of hand hygiene.e Hand hygiene before or after patient contact dependedhighly on care type. A notion of perceived risk appears tocorrelate with personal care where patient contact islikely, but this is less clear in care episodes where patientcontact occurs unpredictably, such as direct care.e Surface contacts were non-random. The sequence of hand-to-surface contacts by staff during clinical activities pro-vides a theoretical demonstration of how hospital organ-isms could spread from one environmental site to another.Research also suggests that how and when surfaces arecleaned may be influential in its overall effectiveness.8This has potentially important implications for the stra-tegic planning of surface cleaning, particularly when andby whom the surfaces should be cleaned, ultimatelyimpacting on hospital costings and patient care.1AcknowledgementsEthical approval was granted by South East Wales ResearchEthics Committee (Ref: 11/WA/0200). The authors would liketo thank Ysbyty Aneurin Bevan staff for participating in thestudy. Data available at: http://doi.org/10.5518/10.M-F. King et al. / Journal of Hospital Infection 94 (2016) 48e51 51Conflict of interest statementNone declared.Funding sourceThis research was undertaken as part of a PhD sponsored byUK Engineering and Physical Sciences Research Council andArup (EP/G029768/1).References1. Harbarth S, Sax H, Gastmeier P. The preventable proportion ofnosocomial infections: an overview of published reports. J HospInfect 2003;54:258e266.2. Bhalla A, Pultz NJ, Gries DM, et al. Acquisition of nosocomialpathogens on hands after contact with environmental surfaces nearhospitalized patients. Infect Control Hosp Epidemiol2004;25:164e167.3. King M-F, Noakes CJ, Sleigh P. Modelling environmental contami-nation in hospital single and four-bed rooms. Indoor Air2015;25:694e707.4. Dancer SJ. Mopping up hospital infection. J Hosp Infect1999;43:85e100.5. Huslage K, Rutala W, Sickbert-Bennett E, Weber DJ. A quantitativeapproach to defining ‘high-touch’ surfaces in hospitals. InfectControl Hosp Epidemiol 2010;31:850e853.6. Smith SJ, Young V, Robertson C, Dancer SJ. Where do hands go? Anaudit of sequential hand-touch events on a hospital ward. J HospInfect 2012;80:206e211.7. Kohli E, Ptak J, Smith R, Taylor E, Talbot EA, Kirkland KB. Variabilityin the Hawthorne effect with regard to hand hygiene performancein high- and low-performing inpatient care units. Infect ControlHosp Epidemiol 2009;30:222e225.8. Bogusz A, Stewart M, Hunter J, et al. How quickly do hospitalsurfaces become contaminated after detergent cleaning? HealthcInfect 2013;18:3e9.

Relationship between healthcare worker surface contacts, care type and hand hygiene: an observational study in a single-bed hospital ward

SummaryThis study quantifies the relationship between hand hygiene and the frequency with which healthcare workers (HCWs) touch surfaces in patient rooms. Surface contacts and hand hygiene were recorded in a single-bed UK hospital ward for six care types. Surface contacts often formed non-random patterns, but hygiene before or after patient contact depends significantly on care type (P=0.001). The likelihood of hygiene correlated with the number of surface contacts (95% confidence interval 1.1–5.8, P=0.002), but not with time spent in the room. This highlights that a potential subconscious need for hand hygiene may have developed in HCWs, which may support and help focus future hygiene education programmes

King, M-F.

Noakes, C.J.

Sleigh, P.A.

Bale, S.

Waters, L.

