These surfaces have good properties and don't encourage any sort of resistances.
edit: I see Pull Clean is trying to get people to clean their hands more, but I also think it is not good to ignore an existing good strategy for eliminating germs in one of the dirtiest places (door handles) in a hospital. I am wondering how well studied this is and if it results in a cleaner environment in a hospital setting compared to installing the copper surface handles everywhere.
I came to mention something similar I read many years back about copper, but it was funded by the "copper industry" and the article is on the Daily Mail from 2008.
I didn't realize that I had to manually page through the slides at the top to understand the product. I scrolled down and had no idea what the product was. Might want to put that first instead of hidden on slide 4.
I still haven't figured it out (partially for lack of trying, I'll admit). Kind of reminds me of Donald Norman's criticism of doors that require a user manual, even if it's only one word.
Last time I visited a hospital, there were gel dispensers beside every single door, already. I googled and those are under $10 for twice the capacity of the PullClean... so 1 PullClean vs 20 wall-mounted dispensers?
I think they'd really have to have some studies showing the different placement really made an impact for hospitals to buy this at scale.
Yeah, that was my thought, as well. Sanitizer dispensers are everywhere in hospitals. You can't walk through a door without passing one. Staff habitually sanitize on their way into a room, where they then put on sterile gloves to interact with the patent, and then dispose of the gloves on their way out.
This looks like a solution in search of a problem.
Our local hospital has hand sanitizer dispensers that talk to you as you go past them even "Have you washed your hands?" then light up sort of thing as they detect movement
Here's a report[0] given to the Sheffield Trust Executive Group talking about cystic fibrosis, one of the recommendations they made included:
"... bactericidal copper touch plates on doors and handles... "
For much the same reasons as other commenters have pointed out, they have excellent antimicrobial properties. I'm moving into a new build at the moment, and we're using copper for the very same reasons. Being quadriplegic, infections are an absolute nightmare to get rid of so these things are going to be invaluable.
What about my carefully cultivated habit of not touching the door? If I change habits and start touching doors someday I'll mistakenly touch the wrong door. If I mistakenly touch the wrong door I'll start spreading The Disease.
I might be an idiot but... how about automatic doors? (that you don't have to touch)
You want some WiFi app thingie? Ok, link the automatic doors to the nearest gel dispenser and when the ratio of door opening/dispenser use gets too low, the door only opens after the dispenser has been used.
Big Brother class 0 is the automatic doors don't open till you sanitize (connected over wifi). Or your phone/tablet disconnects from the wifi network 5 minutes after sanitization.
Big Brother class 1 is your smart wifi nametag displays how long its been since you used hand sanitizer for everyone to read.
Big Brother class 2 is it also goes on your permanent record for review time and of course malpractice lawsuit time via wifi.
I also think that these kind of gels give a false sense of security, I have anywhere up to four different carers coming through this house on any given day using the stuff. And they do something that might be slightly medical in nature, then it's a quick squirt of the gel and hey presto no more tiny stinky biting things!
But that is absolutely NOT how they work, these gels are generally designed to be used AFTER washing your hands and only work if you rub them in for up to 30 seconds. But I would be surprised if many people knew that, *II only knew that because - and this is going to sound like total hyperbole - my life literally depends upon people washing their hands.
I think it's really interesting that when doctors, nurses or any other medical professionals come through they always wash your hands but carers always seem to rely on the magic gel. People need education as well as these tools, not instead of.
There are handwashing demonstration soaps that include an ingredient that fluoresces under UV light. You wash your hands normally using the soap then a UV light shows you how bad you are at washin your hands.
UV sterilization works by disrupting the DNA of pathogens -- which is exactly the same mechanism that causes skin cancer. So I don't see this product arriving anytime soon.
That may be true of your basic drugstore Purell, which just contains ethyl alcohol. But the literature does indicate that hospital-grade hand sanitizers (a blend of alcohols, and/or a non-alcohol equivalent) are far superior and immediately effective against most organisms.
Hand washing should be done with runnin water and soap when possible. If you don't hav running water and soap you cannise handgels, but they don't kill everything. Alcoholgels don't kill c.diff. Alcohol gels only work on hands that are clean.
You need to be careful with the soap you chose because hands can be "too clean" - some soaps are harsh on the skin and cause conditions suitable for bugs.
