Hospital elevator buttons show more germs than toilet stall surfaces

Hospital elevator buttons harbour more bacteria than surfaces in hospital bathrooms, Toronto researchers have found.

The findings are a reminder for patients, family members, visitors and health-care providers to wash their hands, including after touching the buttons in an elevator, the team said in Tuesday’s issue of the journal Open Medicine.

For the small study, scientists swabbed 120 elevator buttons and 96 toilet surfaces at three teaching hospitals in Toronto over weekdays and weekends.

Elevator buttons showed a higher prevalence of colonization by bacteria (61 per cent) than toilet surfaces (41 per cent), Donald Redelmeier, director of clinical epidemiology at Sunnybrook Health Sciences Centre, and his co-authors found.

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"The principal motivation for our study was that elevators inside modern hospitals are ubiquitous and active and an essential part of patient care and are colonized by bacteria to a degree that's actually slightly greater than a toilet and potentially a contributor to hospital-acquired infections that all might be completely avoided through better hand hygiene," Redelmeier said.

Redelmeier advocated for everyone in hospitals, patients, their relatives and visitors as well as health-care workers, to step up their hand hygiene.

"When you are waiting for the elevator, that's a good time to be washing your hands," such as with gel from a hand sanitizer dispenser.  

Redelmeier’s suggestions include:

• Activate the buttons with your elbow.
• Use another object such as a pen to press the button.
• Ask someone else to push the button for you, which is often his choice.  

The bacterial species were identified by a technician who didn’t know where the samples were taken. The experiment was also repeated at the same hospitals a few months later.

For each public washroom with a manual toilet, scientists took swabs from the exterior and interior door handles, the privacy latch and the toilet flusher.

The elevator buttons were colonized with bacteria commonly found on our skin and the majority of bacteria were harmless in terms of disease-causing capabilities. 

The tests weren’t able to pick up C. difficile or other gastrointestinal bugs that might be expected in washrooms.

Wash up, you're being watched

Previously, researchers have also tested for bacterial contamination on objects including neckties worn by male doctors, stethoscopes, and computer keyboards.

"There's studies showing that call bells and bedside tables and blood pressure cuffs and all those things that are nestled right next to the patient, those typically carry the same pathogenic bacteria that patients carry," said Dr. Michael Gardam, director of infection prevention and control at the University Health Network and Women’s College Hospital in Toronto.  

"Those surfaces I really worry about, so that's why we want people people cleaning their hands right before touching a patient and right after touching a patient."

On Monday, Gardam and his colleagues in Hamilton published a hand hygiene study in the journal BMJ Quality & Safety that focused on compliance among health-care workers at two organ transplant units at a teaching hospital at UHN.

In the study, 60 health-care workers tested an electronic monitoring system for hand hygiene. The participants didn’t know what the research questions were.

Hand hygiene rates were three times higher when real-life auditors were in the line of the sight than when no auditors were present, the researchers found.

The rate of hallway hand washes per hour among health-care staff when an auditor was visible was 3.75 per hour compared with 1.48 per hour in a location where the auditor was not visible and to 1.07 per hour the week before.

"Everybody kind of knows that having somebody stand there looking at you might change your behaviour, but no one has ever actually nailed that. We've been able to show that not only does it happen, but it happens a lot," Gardam said.

The findings mean that hospital hand hygiene compliance rates, which hospitals in Ontario publicly report, are probably substantially lower than thought, he said.

The next step for hospitals like UHN might be to consider adding electronic monitoring systems. The one in the study is used in the U.S. but not in Canada.

The monitoring study was funded by Canada Health Infoway, the Health Technology Exchange, Infonaut Inc., and by GOJO Industries.

A Canada Research Chair in Medical Decision Sciences, the Canadian Institutes of Health Research and the University of Toronto's faculty of medicine supported the elevator button study.