Microbial Contamination of Door Handles: A Global Systematic Review and Meta-Analysis of Public and Healthcare Settings.

Background: The public health risk of microbial contamination of fomites is evident from the numerous fomite-associated outbreaks that have occurred in several countries. Despite the high-touch nature of door handles across various settings, no comprehensive synthesis of contamination rates and microbial profiles has been performed.

Aim: The aim of this work was to assess the prevalence and types of microbial contamination on door handles in public and healthcare settings.

Methods: We systematically searched PubMed, Web of Science, and Scopus for studies published up to July 2024. A systematic review and meta-analysis were conducted according to the PRISMA guidelines. Pooled prevalence estimates were calculated via a random-effects model, and subgroup analyses were performed to assess differences on the basis of pathogen type, handle location, and setting.

Results: A total of 27 studies met the eligibility criteria. The overall estimation of microbial contamination of door handles revealed a prevalence of 9.96% (95% CI: 5.87‒14.11). Compared with viral contamination which was observed to be 17.73% (95% CI: 9.24‒27.81), bacterial contamination was less common at 6.20% (95% CI: 2.90‒10.42). The most predominant bacterial agent was Bacillus spp. (55.74%), followed by Acinetobacter baumannii (25.00%); the most prevalent virus was rotavirus (62.50%). The rate of contamination was higher for toilet door handles (23.04%) than for other public and healthcare handles (7.75%). Hospitals presented slightly higher contamination rates (10.82%) than did public settings (8.97%).

Conclusion: This systematic review highlights the widespread microbial contamination of door handles, particularly in public and healthcare environments. While bacterial contamination is predominant, the finding of viruses such as rotavirus, norovirus and even SARS-CoV-2 highlights the stringency of cleaning that has to be applied. These findings emphasise the need for targeted hygiene interventions to reduce the risk of pathogen transmission via door handles, particularly in high-traffic areas.