Report

Trials of a self-actuating handle hygiene system on heavily used toilet doors in a Major Hospital in the Republic of Ireland.


INTRODUCTION

Context

Studies have shown that hand contact surfaces in toilets including door handles are heavily contaminated with microbes of faecal origin. Studies have also shown that even where handwashing occurs after toilet use, tap handles and the door handle can recontaminate the hands.

It has also been shown that users often try to avoid using the door handle on exiting by using tissues or some alternative strategy. The concern over toilet door handle hygiene in shared or public facilities is frequently voiced in hygiene surveys and is a real issue for catering, food production or healthcare staff where it can lead to serious public health risk.

The Handle Hygiene system

The Handle Hygiene system consisted of a horizontal pull handle fitted in the normal location. The contact bar of the handle was free to rotate in its mounting ensuring maximal disinfectant exposure and contact with hands.

The disinfectant dispensing system was fitted to the door above the handle and this applied a vectored atomised spray to the handle actuated by each opening or closing of the door.

The handle was therefore coated with disinfectant on its upper surfaces and sides and gravity caused this to extend the coating to the underside also. This action disinfected the handle itself. Touching the disinfected handle transferred some disinfectant to the hand and rotated the bar also, exposing a different surface to the disinfectant jet for next actuation.

Rubbing the hands together on leaving would spread the disinfectant over the contact surfaces of the hands and achieve the purpose of disinfecting all users’ hands.

This approach maximises the possibility that all users will have to contact disinfectant on leaving the toilet and that the handle itself will be a reduced vector of infection.

THE TRIAL

Five doors in a busy establishment were selected for the trial. These comprised doors of a canteen, a ladies and a gents staff toilets and ladies and gents public toilets.

Handles were sampled microbiologically several times per day over a period of two weeks using double-sided direct contact Hygicult slides.

The slides were applied to the door handle, first one side, then the other. These slides were incubated for 48 hours at 37oC before reading.

The number of microbial colonies appearing on both sides of each slide were counted. This was done for multiple samples per day for each handle. The average count per contact was calculated for each day for each handle and this value was used to provide a value for graphical purposes.

COMPARATIVE FIGURES

All handles were sampled for one week to establish a baseline pattern of contamination on the handles under normal usage. No disinfection was used during this period.

During the second week the Handle Hygiene system was charged with Sterillium, a highly effective disinfectant for hands. All handles were again sampled in a manner similar to the previous week.

The results obtained for the baseline period and during the period of disinfectant use are shown graphically at the end of this report.

THE MICROBIAL CONTAMINATION BASELINE

All of the handles showed considerable contamination by a range of bacteria, yeasts and fungi. The numbers increased generally on all handles except in the Gents Public toilet (GPT) on the Tuesday and Wednesday of the baseline week and fell to lower levels towards the end of the week. The highest contamination levels were recorded on the canteen and ladies staff and public toilet door handles (LST and LPT).

Typical contamination pattern from Gents Public toilet door handle

Typical contamination pattern from Canteen door handle

Typical contamination pattern from Ladies Staff toilet door handle

Typical contamination pattern from Ladies Public toilet door handle

Typical contamination pattern from Gents Staff toilet door handle

TESTING DURING THE HANDLE HYGIENE IMPLEMENTATION PERIOD

The Handle Hygiene system was implemented on 31st March. Sampling of the handles was undertaken in the same way as during the baseline period.

Most of the samples were negative during the week although the Canteen and Ladies Staff toilet door handles were lightly contaminated on the Tuesday reflecting the contamination loading pattern of the previous week.

Typical contamination from Ladies Staff Toilet door handle

Typical contamination from Ladies Public toilet door handle

Typical contamination from Gents Staff toilet door handle

Typical contamination from Canteen door handle

CONCLUSIONS

This trial demonstrated the ability of the Handle Hygiene system to reduce the contaminant microbial population on door handles to negligible levels using an effective disinfectant.

ENDS

R.J Russell Ph.D
Senior Lecturer in Microbiology
The Moyne Institute for Preventive Medicine
Trinity College
Dublin 2

  • Where is Handle Hygiene for?

    A Handle Hygiene systems is extremely important on high contact door handles where bacterial cross-contamination would present a potential health risk.

    • Hospitals
    • Retirement homes
    • Schools and educational facilities
    • Doctors surgeries
    • Dentists
    • Food industry
    • Nurseries
    • Restaurants
    • Public Bars
    • Cinemas
    • Sporting venues
    • Hotels
    • Day care facilities
    • Cruise ships
    • Office buildings
    • Coffee shops
    • Banks