This blog is an opportunity to provide you timely tips, news, and information not just from us but also from leaders in the building industry. Today’s guest post is by one of those experts, Dan McCoy, at Darman Manufacturing, Utica, NY. Thanks, Dan, for sharing your valuable insights into hand washing systems for our clients’ restrooms.
Endura II CRT Cabinets
New research and clinical testing reveal cloth roll towels rank #1 as the most hygienic for hand washing in restrooms. And high-speed air dryers, though they have been found to be environmentally friendly, are not nearly as hygienic asoften claimed.
The US Center for Disease Control (CDC) and World Health Organization (WHO) and most other hygiene related agencies recommends washing with soap and water for 15-20 seconds, or more. The vast majority of people, however, improperly wash their hands (for only about 10 seconds) #1-12. Furthermore most people do not dry their hands adequately and leave with damp hands, which transmit 1,000 times more bacteria than dry hands #23
Because people don’t wash properly it increases the need for hand drying systems that will remove the most residual dirt/bacteria and dry the hands as fast as possible in order to achieve the most hygienic results.
I’ve reviewed many hand washing systems and studied the research and here are my findings as to their hygiene:
Hygiene ranking – best to worst:
1. Reusable Cloth Roll Towel (CRT) systems appear to be the most hygienic. #13-17 A clean section of a reusable cloth roll towel is dispensed for each use. The used toweling rolls back into a separate section of the dispenser. This provides excellent mechanical action for removal of bacteria (and residual grime), dries the hands/arms the fastest (helping to prevent additional growth of bacteria), leaves the least amount of bacteria on the hands, and is the only system type that isolates the bacteria inside the dispenser – helping to prevent the spread of the bacteria.
2. Disposable Reinforced Retractable Paper (DRRP) roll towels used in a CRT style dispenser system. The paper towel is NOT torn off for use. The soiled sections roll into a separate compartment of the CRT dispenser (just like in a typical CRT system). They provide the mechanical action to help remove dirt/grime and bacteria. Made of very absorbent multi-layered paper, it dries hands quickly helping prevent bacteria growth. Prevents the problem of bacteria laden standard paper towels (see #3) from being spread around the restroom and helps prevent the plugging of toilets (a source of bacteria).
3. Standard paper towels (rolls or sheets). Have mechanical action. Bacteria found on unused towels transfers to the users’ hands. #32 The soiled waste paper can be strewn around the restroom spreading bacterial contamination. Are a leading cause of plugged toilets (which can also contaminate restrooms with bacteria). #13-17 They typically are not as absorbent as a CRT (or DRRP), thus leaving the hands damper after typical use. Dispensers have been found to cause cross contamination of the users hands. #27 Bacteria can also be spread from the waste container via air currents, spread during the closure of plastic bags used to get rid of them, from paper towels being blown out of dumpsters, employee contact in sorting facilities, and in/around dumps.
4. Air knife (blade) style air dryer units with a HEPA filter. The user places their hands in a narrow slot and uses high-speed air jets for drying. These have no mechanical action. They filter incoming restroom air, but they spread bacteria, blown off typically improperly washed hands, which contaminates the restroom, the users clothing, and surrounding area. #18 They can also contaminate the users’ hands from touching the sides of the narrow opening of the unit. #18 They can not dry forearms or faces and may not work for deformed hands. Dries hands faster than warm air driers. In certain cases, if used in a restroom that food workers use, the 2009 FDA Food Code (appendix) regulations require that an alternative hand drying method must be present for use. #19
5. Warm air dryers. They can put 150% – 500% more bacteria on your hands than you washed off! #16, 18, 20, 21 They just re-circulate the bacterial laden air in the restroom. This contaminates the user’s hands, face, arms, clothing, wall and floor. #16, 18, 20, 21 Have no mechanical action. Most people do not use them long enough (35–40 seconds) to properly dry the hands. #13 Damp hands increases bacteria growth and transfer 1,000 times more bacteria than dry hands. #28 Can cause chapping of the hands, which increases the potential of infection. #22
6. Jet air dryers - air knife (blade) style (without HEPA filter). Dries hands faster than warm air driers. They work the same as the Air Blade driers but without a HEPA filter (see #4), thus have the same hygiene problems as warm air dryers. The higher speed air flow could increase the bacteria circulation, blowing more bacteria laden air on the user’s hands, clothing, and spreading bacteria in the restroom. If in a restroom that is used by food workers the 2009 FDA Food Code (appendix) regulations require that an alternative hand drying method must be present for their use. #19
7. Jet air dryers are very high speed air driers not containing a warm air heater. They are not listed as an acceptable hand drying method under the 2009 USDA Food Code #19. Because they operate the same way a warm air dryer does, they re-circulate the bacterial laden air in the restroom, so they are assumed to have at least the same hygiene problems as warm air driers. Their stronger air flow has a high probability of blowing the bacteria (from poorly washed hands, air borne bacteria in the air, and bacteria that may grow in the dryer), a greater distance in the restroom, contaminating the user’s hands, face, arms, clothing, the wall and floor. They have no mechanical action. Dries hands faster than warm air driers.
