Bacterial Contamination of Critical Care Observation Charts: a Randomized Trial Comparing Matt and Antimicrobial Cellomed Laminates.

Although hand hygiene remains an important intervention in reducing the incidence of nosocomial infection, poor compliance may limit its impact especially in critical care units when clinical demands on staff are high. Although focused programmes to improve compliance have been shown to produce good results this may not be sustained in the longer-term. Hand hygiene only reduces and does not completely eliminate hand contamination and therefore transmission of hand microbes to the near-patient environment including paperwork will inevitably occur. It is recommended that healthcare professionals undertake hand hygiene after interacting with the patient environment even if contact with the patient has not taken place. In practice this may not occur as the potential for the environment to act as a reservoir may not be realised by healthcare workers.

Doctors reviewing physiological trends on critical care observation charts often move between bed-spaces without touching patients or undertaking hand hygiene. Since doctors exhibit the lowest level of compliance with hand hygiene programmes, it is likely to be difficult to persuade them to undertake additional manoeuvres before and after handing paperwork as has been recommended. Effective cleaning and disinfection of the near-patient environment should occur concurrently to hand hygiene programmes in order to reduce transmission. Critical care observation charts in Darlington Memorial Hospital are paper-based, located in near-patient hand-touch zones and are therefore prone to contamination. It is proposed that treated paperwork may exhibit reduced levels of contamination; decreasing the potential for cross infection resulting from an area of the near-patient hand-touch environment that has received little attention in the past.

Recently published research (2009) has reported that up to 90% of critical care observation charts may be contaminated with potential or actual pathogens. It is on critical care where nosocomial infections potentially have the most devastating effect. Cellomed is a triclosan based laminate that has been available since 2008 through Celloglas, a UK company specialising in decorative and other print finishes. Celloglas claim the laminate possesses anti-microbial activity citing three reports from Ciba laboratories (Switzerland), Scientific Services (UK) and Manchester University (UK). All tests have shown activity against MRSA and E.Coli with the most recent test reporting additional activity against Enterococcus, Stenotrophomonas and Klebsiella when compared to control. To date there have been no studies of Cellomed carried out in the clinical environment. Cellomed can be applied to any hospital paperwork through a lamination process. It is proposed that 'treated' paperwork will exhibit reduced levels of contamination when used in the clinical environment compared with standard patient documentation.

This will be a prospective, randomised study comparing percentage increases in bacterial total viable count on critical care observation charts coated with one of two different materials; standard matt or Cellomed antibacterial laminate.

Two-hundred of our standard white critical care observation charts will be provided to Celloglas (Leeds, UK). 100 of these will be laminated with standard matt (group 1) and 100 with anti-microbial Cellomed (group 2). The two types of charts will be separately packaged by Celloglas, labelled and delivered to lead investigator at Darlington Memorial Hospital. The packages will be opened on a sterile work surface and the lead investigator will number the charts in a random order determined by an Excel spreadsheet. Randomisation will be restricted to ensure 100 charts remain in each group. The lead investigator will record which chart type is assigned to each number for analysis purposes. The charts will be used by the critical care nursing staff in the assigned order to ensure the random sequence is maintained.