Effect of
Surface Coating and Finish upon the
Cleanability of Bed Rails and the
Spread of Bacteria
Lay Summary - June 2010
Background
Hospital-acquired
infection is transmitted by hands
and via the environment. Although
cleaning is likely to reduce the
transmission of bacteria, the
evidence is poor. A previous study
which looked at different cleaning
practices in intensive care wards
identified bed rails as being some
of the most heavily contaminated
surfaces within the ward
environment. The same study also
demonstrated that the number of
bacteria present on moulded plastic
rails was significantly greater than
that on painted steel rails.
Aims
This subsequent
laboratory-based study was designed
to assess whether surface coating
and/or finish
i)
affected the
ease with which bacteria could be
removed from bed rails during
cleaning
ii)
influenced the
number of bacteria transferred from
a contaminated bed rail to hands
(and vice versa) during contact
Methods
Five different
bed rails representative of those
currently in use within the NHS were
selected for study. The hand-grip of
one of the moulded plastic foot
boards had two different textures to
facilitate handling. The test
surfaces were labelled rails A to F:
Rail A: a moulded
plastic foot board
Rail B: a moulded
(visually rough) plastic foot board*
Rail C: a
stainless steel side rail
Rail D: a moulded
(visually smooth) plastic foot
board*
Rail E: a nylon
painted mild steel side rail
Rail F: a moulded
plastic side rail
* different
surface-types of the same moulded
foot board.
Six solutions
were used to mimic what might reach
the bed rail in practice:
i)
saline (salt
water)
ii)
protein
solution - used to represent food
residues
iii)
synthetic urine
iv)
synthetic
faeces
v)
horse blood -
used to simulate human blood
vi)
bovine serum
albumin – used to simulate human
blood products
Bacteria were
added to each solution and used to
artificially contaminate the six bed
rails. The ability of either a
microfibre cloth or an antibacterial
wipe to remove the bacteria
from each rail was assessed. The
number of bacteria transferred from
each bed rail to a clean finger was
also determined as was the number of
bacteria transferred to each rail
from a ‘dirty’ contaminated finger.
Results
After the rails
were cleaned with a microfibre cloth
no bacteria remained on rails B, D
and E. Microfibre cloths were less
effective in removing bacteria from
rails A, C and F (i.e. when using a
microfibre cloth, rails A, C and F
were the hardest to clean; Figure 1)
When the same
contaminated bed rails were left for
24 h before being cleaned, wiping
with a microfibre cloth removed all
bacteria from rails A, B, C and D.
However, some bacteria remained on
the surface of rails E and F (i.e.
the microfibre cloth was less
effective in cleaning rails E and F;
Figure 2).
Unlike the
microfiber cloths, the antibacterial
wipes were impregnated with a
disinfectant. Cleaning the bedrails
with an antibacterial wipe removed
all bacteria from all rail types
(Figure 1 and 2).
Figure 1: A solution containing
bacteria and synthetic food residues was used to
artificially contaminate the six bed rails. This
graph shows the number of bacteria on each bed rail
before and after they were cleaned with a microfibre
cloth or antibacterial wipe. Rails were cleaned
immediately after they were contaminated.
Figure 2: The number of bacteria
on each bed rail before and after they were cleaned
with a microfibre cloth or antibacterial wipe. Rails
were cleaned 24 hours after contamination.
In the presence of saline, more
bacteria were transferred to clean, disinfected
fingers from rails A, B and D than from rails C, E
or F. The effect of the different solutions varied
depending on bed rail. However, the presence of
blood increased the number of bacteria transferred
from all rails (Figure 3). When the blood was
allowed to dry onto the surface for 24 hours, the
transfer to fingers was greatest from rail B.
Figure 3: The percentage of
bacteria transferred from a contaminated bed rail to
a clean (disinfected) fingertip.
In the presence of saline, more
bacteria were transferred from a contaminated finger
to rails B, C, D and E than from rails A or F. The
presence of blood reduced the number of bacteria
transferred to rails A, C, E and F. However, it had
no significant effect upon bacterial transfer to
rails B and D (Figure 4).
Figure 4: The percentage of
bacteria transferred from a contaminated fingertip
to a clean (disinfected) bed rail.
Conclusions
The bed rail is one of the few
surfaces in the ward environment that is touched by
staff, patients and their visitors. Consequently,
bed rails can become heavily contaminated. Bed rails
that are difficult to clean and/or those from which
bacteria are readily transferred to fingers during
contact could contribute to the spread of
hospital-acquired infection.
-
A moulded plastic side rail (Rail F)
was the most difficult bed rail to
clean
-
Bacteria were readily transferred
from contaminated fingers to a
moulded plastic foot board (rail B).
-
Rail B also readily transferred
bacteria to fingers during contact
-
Neither rail F nor rail B are
particularly suited to the ward
environment
-
Rails that are comparatively easy to
clean may also readily transfer
bacteria to fingers during contact
-
It is important that ‘easy-to-clean’
surfaces are adequately cleaned
-
Cleaning of bed rails with
antibacterial wipes should be
incorporated into cleaning protocols
-
Studies similar to the one described
here should be conducted to build up
a library of materials appropriate
for use in the hospital ward
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