Elsevier - Publisher Connector 

ww.sciencedirect.com
Journal of Hospital Infection 94 (2016) 48e51Available online at wJournal of Hospital Infection
journal homepage: www.elsevierheal th.com/journals / jh inShort report
Relationship between healthcare worker surface
contacts, care type and hand hygiene: an observational
study in a single-bed hospital ward
M-F. King a,*, C.J. Noakes a, P.A. Sleigh a, S. Bale b, L. Waters b
a Institute for Public Health and Environmental Engineering, School of Civil Engineering, University of Leeds, Leeds, UK
bResearch & Development Department, The Friars, Newport, UKA R T I C L E I N F O
Article history:
Received 19 February 2016
Accepted 5 May 2016
Available online 13 May 2016
Keywords:
Hospital-acquired infection
Hand hygiene
Surface contacts* Corresponding author. Address: Institute
Environmental Engineering, School of Civil E
Leeds, Leeds LS2 9JT, UK. Tel.: þ44 113 343
2265.
E-mail address: m.f.king@leeds.ac.uk (M-
http://dx.doi.org/10.1016/j.jhin.2016.05.003
0195-6701/ª 2016 The Authors. Published by
under the CC BY license (http://creativecomS U M M A R Y
This study quantifies the relationship between hand hygiene and the frequency with which
healthcare workers (HCWs) touch surfaces in patient rooms. Surface contacts and hand
hygiene were recorded in a single-bed UK hospital ward for six care types. Surface con-
tacts often formed non-random patterns, but hygiene before or after patient contact
depends significantly on care type (P¼0.001). The likelihood of hygiene correlated with
the number of surface contacts (95% confidence interval 1.1e5.8, P¼0.002), but not with
time spent in the room. This highlights that a potential subconscious need for hand hy-
giene may have developed in HCWs, which may support and help focus future hygiene
education programmes.
ª 2016 The Authors. Published by Elsevier Ltd
on behalf of the Healthcare Infection Society. This is an open access article
under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Introduction
The risk of acquiring nosocomial infections is a recognized
problem in hospitals worldwide.1 Recent studies have high-
lighted the importance of surface contamination and suggest a
causal link to subsequent patient infection.2e4 Understanding
which surfaces are touched by healthcare workers (HCWs) and
how this relates to hand hygiene is therefore important in
assessing patient risk. This paper reports an observational
study to record the sequences of HCW surface contacts infor Public Health and
ngineering, University of
31957; fax: þ44 113 343
F. King).
Elsevier Ltd on behalf of The
mons.org/licenses/by/4.0/).single-patient rooms, and quantifies the relationships with care
type and hand hygiene frequency.Methods
This observational study was conducted in 2012 at Ysbyty
Aneurin Bevan, a National Health Service single-bed commu-
nity hospital in Ebbw Vale, Wales, UK. The hospital opened in
2010 and deals with subacute patients. The ward was staffed at
all times by seven or eight nurses divided between the two
‘pods’ of 16 beds, where at least two members were registered
nurses (RNs), rotated in 8-h shifts. The complement of staff was
completed by five or six auxiliary nurses (ANs) depending on the
shift. One doctor made daily rounds, while a second consultant
made biweekly rounds. HCWs carried out six types of care as
described in Table I. The housekeeping observed was per-
formed by nurses who had responsibility for cleaning high-Healthcare Infection Society. This is an open access article
Table I
Examples of procedures within each care type
Direct care Housekeeping Mealtimes Medication rounds Miscellaneous Personal care
Blood pressure
measurement
Weighing patients
Blood sugar saturation
Equipment cleaning
Cleaning ‘high-touch
surfaces’
Distribution
of meals
Distributing
medication
Injections
Call bell request
Response to pressure
mattress alarms
Toileting
Patient changing
Minor procedures (e.g.
cannula insertion)
M-F. King et al. / Journal of Hospital Infection 94 (2016) 48e51 49touch surfaces, such as medical equipment and near-bed sur-
faces, with disposable chlorine wipes.5 Additional daily surface
cleaning by domestic staff was performed using microfibre
cloths and water, and terminal cleans included bleach. These
activities were not included in this survey.
During each care episode, the surfaces touched by the HCW
and the order in which this occurred were recorded. Surfaces
were categorized following Smith et al.:6
e equipment (intravenous stand, hoist, blood pressure cuff,
notes/medication trolley);
e patient;
e near-bed (bedrail, bedding tray, TV, chair, locker);
e far-bed (window, light switch, patient chart in a folder on a
