Hand touches on the surfaces of a healthcare waiting area.

Sir,

The COVID-19 pandemic has triggered an urgency to prevent the rapid transmission of diseases. Environmental surfaces play a role in the transmission of diseases through physical contact with users [1]. Pathogens could persist on surfaces for certain periods [2], and transmission of diseases could occur when hands of users touch a contaminated surface. It is necessary to pay attention to environmental surfaces in public areas, especially high-touch surfaces [3] that tend to be touched mutually by different users [4]. Only a few studies have been conducted in public areas of healthcare facilities [5], despite the high potential for disease transmission in these areas due to the higher possibility of surfaces being mutually touched by many users.

Previous studies on healthcare surfaces indicated the abilities of different surface materials to retain and transmit pathogens [2,6]. In practice, surface materials are applied on to objects in particular shapes and sizes, yet most studies only consider the types of surface materials generally; only a few studies addressed other aspects of surface design [7]. Most objects are three-dimensional with surfaces on several sides and different types of materials. Such three-dimensionality presents different possibilities of touch occurrences, but these were rarely considered when studying high-touch objects in the healthcare environment. This study explores the occurrences of hand touches in a healthcare waiting area, by identifying where exactly the touches occurred on object surfaces.

In this study, the occurrences of hand touches were observed on 26 object surfaces consisting of doors, chairs, and horizontal working surfaces in a waiting area of a ‘puskesmas’, a type of healthcare facility in Indonesia. The location of each touch on the surface was noted, along with the types of user (adult, child, or staff) and the related activities. Each object was observed during a 2-h period, resulting in a total of 1340 hand touches (723 by adults, 312 by children, and 305 by staff). The data from the observation were mapped into surface touch maps for each object.

The results indicate that there are certain parts of object surfaces most likely to be touched by the users, and this seems to relate to the users' activities (Figure 1 ). The door surface areas most likely to be touched were the door handles and their surrounding areas, the door panels, the door frames, the side of the door panels, and the nearby wall. These touches occurred when the users opened or closed the door, leaned on or stood near the door, and when the children played around the door. The waiting chair surface areas most likely to be touched were the front edge of the seat, the area between connected seats, the top surface of the armrest, and the edge of the backrest. These touches occurred when the users sat, stood up from sitting position, or when the children played near the chairs. Touches on horizontal working surfaces mostly occurred on the top side, around the edge of both sides of the surfaces. These touches occurred during the healthcare service activities, such as during the measurement of patient blood pressure or when the staff wrote on the medical cards or handed them to the patient.

Figure 1

Map of hand touches on door and chair surfaces.

The hand touches on surfaces also seemed to be related to some other aspects. Different patterns of touch were found on the closed and opened doors. The touches on the closed doors tend to be concentrated around the door handles and extended to the wall area near the handle. Meanwhile, the touches on the doors that remained open were found not only around the door handles but also on the whole door panel surfaces. For horizontal working surfaces, most touches were observed on the top side around the edge of the surface; however, when the surfaces are higher, touches were also found on the side surface. The position of the object in relation to other objects could also trigger particular hand touches. Touches on the backrest edge were observed on the front row chairs when the users from the back row used the backrest as a support to stand up from a sitting position. The upper parts of the surfaces were touched by adults, while the lower parts were touched by children. The children tend to move around extensively while waiting, so their touches were found on many surfaces, sometimes on unusual spots.

During a pandemic, reducing the risk of disease transmission could be supported by minimizing mutual touches on environmental surfaces in public areas. This study indicates that there are particular areas of surfaces on which hand touches most likely occurred. Various aspects of surfaces should be considered in the design of objects and the application of surface materials to minimize the transmission of disease. The findings could also inform the procedures for environmental surface cleaning [8], by paying more attention to particular parts of surfaces.

Conflict of interest statement

None declared.

Funding sources

The study was funded by the , and through PDUPT Research Grant.