Yeah this is correct for Noroviruses as well - good old soap and water is the most effective against Norovirus, more so than alcohol and disinfectant gels.
My wife works as a paediatric doctor in the NHS, and has told me that the regular use of alcohol gels leaves a slimy residue after 2 or 3 uses, prompting her to properly wash her hands (as well as wearing new gloves for every patient, obviously).
No problem, from the CDC[0] report entitled "Guideline for Hand Hygiene in Health-Care Settings"[1] From that reference it says, we have:
"Alcohols are not appropriate for use when hands are visibly dirty or contaminated with proteinaceous materials."
"Alcohols are rapidly germicidal when applied to the skin, but they have no appreciable persistent (i.e., residual) activity."
"Despite its effectiveness against these organisms, alcohols have very poor activity against bacterial spores, protozoan oocysts, and certain nonenveloped (nonlipophilic) viruses. Similarly, certain accepted methods for evaluating waterless antiseptic agents for use as antiseptic hand rubs require that 3 mL of alcohol be rubbed into the hands for 30 seconds, followed by a repeat application for the same duration. This type of protocol also does not reflect actual usage patterns among HCWs."
The alcohol gels are good, but I think they're not a cureall was my point.
I honestly don't know a single nurse / medical staff or even IT person in a hospital or university that thinks they are, though. You might not be giving people enough credit. Anecdotal, yes, but I've never seen people think of them as a "cureall" or even as a replacement of washing hands. It is always in addition or inbetween things where you can't get to a handwashing immediately (e.g., candidates shaking hands)shrug
You're absolutely right, my evidence is anecdotal. But I'm 36 years old now, and I've been in and out of hospital probably thousands of times and had medical care each day in one form or another.
So yes, anecdotes for sure. But that's one hell of a lot of anecdotes. :-)
The difference between anecdote and systematically gathered data to resolve a question isn't one of how extensive the anecdote is, its about how representative it is. (And, of course, there's other issues with anecdote about what other people think, since what that really is is is one persons inferences about what lots of other people think.)
Absolutely, and I would imagine that once I'd made my mind up about this there was a fair degree of confirmation bias thrown in as well. Along with a whole host of other Things One Mustn't Do When Collecting Trustworthy Data™.
Just from - terrible - experience, C. Diff is one bug which is certainly not sanitized by any sort of alcohol-based sanitizer. Spreading C. Diff throughout a hospital population (even one floor) is pretty devastating and dangerous.
Is there any empirical research showing that placing sanitizer in door handles (as opposed to next to the door, or in the hallway, or wherever- - most hospitals have sanitizer everywhere) has an increase in use - especially for caregivers?
Unsure. In the hospitals I've worked at, there are sanitizing stations mounted either directly outside of any n-set of rooms (in ER's, they're mounted outside every room). It's habit for any health personnel to sanitize on the way in, rub a bit, wash hands at sink, and sanitize on the way out. In some cases (should theoretically be all...but hey, we're lazy) we wash on the way out as well.
Another solution in search of a problem. How about posts about truly interesting things like beneficial microbial populations etc. The days of "sanitizing" are rapidly coming to a close in the face of modern science.
The handles on inward opening doors are a vector for bacteria because there is no way of physically interacting with them without using your hands and touching the same place as everyone else. This product does not solve this problem, but instead tries to insert itself into the users' task flow at precisely the time when their goals are focused elsewhere (on opening the door). This is a rude interruption and will likely annoy rather than encourage more sanitization.
In the video (0:59), a woman sanitizes her hands then must immediately compromise them again to actually open the door.
I'd prefer to see a handle designed for safe operation by the elbows or feet so that the hands don't need to be compromised. Think of how a surgeon enters an operating room by pushing the door with their shoulder and their hands held up out of the way.
> This product does not solve this problem, but instead tries to insert itself into the users' task flow at precisely the time when their goals are focused elsewhere (on opening the door).
I agree wholeheartedly.
> This is a rude interruption and will likely annoy rather than encourage more sanitization. In the video (0:59), a woman sanitizes her hands then must immediately compromise them again to actually open the door.
The idea is that you open the door with one hand and dispense sanitizer into your other hand simultaneously and then sanitize the other hand after passing through.
I had to deal with my dad going in and out of hospitals for the last month now, and one of the facilities is a ~2 month old beauty (Kaiser in San Leandro).
