Coronavirus disease 2019; COVID-19; 3D printing; door handle
Human-to-human transmission of SARS-CoV-2 is facilitated by droplets, contaminated hands, or surfaces of various materials.
Environmental contamination by patients with SARS-CoV-2 has been suggested as a likely medium of transmission.
One recent study demonstrated that SARS-CoV-2 may remain viable and infectious on surfaces for days, reminiscent of the nosocomial spread and fomite transmission of SARS-CoV-1.
Besides viruses, hospital environmental surfaces may easily be contaminated by multidrug-resistant organisms.
Therefore, environmental surfaces in hospital settings may act as a vectors for the transmission of viruses and multidrug-resistant organisms responsible for nosocomial infections.
Both healthcare providers and the work environment may serve as vectors for disease transmission by viruses and multidrug-resistant organisms among patients.
Reducing bacterial transmission via hands and the frequently touched door handles may reduce the risk of healthcare-associated infections.
The use of automatic doors may be a solution to decrease the spread of microorganisms acquired from door handles, but it is not feasible in most hospitals. A recent study attempting to address this issues focused on improving of the design of door handles.
Here, we present a novel device to augment existing door handle with the goal to avoid direct contact by hand, reducing the spread of microorganisms via healthcare workers.
The production of this device was a multidisciplinary team effort. Surgeons provided their direct insights based on their infection control strategies in the operating room. Engineers at the 3D Printing and Design Center of our hospital supported the technical aspects of materializing the design concept. The product was designed by using SolidWorks (Waltham, MA, USA) and Autodesk® Fusion 360™ (San Rafael, CA, USA). Before putting the design into production, fine element analysis was completed to ensure that the structure could sustain mechanical forces from repeated use. The computer-aided design files were then saved in the stereolithography (.stl) format for additive manufacturing ([D-force, Kaohsiung, Taiwan]). Additive manufacturing technology not only allows our team to produce prototypes rapidly and accelerates design iteration, but it also enables small volume manufacturing in a short period of time at a low cost. As for the material, polylactic acid was chosen for its low cost, readily available supply, and durability.
At our hospital, enhanced infection control measures were implemented in January, 2020 soon after reports of COVID-19 transmission emerged in China. We evaluated residual contaminant levels on the door handle in a medical ward 5 minutes and 3 hours after routine cleaning by using the adenosine triphosphate (ATP) bioluminescence test. An ATP bioluminescence value < 150 was defined as clean. We found a significant increase in ATP readings on door handle 3 hours after routine cleaning compared to readings obtained 5 minutes after cleaning (18.3±8.4 versus 1188.3±72.6, P value=0.001). Aerobic colony counts in sheep blood agar plate from the hands of healthcare workers (n=10) also increased significantly after touching the door handles (18.9±24.0 before touching versus 28.6±37.9 after touching, P value=0.018). After installing the novel extension device on the door handles, we found similar ATP readings on the surface of the extension device 5 minutes and 3 hours after routine cleaning. Consistently, aerobic colony counts from hands of healthcare workers (n=10) were similar before and after operating the door.
In conclusion, the novel door handle extension device reported here is a feasible approach to reduce hand contact with environmental surfaces and disease transmission in hospital settings, which is critically important during the COVID-19 pandemic.
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In Press Journal Pre-Proof
Funding: This work was supported in part by grants from Taipei Veterans General Hospital (109 CIC005), and Ministry of Science and Technology in Taiwan (MOST 107-2410-H-075-001).
Conflicts of Interest: none: All authors have participated in the preparation of this manuscript.
© 2020 Published by Elsevier Inc.