workstation in the room, door handles); and
e hygiene items (soap, tap, alcohol gel, sink, paper towel
dispenser).
Observations took place from outside the patient room
through a window in order to avoid disrupting the care; in all
cases, data were only recorded where there was a clear line of
sight. Each observation period began when a HCW entered a
patient room, and concluded once they left the room at the
end of the care episode. Interruptions in a care episode (i.e.
leaving the room) occurred on a small number of occasions, and
were recorded as an integral part. The majority of care activ-
ities observed involved a single HCW; however, if more than
one HCW was present, both sets of surface contacts were
recorded as separate episodes. Hand hygiene was recorded
each time it occurred, with the observation noting the type of
antisepsis (soap and water or alcohol gel) and whether or not
gloves were worn. Separate hand antisepsis events were
recorded if the HCW donned gloves and also washed their0
0.2
0.4
0.6
0.8
1
Direct care Housekeeping Mealtimes
Ca
Li
ke
lih
oo
d 
of
 h
an
d 
hy
gi
en
e
Figure 1. Likelihood of hand hygiene plotted against surface contact c
contacts; black bars, 11 to 15 contacts; striped bars, more than 15 cohands. In total, 431 care episodes were observed over 8-h pe-
riods during two visits of three and four days by one observer.
Ward occupancy was 100%; however, data were not recorded
on specific patients or rooms.Results
Hand hygiene
Care type influenced the choice of hand antisepsis
(P¼0.0003), with personal care being dominated by hand-
washing with soap and water (60% handwashing, 43% alcohol
gel). For all other care types, the choice of antisepsis method
was almost equal between soap and water or alcohol gel.
Gloves were only worn for a small number of care episodes
(6%); antisepsis before donning gloves and after their removal
occurred on 50% of occasions.
RNs and ANs were involved in 47% and 41% of observations,
respectively. On average, ANs performed hand hygiene 17%
more often than RNs in equivalent care types (54% vs 37%). ANs
performed hand hygiene on 51% of occasions for procedural
care, such as direct care, compared with 27% for RNs. However,
in care types with a higher level of variability, such as miscel-
laneous or personal care, this trend was reversed (30% vs 40%
and 62% vs 80%, respectively).
The likelihood of any type of hand antisepsis following care
increased proportionally with the number of surface contacts
(Figure 1). Strong positive correlation by means of logistic
regression upheld this observation in all cases [odds ratio (OR)
1.5, 95% confidence interval (CI) 1.1e5.8; P¼0.002]. However,
time spent in the room did not correlate with number of sur-
face contacts or hand hygiene.Medication Miscellaneous Personal care
re type
ount. Light grey bars, one to five contacts; dark grey bars, six to 10
ntacts.
10
9
8
7
6
5
4
3
2
1
0
Su
rf
ac
e 
co
nt
ac
t c
ou
nt
Equipment Hygiene items Patient Near-bed Far-bed
Figure 2. Surface contacts for direct care (grey bars) and personal care (black bars). Error bars show one standard deviation either side
of the mean.
M-F. King et al. / Journal of Hospital Infection 94 (2016) 48e5150Influence of patient contact on hand hygiene
Hand hygiene before patient contact occurred on 0e62% of
occasions (direct care 1%, N¼1/197; housekeeping 11%, N¼2/
17; mealtimes 0%, N¼0/21; medication rounds 10%, N¼11/111;
miscellaneous care 1.5%, N¼1/72; personal care 62%, N¼8/13).
The likelihood of hand antisepsis after patient contact was only
significant in the cases of direct care (OR 3.8, 95% CI 2.1e7.1;
P¼0.001) and personal care (OR 3.8, 95% CI 0.1e7.8; P¼0.03),
with likelihood of hygiene following contact of 73% and 80%,
respectively. In all other care types, the likelihood of hand
hygiene was close to 50%. For all care types where antisepsis
occurred after patient contact, HCWs preferred handwashing
with soap and water to alcohol gel (P¼0.0003).Surface contact sequences
Surface contacts during direct care show a regular non-
random (Pw0.04) pattern of movement. Medication rounds
exhibit peaks for near-bed and far-bed surface contacts due to
nurses always touching the workstation and patient notes (on
the workstation). Near-bed surfaces and medical equipment
fall into the category of ‘high-touch surfaces’ and were
cleaned by HCWs, but the patient’s chart and workstation
which were touched in almost every care episode were never
cleaned by HCWs. Surface contact sequences tended to be less
ordered in personal care or housekeeping, both exhibiting a
higher number of contacts during an episode. Although the
likelihood of hand hygiene increased with contacts (Figure 1),
