Infection Prevention & Control

Hospital Acquired Infection from untreated door handles in healthcare and care home environments.

With costs spiralling and close to 250,000 deaths per year in the USA and Europe, from Nosocomial or HAI’s (Hospital Acquired Infections), they remain a major problem confronting all health care facilities.

According to the US based “Journal of the Hospital Infection Society” The proportion of nosocomial infections potentially preventable under routine working conditions remains unclear but an evaluation of 30 reports suggests that great potential exists to decrease nosocomial infection rates, from a minimum reduction effect of 10% to a maximum effect of 70%, depending on the setting, study design, baseline infection rates and type of infections.

The World Health Organization have also stated that improved compliance with hand hygiene protocol, could reduce the nosocomial infection rate by as much as 40%.

There are, of course, numerous causes of HAI’s and while hand hygiene is only one of them, it is predictably the most important one. There can be no doubt that clean hands ultimately save lives and washing your hands correctly is paramount, but this action is only part of the answer to cleaner safer hands. The hygiene standards applied to the physical environment where patients are treated or convalesce must be afforded the same level of importance as the initial act of cleaning your hands.

Despite improvements in the methods and techniques applied to the cleaning and sterilization of environmental surfaces, they still play a significant role in transmission of pathogens such as Methicillin Resistant Staphylococci (MRSA), Vancomycin Resistant Enterococci (VRE), Clostridium difficile, Acinetobacter spp and many others.

Door handles, in particular, are a well-documented breeding ground for pathogens and present a focal point or high risk common contact surface facilitating the transmission of germs throughout a building. A recent study by Dr. Charles Gerba of the University of Arizona showed, with the use of tracer viruses, how the contamination of  a single doorknob or table top results in the spread of viruses throughout office buildings, hotels, and health care facilities. Within 2 to 4 hours, the virus could be detected on 40 to 60 percent of workers and visitors in the facilities.

Much more focus should be placed on door handles and their contribution to the spread of hospital acquired infections and as the most commonly touched surface in any health care facility, they should always be referred to and as “critical contact points”

To further emphasize the extent of the problem with door handles, the photo below shows an agar swab taken from the exit door handle of a washroom in a public hospital in Dublin. This swab clearly demonstrates the extent of one of the more serious non-addressed issues facing the infection control team within that particular hospital.


This swab is a typical example of what most visitors, staff and patients may come into contact with immediately after washing their hands following a visit to the washroom. These organisms, if acquired by patients, have the potential to create clinically important antimicrobial resistance problems.

Associate Professor, Dr Ronnie Russell from the Department of Microbiology at Trinity College Dublin (Applied & Environmental Microbiology) undertook a report to determine the antimicrobial efficacy of the installation of a door handle sanitising system in uncontrolled, in-use, community conditions.

The report stated that the viable count or colony forming units per cm2 (cfu/ cm2) is the standardized measure of how clean or dirty a surface is in microbiological terms. In the meat industry, >10 cfu/ cm2 is regarded as unacceptable (a). In healthcare, Handle Hygiene system was actively dispensing sanitiser.“It is easy to see how implementation of the Handle Hygiene system could help improve hygiene and reduce risk in those environments”

  • References

    • (a) Commission Decision (2001/471/EC)
    • (b) Dancer SJ. 2004. How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals. The Journal of Hospital Infection 56:10-15.
    • (c) Schmidt MG, Attaway HH, Sharpe PA, John J, Jr., Sepkowitz KA, Morgan A, Fairey SE, Singh S, Steed LL, Cantey JR, Freeman KD, Michels HT, Salgado CD. 2012. Sustained Reduction of Microbial Burden on Common Hospital Surfaces through Introduction of Copper. Journal of Clinical Microbiology 50:2217-2223.

Ronnie Russell Graph

The monitoring and evaluation of hospital door handles should always be a vital procedure for infection control teams to protect staff , visitors and vulnerable patients. Door handle sanitisers should be recognised as an essential element in the fight against Hospital Acquired Infections

In another study, 100 swab samples were collected from door knobs from the different departments of Al-Shifa hospital (including wards, offices, and rest rooms) and all samples were transported and processed with two hours of collection. The swabs were cultured on routine microbiological media and incubated for 24 hours before examination and bacterial identification. Antimicrobial susceptibility of the isolated bacteria was also performed according to CLSI guidelines.

The results of this investigation has shown that most of the tested samples contained a variety of pathogenic and non-pathogenic organisms like methicillin-resistant Staphylococcus aureus (MRSA) which is 100% resistant to teicoplanin and 96.5% to penicillin and erythromycin, klebsiella pneumonia which exhibited 50% resistance to meropenem, Aeromonas hydrophila which is 100% resistant to teicoplanin, and Serratia marcescens which is 100% resistant to tetracycline and all of them were sensitive to imipenem.

While quality improvement initiatives have decreased HAI’s incidence and costs for some hospitals, much more remains to be done. As hospitals realise savings from prevention, the installation of innovative solutions such as Door Handles Sanitizers will become more and more prevalent in the fight to control the transmission of harmful pathogens within hospital settings and as such, should no longer be ignored.


Dr Ronnie Russell – Applied Microbiology and Immunology – Determination of antimicrobial efficacy of the Hygiene Handle System in uncontrolled, in-use, community conditions.

Department of Medical Microbiology, Federal School of Medical Laboratory Sciences, Jos University Teaching Hospital, Plateau State Nigeria – Bacterial contamination of door handles in selected public conveniences in Abuja metropolis, Nigeria – A public health threat.

American Society for Microbiology – How quickly viruses can contaminate buildings — from just a single doorknob –

The Direct Medical Costs of Healthcare-associated Infections in U.S. Hospitals and the Benefits of Prevention  [PDF – 835 KB]

Hospital Door Knobs as a Source of Bacterial Infection Abdelraouf A. Elmanama, Eman M. Qwaider, Fatma M. Hajjaj, Haneen Z.Abu Rasas, Lobna A. Snuono Presented by: Eman M. Qwaider Email:

Health Care–Associated Infections – A Meta-analysis of Costs and Financial Impact on the US Health Care System

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