Quantitative summarization of High-touch Fomites for Healthcare Associated Infection (HAI) Risks: a systematic review

Background Nearly 700,000 people in the U.S. acquire healthcare associated infections (HAIs) annually, and the situation might have worsened during the COVID-19 pandemic. Evidence has shown that fomites, such as environmental surfaces and medical devices, play a critical role in the transmission of HAI. Our study systematically reviews findings from studies that provided quantitative evidence on the contact pattern and/or rank of high-touch surfaces (HTS). Methods We systematically searched 4 major databases (PubMed, Web of Science, CINAHL and Cochrane Database) for articles published before June 30, 2023 based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (international prospective register of systematic reviews registration CRD42023408483). Relevant search terms we used, including Fomites AND Contact Pattern (eg high-touch OR mutual-touch) AND Healthcare Setting (eg ICU OR Emergency Department) AND HAI (eg Clostridiodes difficile ). We also searched for relevant articles in the reference list. Result A total of 2,826 studies were screened across all four databases with 7 studies meeting the eligibility criteria. The fomite which was most frequently touched was the bed rail. Frequently touched surfaces are supply carts, bed surfaces, patient files/notes, medication carts, bedside tables, and Intravenous pump. Other frequently contacted fomites were vital sign monitors, phones, curtains, computer/computer keyboards, chair and sink surfaces, blood pressure cuffs, computer mouse and light switch. Common mutually touched fomites were bedside rail, patients’ body, patient file, bedside table and hand washing faucet handles. Only 2 studies utilized a covert observational technique, the other 5 applied either direct observation or did not state explicitly. Conclusion Our study provides empirical data which is important for the prioritization in cleaning and disinfection practices, development of HAI prevention and control protocols, and the optimization of cleaning and disinfection resources. We suggest that more rigorous studies quantifying high-touch fomites, especially those including detailed contact duration, sequence and temporal variations, be conducted.