I have never in my life seen so many motion sensor things from doors to sinks, so many sanitizer dispensers, reminders to sanitize things like keyboards/mice, and reminders/opportunities to get personal protective equipment. Like, not even at other hospitals. While he was in the ICU especially, you could tell: there was a bin for soiled linens, a bin for trash.... then a bin that was basically only used for dirty paper towels right after washing your hands because it's right next to the sink right next to the door (and sometimes there were multiple sinks in a single private room...), and usually another bin for used gowns/masks/gloves next to that since one trash bin generally wasn't enough even if it was emptied 2-3 times a day.
The dispensers especially were all over the place in your face at regular intervals in every area and at all room entrances/exits and then some, so you had no excuse not to use it (hello random visitor who told me to not push elevator buttons with my fingers because "it's a hospital and ewww germs!") While I know part of the reason for this door handle design was because people forget to use sanitizer even though they know better... even super harried ED and ICU staff were using them because it was so fast and stick-your-arm-out-in-a-second-while-leaving convenient. I don't think I saw someone _not_ do that.
I think the solution to this problem is not a door handle, but to design a hospital around this idea in the first place with the assumption that we forget - a lot of this can be retrofitted with great success.
Precisely. This reminds me of my childhood days when I would wash my hands thoroughly with soap liquid before I ate and would close the (unclean) tap with the same hands. I was actually following this routine until one day my neighbor observed me and explained what I was doing wrong. This just seems like an improvised version of my (wrong) routine.
I also think this product is attempting to solve the wrong problem, in the wrong way. Rather than try to insert another workflow step (as a previous commenter ably put it) why not focus on ways of preventing the contact with contaminants in the first place? After all, door handles are just one vector, and how many of the others can be converted into sanitizer dispensers?
Is it just me, or is this a recipe for slippery sanitizer-covered floors after people bump into these handles and trigger the pump? (Whether deliberately, by opening the door with their backs with hands full, or inadvertently just walking around in a crowded corridor.)
Despite actually watching the video and reading the site, I was still kind of visualizing a push door when I wrote this (whoops!) but I have definitely hooked my elbow or shoulder into the right sort of pull doors if I'm carrying a bunch of equipment, or bags, or something. Or, more likely, I'll brace the equipment against the door and grab with a hand, then keep it open with a foot. Raises the same issues with the dispenser.
In any case, I still think there is risk having this ambiguous button like thing, both from passersby bumping it and from normal use. And, as my comment (and the immortal Far Side comic) illustrates, many pull doors and push doors look confusingly similar, so people will push the pull handles.
Also, may I suggest making your correction in a friendlier way next time? Especially because it is possible that the person you're correcting may not be the total doofus you imagine them to be!
Slightly related: I wish door handles, taps, bathroom flushes, up/down lift buttons etc. are mostly foot operated everywhere. There's really not much advantage of interacting with all these knobs with your hands.
The idea was to cover door handles with it in hospitals etc and had received positive feedback from quite a few local hospitals if I'm remembering correctly. I'm not sure what happened to that project though. I like that solution much better than this though.
I get the sense that while well intentioned, the designer has not adequately observed a full range of health care activities typical in many modern hospitals. Those big swinging doors are big and swinging so that beds can pushed through quickly in an emergency.
Because emergencies can occur anywhere, [e.g. a few years ago my sister-in-law was a code blue in the CT-room -- and that's how the staff remembered her following her recovery], doors and walls and everything below a certain height must be designed for impact by a fast moving fully loaded hospital bed.
One of the reasons door handles are so big and bulky to begin with is that's where they get hit, and they get hit to prevent damaging the door. Hospitals place scrub sinks in alcoves and up high. Same with the typical hand-sanitizer stations.
The other concern with the design is that it creates places for bacteria to 'hide' from cleaning - the seams and hinges of the door handle that allow access for refills and that operate the dispensing mechanism. Of more concern is that these are places where a health-care worker will place their hands and that by incorporating these into an architectural specialty, they are not disposable and require ongoing cleaning.
Monolithic is good. Anything that requires manipulation should fit in an autoclave or be disposable.
Clever idea, but I think I would prefer automatic doors and conveniently located motion-sensing sanitizer dispensers. And as much as I like embedded software, I don't think it's particularly useful or worthwhile in something like this, with the exception of monitoring the amount of remaining sanitizer in individual handles.
