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Background High-touch surfaces in the hospital environment, such as bed rails, tray tables, and supply carts, are considered important in the epidemiology of transmission of healthcare-associated infections (HAIs). If not removed adequately, pathogens can remain viable on fomites for months, serving as a source of transmission on a number of susceptible patients. An additional source of transmission for which there is limited available research is portable medical equipment (PME). The purpose of this study was to investigate the patterns and sequence of touch events among health care workers, patients, surfaces, and equipment in the hospital environment, to better inform our understanding of potential infection transmission pathways. Methods This observational study was conducted at a 120-bed Veterans Affairs (VA) hospital in Temple, TX, on six inpatient units. Continuous 24-hour observation was performed separately on each unit by two research team members observing for 8-hour sessions. Observations of healthcare workers’ (HCW) touches of surfaces, patient, and objects were recorded in sequence. The observations of touches were recorded as a sequence of events analyzed with sequence analysis software and visually represented by network plots. Results The sequence of touches are visualized in the network plots. The sequence analysis revealed the top 20 subsequences. Conclusion The network plots revealed that almost all of the items touched were connected to at least a few other items in a sequence of touches. The patient, the most commonly touched item, had a potential for contamination from other surfaces as well as a potential for transmitting pathogens to other surfaces. Thus most items in the room have the potential to be contaminated if indeed the patient is considered the primary source of the contamination, and the patient has the potential be become infected if the other objects are consider the source. Our results illustrating the interconnectedness of touch sequences between HCW and PME are consistent with the study by Hayden et al. that showed that HCW’s hands were contaminated almost as much by touching only the environment in the patient room as when they touched both the patient and environment. Disclosures C. Jinadatha, NIH: Grant Investigator, Grant recipient. C. Dale, NIH: Grant Investigator, Grant recipient and Research grant. R. Whitworth, NIH: Grant Investigator, Grant recipient. M. Stibich, NIH: Grant Investigator, Grant recipient.

Portable Medical Equipment: A Network Analysis Showing the Potential Missing Link in Infection Prevention Practices