it was under 50% for housekeeping, which may allow for a wider
spread of pathogens.
Figure 2 shows average surface contact counts for direct
care and personal care. It can be seen that near-bed surfaces
dominated in personal care, followed by patient contacts and
far-bed surfaces. However, equipment was touched more
frequently during direct care. On average, it was found that
even if hand hygiene occurred, the patient was often touched
again before the HCW left the room.Discussion and conclusion
This observational study investigated the relationship be-
tween surface contacts, patient contact and hand hygiene. The
Hawthorne effect7 is known to improve hygiene compliance, so
this report is probably a best-case scenario. The study
measured surface contacts and frequency of hand hygiene, but
did not measure the effectiveness of hand hygiene or whether
or not HCWs were compliant. The results suggest the following.
e The likelihood of hand hygiene increased with surface
contacts for all care types. A subconscious need for hand
hygiene may have developed, possibly as a result of HCW
hygiene education programmes.
e No correlation was found between the time spent in the
room by HCWs and the likelihood of hand hygiene.
e Hand hygiene before or after patient contact depended
highly on care type. A notion of perceived risk appears to
correlate with personal care where patient contact is
likely, but this is less clear in care episodes where patient
contact occurs unpredictably, such as direct care.
e Surface contacts were non-random. The sequence of hand-
to-surface contacts by staff during clinical activities pro-
vides a theoretical demonstration of how hospital organ-
isms could spread from one environmental site to another.
Research also suggests that how and when surfaces are
cleaned may be influential in its overall effectiveness.8
This has potentially important implications for the stra-
tegic planning of surface cleaning, particularly when and
by whom the surfaces should be cleaned, ultimately
impacting on hospital costings and patient care.1Acknowledgements
Ethical approval was granted by South East Wales Research
Ethics Committee (Ref: 11/WA/0200). The authors would like
to thank Ysbyty Aneurin Bevan staff for participating in the
study. Data available at: http://doi.org/10.5518/10.
M-F. King et al. / Journal of Hospital Infection 94 (2016) 48e51 51Conflict of interest statement
None declared.
Funding source
This research was undertaken as part of a PhD sponsored by
UK Engineering and Physical Sciences Research Council and
Arup (EP/G029768/1).References
1. Harbarth S, Sax H, Gastmeier P. The preventable proportion of
nosocomial infections: an overview of published reports. J Hosp
Infect 2003;54:258e266.
2. Bhalla A, Pultz NJ, Gries DM, et al. Acquisition of nosocomial
pathogens on hands after contact with environmental surfaces near
hospitalized patients. Infect Control Hosp Epidemiol
2004;25:164e167.3. King M-F, Noakes CJ, Sleigh P. Modelling environmental contami-
nation in hospital single and four-bed rooms. Indoor Air
2015;25:694e707.
4. Dancer SJ. Mopping up hospital infection. J Hosp Infect
1999;43:85e100.
5. Huslage K, Rutala W, Sickbert-Bennett E, Weber DJ. A quantitative
approach to defining ‘high-touch’ surfaces in hospitals. Infect
Control Hosp Epidemiol 2010;31:850e853.
6. Smith SJ, Young V, Robertson C, Dancer SJ. Where do hands go? An
audit of sequential hand-touch events on a hospital ward. J Hosp
Infect 2012;80:206e211.
7. Kohli E, Ptak J, Smith R, Taylor E, Talbot EA, Kirkland KB. Variability
in the Hawthorne effect with regard to hand hygiene performance
in high- and low-performing inpatient care units. Infect Control
Hosp Epidemiol 2009;30:222e225.
8. Bogusz A, Stewart M, Hunter J, et al. How quickly do hospital
surfaces become contaminated after detergent cleaning? Healthc
Infect 2013;18:3e9.


Relationship between healthcare worker surface contacts, care type and hand hygiene: an observational study in a single-bed hospital ward 

M-F. King

C.J. Noakes

P.A. Sleigh

S. Bale

L. Waters

Crossref

Journal of Hospital Infection

Data resulting from observational audit of health care worker surface contact and hand hygiene at Ysbyty Aneurin Bevan 2012

King, Marco-Felipe

Noakes, Catherine

Sleigh, Andrew

Waters, Liz

Bale, Sue

Research Data Leeds Repository (University of Leeds)

Ysbyty Aneurin Bevan surface contact and hand hygiene audit

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Relationship between healthcare worker surface contacts, care type and hand hygiene: an observational study in a single-bed hospital ward

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