Is it correct to assume that manual daily cleaning provides the best protection for people who frequently use high-touch surfaces like door handles? It’s well documented that only 5% of people wash their hands correctly after using the toilet, so are you confident that the door handle is safe to use?
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.
To investigate this further, Glana Ltd undertook a series of trials at the University of Strathclyde comparing normal daily cleaning procedures against the new Axiene hygiene innovation to understand the influencing factors in cleaning and to assess the level of protection that can be achieved.
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 has driven a clear need to improve hygiene standards and ensure a higher level of safety for all users.
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 anti-bacterial 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 assess if these are truly appropriate to the increased hygiene levels needed for protection of the general population.
Studies have assessed the effectiveness of cleaning high-touch surfaces under controlled conditions, and whilst the findings of such studies 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. Whilst each of these options have unique benefits, they may not provide the consistent or continual 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 continual protection offered.
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, usage and cleaning regime 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, 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 per the product instructions, by the same staff albeit requiring less cleaning attention.
AXIENE CLEAN TOUCH SYSTEM
On 7th October 2021, the comparison trial commenced and continued until 15th 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 subject to human error by the cleaner and is dependent on the effectiveness of the cleaning materials used. Only occasionally did the manually cleaned handle come close to complying with the international regulations for health and food sector, advised as a maximum limit of 5cfu’s/cm2 (colony forming units). Directly after cleaning and following some use of the standard existing handle, 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 test results of the manually cleaned handle indicated a worst-case total surface colony count of up to 240,000cfu’s equating to 2376cfu’s/cm2. As a comparison, the active anti-bacterial surface treatment of the Axiene handle repeatedly and consistently returned a total surface colony count of <10cfu’s on the complete handle surface area, equating to <0.07cfu’s/cm2.
Whilst 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 continually 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 below and indicate that the manual intermittent cleaning procedure offers only short-term improvement, 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 and continual basis.
TABLE OF INDEPENDENT LAB ANALYSIS RESULTS
When someone touches the Axiene handle, they’re touching a continually disinfected and safer surface as the disinfectant actively kills bugs within seconds and keeps the handle protected for both you and the next person. This means that you’re not leaving your germs or picking up bugs from the person before you, which helps prevent infection spread.” – Ian Graham – Founder & Developer of Axiene Hygienic Handles
The effectiveness of intermittent normal daily cleaning of high-touch surfaces can be illustrated by the following graphic, signifying the surface contamination growth over time caused by multiple users (saw-tooth pattern). This is entirely representative of normal use and can represent any typical door handle installation in a multi-user facility e.g. care homes, offices, education or hospitality. This indicates that manual intermittent cleaning may not provide the required level of ongoing cleanliness. By comparison, the innovative Axiene solution can be seen to continually and consistently provide a safer touch surface.
TYPICAL DAILY HIGH-TOUCH SURFACE CONTAMINATION (TWICE PER DAY CLEANING)
The findings from the trials at the University of Strathclyde verified the performance of the Axiene Clean Touch system and substantiate the test results from numerous previous installation trials and studies carried out by Glana Ltd. Throughout 2021, a number of multi-user facilities volunteered to support product development works by installing the Axiene system on a trial basis. Amongst the trial sites were a primary school in Lincolnshire, an office complex in Chester, an office complex in Glasgow and a care home in Glasgow.
This wide range of different facility types was engaged on the trials to allow an extensive assessment of achievable performance when the active surface treatment was used. These facilities all presented trials in heavy duty areas with high occupancy rates, allowing a full evaluation of the product performance and confirmation of the durability in a real-world setting.
The factors that may impact the high-touch surface cleanliness on standard installed handles are variable across the different types of facilities and include;
Efficiency – is the existing handle surface correctly cleaned by the operative? A casual wipe will not decontaminate the full touch surface.
Materials – is each surface cleaned using a new wipe? Re-used, old and dirty cleaning wipes will transfer contamination between the wiped surfaces
Fluid – is the correct cleaning fluid used? Appropriate and broad-spectrum cleaning fluid is a key factor e.g. alcohol will quickly evaporate and provide short term protection only.
Location – is the handle is in a high-traffic area? If so, the cleaning frequency must be increased to provide ongoing protection.
Behaviour – does user activity present a risk? Multi-occupancy use in low hygiene areas such as washrooms, common access ways, food or care settings increases the potential for contamination.
The facility trials provided an understanding of these effects with individual installations presenting different aspects. For example, the primary school corridor access trial experienced in excess of 300 uses/day by uncleaned children’s hands and the office complexes allowed assessment on lower use but high contamination washroom facilities.
The Axiene Clean Touch system is not susceptible to the variable factors that impact standard cleaning processes and surface condition. The independent lab analysis results from these previous trials has repeatedly and consistently reported a total surface colony count of <10cfu’s on the complete handle surface area, equating to <0.07cfu’s/cm2.
Recalling the international regulations maximum limit of 5cfu’s/cm2, it can be seen that employing an active treatment system can achieve a surface condition that will allow compliance with regulation requirements and can additionally provide confidence for both users and hygiene managers in the hygiene and health condition of the facilities. This can be achieved irrespective of the installation location, type of facility or institution or the type of use.
The analysis results demonstrated that Axiene active surface treatment can achieve extremely low surface contamination on an ongoing and consistent basis. The novel treatment of the grip area offers a tenacious level of protection on the touch surface of the handle to provide a level of protection that cannot be equalled by a manual intermittent cleaning process.
In addition to the analytical assessment, user comments were also considered as part of the feedback from these installation trials. With any new product there is a degree of learning and user familiarity and Axiene also requires this adaption. The most noticeable user feature of Axiene is the cold or slight moist film on the handle grip area. This characteristic is caused by the continually replenished, skin safe disinfectant treatment on the touch surface and whilst user’s question this on the first use, it becomes quickly accepted and appreciated. Ian Graham, founder of Glana Ltd and developer of Axiene explains that “When someone touches the Axiene handle, they’re touching a continually disinfected and safer surface as the disinfectant actively kills bugs within seconds and keeps the handle protected for both you and the next person. This means that you’re not leaving your germs or picking up bugs from the person before you, which helps prevent infection spread.”
The University of Strathclyde trial reported similar verbal responses to those from users at all other sites, where people welcomed the function of the product, appreciating that they are touching a surface with improved protection. Feedback from care homes, offices and schools showed that users were more aware of hygiene when using the Axiene product and that this fostered a personal realisation of hand cleanliness. This suggested that the Axiene Clean Touch system provided a secondary benefit in hygiene awareness raising for users, in addition to the core benefit in improved touch surface hygiene condition.
This trial and case study was selected as being representative and typical of any building or facility in daily use being subject to high traffic and multiple users. The case study and the independent results clearly demonstrate that the efficacy of manual intermittent cleaning on high-touch surfaces, such as door handles, 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 versus new technology, indicates the huge improvement in surface cleanliness and user protection that can be achieved on a continual basis by employing active surface treatment provided by the Axiene Clean Touch system. The results of the study signify the large 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 own duty-of-care as a responsible and caring organisation.