Also, from what I've heard, hand sanitizers aren't great for you. Placing them on doors, encouraging (or perhaps pressuring) people to use them frequently, might do more harm than good. It would be vastly more practical and effective to strategically place motion-triggered sanitizer dispensers after doors, especially in patient rooms and on the way out of certain sections of the hospital.
It's respectable that you're thinking outside the box and looking to solve a real problem, but this needs more thought.
FDA approval / clearance is a nightmare. I think it took Vioguard 4+ years to get it for their UV-sanitizing keyboard. You need to be connected, funded, and/or patient.
56 comments
[ 3.4 ms ] story [ 112 ms ] threadThese surfaces have good properties and don't encourage any sort of resistances.
edit: I see Pull Clean is trying to get people to clean their hands more, but I also think it is not good to ignore an existing good strategy for eliminating germs in one of the dirtiest places (door handles) in a hospital. I am wondering how well studied this is and if it results in a cleaner environment in a hospital setting compared to installing the copper surface handles everywhere.
http://www.dailymail.co.uk/health/article-1081359/Copper-doo...
Alternatively I found another article sighting a study that says brass is good from 2012.
http://www.telegraph.co.uk/health/healthnews/9762689/Fit-bra...
I think they'd really have to have some studies showing the different placement really made an impact for hospitals to buy this at scale.
This looks like a solution in search of a problem.
"... bactericidal copper touch plates on doors and handles... "
For much the same reasons as other commenters have pointed out, they have excellent antimicrobial properties. I'm moving into a new build at the moment, and we're using copper for the very same reasons. Being quadriplegic, infections are an absolute nightmare to get rid of so these things are going to be invaluable.
[0]:http://www.sth.nhs.uk/clientfiles/File/Enclosure%20I%20-%20C...
You want some WiFi app thingie? Ok, link the automatic doors to the nearest gel dispenser and when the ratio of door opening/dispenser use gets too low, the door only opens after the dispenser has been used.
Big Brother class 1 is your smart wifi nametag displays how long its been since you used hand sanitizer for everyone to read.
Big Brother class 2 is it also goes on your permanent record for review time and of course malpractice lawsuit time via wifi.
My brother-in-law sells doors to hospitals by a wonderful coincidence. Heard so much about the damn things it's depressing.
But that is absolutely NOT how they work, these gels are generally designed to be used AFTER washing your hands and only work if you rub them in for up to 30 seconds. But I would be surprised if many people knew that, *II only knew that because - and this is going to sound like total hyperbole - my life literally depends upon people washing their hands.
I think it's really interesting that when doctors, nurses or any other medical professionals come through they always wash your hands but carers always seem to rely on the magic gel. People need education as well as these tools, not instead of.
/Rant
Sort of like when you throw white paint around at a rave and everybody has got their hands in the air, glowing white skin and…
That may be true of your basic drugstore Purell, which just contains ethyl alcohol. But the literature does indicate that hospital-grade hand sanitizers (a blend of alcohols, and/or a non-alcohol equivalent) are far superior and immediately effective against most organisms.
See for example, http://cmr.asm.org/content/17/4/863.short
You need to be careful with the soap you chose because hands can be "too clean" - some soaps are harsh on the skin and cause conditions suitable for bugs.
http://www.nhs.uk/Conditions/Clostridium-difficile/Pages/Pre...
http://www.cdc.gov/handwashing/show-me-the-science-hand-sani...
http://en.wikipedia.org/wiki/Norovirus#Prevention
My wife works as a paediatric doctor in the NHS, and has told me that the regular use of alcohol gels leaves a slimy residue after 2 or 3 uses, prompting her to properly wash her hands (as well as wearing new gloves for every patient, obviously).
"Alcohols are not appropriate for use when hands are visibly dirty or contaminated with proteinaceous materials." "Alcohols are rapidly germicidal when applied to the skin, but they have no appreciable persistent (i.e., residual) activity." "Despite its effectiveness against these organisms, alcohols have very poor activity against bacterial spores, protozoan oocysts, and certain nonenveloped (nonlipophilic) viruses. Similarly, certain accepted methods for evaluating waterless antiseptic agents for use as antiseptic hand rubs require that 3 mL of alcohol be rubbed into the hands for 30 seconds, followed by a repeat application for the same duration. This type of protocol also does not reflect actual usage patterns among HCWs."
