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Hospital elevator buttons coated with more bacteria than bathroom surfaces

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TORONTO - You might want to use an elbow to push the elevator button the next time you are in a hospital.

A new study suggests that elevator buttons in hospitals have more bacteria on them than surfaces in public bathrooms in hospitals.

Analysis of the swabs taken in the study found most of the bugs were benign. But that might not always be the case, said senior author Dr. Donald Redelmeier.

And where people — hopefully — wash their hands after going to the bathroom, they might not think to take the same precaution after doing something as simple as pushing a button to call an elevator and another to select a floor.

"The motivation here is they" — elevator buttons — "are ubiquitous inside hospitals, they're active really every moment of the day and they're touched by multiple people and it's almost always with ungloved hands," said Redelmeier, who is director of clinical epidemiology at Sunnybrook Health Sciences Centre in Toronto.

"It's a theoretic risk. But the main point here is that it's also an avoidable risk through hand hygiene."

While elevator buttons are certainly among the surfaces hospital cleaners target, they are touched so often, by so many people, that it's a bit of a losing battle.

"They can't be cleaned again and again and again, every second of the day," Redelmeier said. "Once they're clean, they don't stay clean very long."

With the rise of antibiotic resistant bacteria and outbreaks of C. difficile diarrhea, concern about infection control in hospitals has grown in recent years. As a result, numerous studies have been conducted to identify where bacteria hide in hospitals and how they are transmitted to patients.

Studies have found bacterial contamination on neckties worn by male doctors, lab coats, stethoscopes, curtains separating beds in multiple-bed rooms, computer keyboards as well as smart phones and digital tablets health-care workers use to enter and check patient data.

But equipment is generally in the hands of health-care workers. And hospital staff are regularly bombarded with messages about the need to observe good infection control practices such as washing hands between patients.

Hospital visitors and even patients themselves may have less of an idea that they could play a role in moving bacteria around hospitals, Redelmeier acknowledged.

For the study, swabs were taken from 120 different elevator buttons and 96 toilet surfaces in three different hospitals in Toronto. Swabbing was done on weekdays and weekends, and a variety of elevator buttons were tested. As well, the public washrooms closest to the elevators were also tested, with swabs taken of the door handles on the inside and outside of the main door, the latch used to close cubicle doors and the toilet flush handle or button.

Sixty-one per cent of the elevator buttons tested were colonized with bacteria, compared to 43 per cent of the toilet surfaces tested.

Redelmeier said people should consider using an elbow, a pen or some other item to push elevator buttons in hospitals, or make sure they use hand sanitizer after exiting an elevator. He and his co-authors suggested hospitals should put sanitizer dispensers in elevators.

When washing hands or using cleansing gel, people should remember to pay particular attention to fingertips — especially the forefinger of the dominant hand, he said.

"Often when people use a hand cleanser, they're very good at washing their palms, but not their fingertips. And yet most of the transmission does not occur in the middle of the hand, it occurs at the periphery of the hand."

The study was published in the journal Open Medicine.

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