The association of environmental surface contamination with hand hygiene and infections in nursing homes: a prospective cohort study

Summary Background Little is known about the presence of infections in nursing home residents, the causative microorganisms, how hand hygiene (HH) influences this presence, and to what extent environmental contamination is associated with the incidence of residents’ infections. Aim To establish (1) whether environmental contamination can be used as an indicator for HH compliance, and (2) whether environmental contamination is associated with the incidence of infections. Methods Collection of environmental surface samples (ESS) in an exploratory study as part of a HH intervention in 60 nursing homes. ESS results on three distinct surfaces (nurse’s station, communal toilet, and residents’ shared living area) were compared to nurses’ HH compliance and to residents’ infection incidence. Real-time polymerase chain reaction assays were used for the detection of norovirus genogroup I and II, rhinovirus and E. coli. HH compliance was measured by direct observation. Infection incidence was registered weekly. Findings We detected rhinovirus (nurse’s station: 41%; toilet: 14%; living area: 29%), norovirus (nurse’s station: 18%; toilet: 12%; living area: 16%), and E. coli (nurse’s station: 14%; toilet: 58%; living area: 54%). There were no statistically significant (p Conclusion We detected rhinovirus, norovirus and E. coli on surfaces in NHs. There were no convincing associations between environmental contamination with HH compliance or illness incidence. This study provides reference data about surface contamination.