The alcohol gels are good, but I think they're not a cureall was my point.
[0]:http://www.cdc.gov/ [1]:http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm
I honestly don't know a single nurse / medical staff or even IT person in a hospital or university that thinks they are, though. You might not be giving people enough credit. Anecdotal, yes, but I've never seen people think of them as a "cureall" or even as a replacement of washing hands. It is always in addition or inbetween things where you can't get to a handwashing immediately (e.g., candidates shaking hands)shrug
So yes, anecdotes for sure. But that's one hell of a lot of anecdotes. :-)
Gels and hand washing are one things, but how about actually wearing gloves and changing them when you are about to touch a patient?
Sanitizing is more important because modern science is losing anti-biotics.
Hospital acquired infections kill a reasonable number of people and make quite a few others miserable (vomiting bugs are not fun).
I'd prefer to see a handle designed for safe operation by the elbows or feet so that the hands don't need to be compromised. Think of how a surgeon enters an operating room by pushing the door with their shoulder and their hands held up out of the way.
I agree wholeheartedly.
> This is a rude interruption and will likely annoy rather than encourage more sanitization. In the video (0:59), a woman sanitizes her hands then must immediately compromise them again to actually open the door.
The idea is that you open the door with one hand and dispense sanitizer into your other hand simultaneously and then sanitize the other hand after passing through.
I have never in my life seen so many motion sensor things from doors to sinks, so many sanitizer dispensers, reminders to sanitize things like keyboards/mice, and reminders/opportunities to get personal protective equipment. Like, not even at other hospitals. While he was in the ICU especially, you could tell: there was a bin for soiled linens, a bin for trash.... then a bin that was basically only used for dirty paper towels right after washing your hands because it's right next to the sink right next to the door (and sometimes there were multiple sinks in a single private room...), and usually another bin for used gowns/masks/gloves next to that since one trash bin generally wasn't enough even if it was emptied 2-3 times a day.
The dispensers especially were all over the place in your face at regular intervals in every area and at all room entrances/exits and then some, so you had no excuse not to use it (hello random visitor who told me to not push elevator buttons with my fingers because "it's a hospital and ewww germs!") While I know part of the reason for this door handle design was because people forget to use sanitizer even though they know better... even super harried ED and ICU staff were using them because it was so fast and stick-your-arm-out-in-a-second-while-leaving convenient. I don't think I saw someone _not_ do that.
I think the solution to this problem is not a door handle, but to design a hospital around this idea in the first place with the assumption that we forget - a lot of this can be retrofitted with great success.
In any case, I still think there is risk having this ambiguous button like thing, both from passersby bumping it and from normal use. And, as my comment (and the immortal Far Side comic) illustrates, many pull doors and push doors look confusingly similar, so people will push the pull handles.
Also, may I suggest making your correction in a friendlier way next time? Especially because it is possible that the person you're correcting may not be the total doofus you imagine them to be!
The idea was to cover door handles with it in hospitals etc and had received positive feedback from quite a few local hospitals if I'm remembering correctly. I'm not sure what happened to that project though. I like that solution much better than this though.
Because emergencies can occur anywhere, [e.g. a few years ago my sister-in-law was a code blue in the CT-room -- and that's how the staff remembered her following her recovery], doors and walls and everything below a certain height must be designed for impact by a fast moving fully loaded hospital bed.
One of the reasons door handles are so big and bulky to begin with is that's where they get hit, and they get hit to prevent damaging the door. Hospitals place scrub sinks in alcoves and up high. Same with the typical hand-sanitizer stations.
The other concern with the design is that it creates places for bacteria to 'hide' from cleaning - the seams and hinges of the door handle that allow access for refills and that operate the dispensing mechanism. Of more concern is that these are places where a health-care worker will place their hands and that by incorporating these into an architectural specialty, they are not disposable and require ongoing cleaning.
Monolithic is good. Anything that requires manipulation should fit in an autoclave or be disposable.
Also, from what I've heard, hand sanitizers aren't great for you. Placing them on doors, encouraging (or perhaps pressuring) people to use them frequently, might do more harm than good. It would be vastly more practical and effective to strategically place motion-triggered sanitizer dispensers after doors, especially in patient rooms and on the way out of certain sections of the hospital.
It's respectable that you're thinking outside the box and looking to solve a real problem, but this needs more thought.
http://www.vioguard.com/