The COVID pandemic has raised awareness that hygiene is critical, and has highlighted the risk of infection spread when touch surface cleanliness is overlooked. However, manual cleaning is not always consistent, and surfaces assumed to be safe may actually be contaminated. It is well documented that only 5 per cent of people wash their hands correctly after using the toilet, so are you confident that the door handle is safe to use?
To investigate this further, Glana undertook a series of trials at the University of Strathclyde comparing normal daily cleaning procedures with the new Axiene hygiene innovation, to understand the influencing factors in cleaning, and to assess the level of protection that can be achieved.
Pandemic increased focus on good hygiene
Manual intermittent cleaning is universally regarded as the standard procedure to ensure that facilities and touch surfaces remain hygienic and safe for people to use in institutional, commercial, and domestic buildings. However, the emergence of the COVID pandemic resulted in an ever stronger focus on improving hygiene standards and ensuring a higher level of safety for all users – nowhere more so than in hospitals and other healthcare facilities.
During the initial response to COVID, the increased hygiene requirements on high-touch surfaces, such as door handles, generally demanded a greater frequency of manual cleaning, and a greater demand for antibacterial disinfectants. As the pandemic crisis evolves, and cleaning and maintenance staff become more accustomed to new hygiene procedures, it is relevant to review the efficacy of the revised cleaning processes, and to assess if these are truly appropriate to the increased hygiene levels needed for protection of the general population.
Studies under controlled conditions
Studies have assessed the effectiveness of cleaning high-touch surfaces under controlled conditions, and while the findings are clearly interesting, they may be considered indicative only. In reality, the cleanliness of high-touch surfaces is subject to practicalities such as errors in cleaning procedures, dirty/re-used cleaning equipment, poor cleaning fluids, the behaviour of users, the frequency of use, and the location. These practicalities mean that simply increasing the frequency of cleaning will not always provide the desired increase in hygiene and safety. This has been recognised across multiple industries – for example within the hospitality sector, some cruise ships now advise guests to use paper wipes when touching washroom door handles, even though cleaning of handles is part of the regular hygiene procedure.
In addition to enhanced cleaning practices, a number of alternative innovations have evolved to improve high-touch surface safety. These include new chemical and natural cleaning fluids, fogging spray systems, handle materials, gel dispensing handles, and UV lighting systems. While each of these options has unique benefits, they may not provide the consistent or continuous surface protection required, and there remains a need to evaluate the ongoing cleanliness of the high-touch surface with respect to the cleaning procedure and the continuous protection offered.
Tests at Strathclyde University
To understand the efficacy of the cleaning procedures, it was decided to complete a series of tests in a typical commercial/ educational facility. The Estates office and facility at the University of Strathclyde kindly agreed to allow this assessment as a case study. The Estates office has high occupancy numbers, with office, workshop, university maintenance, and cleaning staff, all working in the building, resulting in high frequency use of the access ways and handle touch surfaces. High-touch surfaces throughout the university are subject to a strict cleaning regime on a once per day basis. This facility, location, and usage, is representative of any typical facility in public/multi-user service, and the findings here are expected to be representative of hygiene standards in offices, care homes, schools, and restaurants, etc
For comparison, the innovative Axiene Clean Touch system was also fitted at the Estates office. Axiene provides ongoing, active, disinfectant treatment on the touch surface of the handle to deliver continually replenished anti-bacterial protection for users. The manually cleaned handle and the Axiene hygienic handle were located on neighbouring doors in a common corridor, ensuring that both handles would be subject to similar footfall traffic and similar use. This allowed a direct comparison of manual intermittent cleaning versus the alternative, new technology. The existing handle was subject to the normal daily cleaning process by maintenance staff, and the Axiene handle was maintained as per the product instructions, by the same staff, albeit requiring less cleaning attention
Start of comparison trial
On 7 October 2021, the comparison trial commenced, and continued until 15 November 2021. Throughout the trial duration, swab samples of the touch surfaces on both the existing, manually cleaned handle, and the Axiene handle, were sent for analysis by an independent laboratory. This allowed a direct comparison of the surface cleanliness data from both the existing handle and the new Axiene product.
The independent assessment results demonstrated that manual intermittent cleaning provides very short-term protection only. The cleanliness of the touch surface is impacted both by any degree of human error by the cleaner, and the effectiveness of the cleaning materials used. Only occasionally did the manually cleaned handle come close to complying with the international regulations for the health and food sector, advised as a maximum limit of 5 cfu (colony-forming units) /cm2 . Directly after cleaning, and following some use, the contamination on the handle touch surface increases drastically, with each user depositing bacteria onto the handle surface and collecting bacteria onto their own hands
Swab tests
Swab test results of the manually cleaned handle indicated a worst-case total surface colony count of up to 240,000 cfu, equating to 2,376 cfu/cm2 . As a comparison, the active antibacterial surface treatment of the Axiene handle repeatedly and consistently returned a total surface colony count of <10 cfu on the complete handle surface area, equating to <0.07 cfu/cm2 . While the surface contamination on the manually cleaned handle varied throughout the day and over the trial period, the very low surface contamination on the touch surface of the Axiene handle was maintained continuously throughout the duration of the trial. It was noted that the Axiene performance surpassed the requirements of the international regulations on every test
The recorded results are compared in Figure 1, and indicate that the manual intermittent cleaning procedure does not provide ongoing protection, and does not satisfy regulation requirements. An alternative system such as the Axiene handle has been demonstrated to provide superior surface protection against pathogens on an ongoing basis.
Impact of intermittent daily cleaning
The effectiveness of intermittent normal daily cleaning of high-touch surfaces can be illustrated by the graphic in Figure 2, showing the surface contamination growth over time caused by multiple users (saw-tooth pattern). This is entirely representative of normal use, and could represent any typical door handle installation in a multi-user facility, such as care homes, offices, education, or hospitality facilities. This indicates that manual intermittent cleaning may not provide the required level of cleanliness. By comparison, the innovative Axiene solution can be seen to continuously and consistently provide a safer touch surface.
This representative case study, and the independent results, clearly demonstrate that the efficacy of manual intermittent cleaning on high-touch surfaces is entirely variable, being a function of the cleaning methods employed and the usage of the handle. The real-life trials, and comparison of standard cleaning procedures with new technology, show the huge improvement in surface cleanliness and user protection that can be achieved on a continuous basis by employing active surface treatment provided by the Axiene Clean Touch system. The results of the study indicate the substantial increase in user safety that can be achieved by institutions and businesses when seeking to improve the health of their facilities, boost the confidence of their employees or visitors, and demonstrate their duty of care as a responsible and caring organisation.
Ian Graham
Ian Graham is a Chartered Engineer, Fellow of the Institution of Mechanical Engineers, and the founder of Glana, based in Glasgow. He graduated from the University of Strathclyde, gaining a 1st class degree in Mechanical Engineering and Business Management, and, following a number of years working on multi-million pound contracts in the energy and construction sectors, formed Glana to develop the technology that has now formed the Axiene Clean Touch System. He has developed the Axiene product working with specialists from the NHS, universities, and industry, ‘progressing from an early-stage concept into a market-ready product that has now been launched to help enhance hygiene across all sectors and applications’. He explains: “The IP-protected surface treatment process, and pioneering design, are now being further developed into a range of supplementary products to provide protection on high-touch surfaces, and to further help the fight against infection spread.”