Why do air dryer manufacturers claim air dryers are the most hygienic to use? Their claims are based on laboratory research studies (not performed in typical restrooms) that don’t reflect the way people typically wash and dry their hands. The test subjects washed their hands much longer than typical, had to totally dry their hands (some for over a minute), and they apparently use new air driers. #24 – 31 The Air Blade researchers did not address the need for drying forearms and faces. When have you washed your hands properly (20 sec.), used a new (uncontaminated) air dryer, were able to use it in a laboratory (which has cleaner air than in restrooms), and used it long enough to totally dry your hands?
I appreciate this forum provided by Innovative Designs to “clear the air” about the hand washing systems that are available to you and the pros and cons of each. Thanks Dan and Tom and I hope you’ll direct any questions or comments you have to them at 315.737.4416.
References used for the above comparison statements (more details and references available on request):
1. Knights, B., Redway, K. & Edwards, V. (1997). A study of hand washing habits in public toilets and the bacterial contamination of the hands before and after washing. A study by the Applied Ecology Research Group, University of Westminster for Deb Hygiene.
2. Olsen, SL., MacKinan J., Goulding, N. Bean, and L. Sltsker 2000 Surveillance for food borne disease outbreaks – US, 1993-1997 Morb. Mortal. Wkly. Rep. 49: 1-51.
3. Ansari, S., S. Satter, V, Springthorpe, G. Wells, and W. Totowaryk, 1989. In vivo protocol for testing efficacy of hand – washing agents against viruses and bacteria: experiments with Rotavirus & Escherichia Coli. Appl. Environ. Microbial 55: 3113-3118.
4. Eckert, D., N. Ehrenkranz, and B. Alfonsa 1989 Indication for alcohol or bland soaps in removal of aerobic gram-negative skin bacteria: assessment by novel method. Infect. Control Hosp. Epidemial 10: 306-311
5. Montville, R., Y. Chen, and D. Schaffer 2001 Risk Assessment of hand washing efficacy using literature and experimental data. Int. J. Food Microbial. 73:305-313. © 2002 Elsevier Science B.V.
6. Larson E., A causal link between hand washing and risk of infection? Examination of the evidence. Infect. Control 1988, 9: 28-36.
7. Boyce, JM., Ptttet, D.: Guideline for Hand Hygiene in Health-care settings: recommendations of Healthcare Infection Control Practices Advisary Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
8. Larson EL, Hughes CA, Pyek ID, Saprks SM, Cagatay EV, Bartkus JM: Changes in bacterial flora associated with skin damage on hands of health care personnel. Am. J. Infect. Control 1998, 26:513-521.
9. Luby SP, Agboatwalla M, Feickin DR, Painter J, Billhimer W., Altaf A, Hoekstra RM: Effect of hand washing on child health: a randomized controlled trial. Lancet 2005, 366:225-233.
10. Steere AC, Mallison GF. Handwashing practices for the prevention of nosocomial infections. Ann Intern Med 1975;83:683-90.
11. Ellwood J, Hands on: a critical look at infection control. Found on the internet at: www.aromacaring.co.uk/hand_washing.htm.
12. Ehrenkranz NJ, Alfonso BC. Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters. Infect Control Hops Epidemiol 1991;12:654-62.
13. Keith Redway & Brian Knights, (Oct. 1998). “Hand Drying Studies of Hygiene and Efficiency of Different Hand Drying Methods”, University of Westminster,
14. Ngeow, Y.F., Ong, H.W. & Tan, P. (1989). Dispersal of bacteria by an electric air hand dryer. Malayaian Journal of Pathology, 11, 53-56.
15. Dr. med. Axel Kramer, “Textile towels or Paper Towels?”, European Association for the Promotion of Hand Hygiene, 1994
16. Blackmore M.A., “A Comparison of Hand Drying Methods, Catering and Health” 1989, 1, 189-199
17. Hans Lamitscka, “The Claims and Counterclaims of Hand Drying”, prepared for the European Association for the Promotion of Hand Hygiene, reprinted in Textile Rental magazine August 1993 and in Maintenance Solutions, June 1994.
18. Keith Redway & Shameem Fawdar, A comparative study of different hand drying methods: paper towel, warm air dryer, Jet air dryer. School of Bioscience, University of Westminster, 115 New Cavendish St., London W1W 6UW, November 2008. Web: www.westminster.ac.uk/~redwayk.
19. 2009 Food Code, U.S. Department of Health and Human Services Public Health Services – Food and Drug Administration, section 6-301.12 Hand Drying Provisions. Listed as: “A continuous towel system that supplies the user with a clean towel”.
20. Knights, B., Evans, C., Barrass, S. & McHardy, B. (1993). Hand drying: an assessment of efficiency and hygiene of different methods. A survey by the Applied Ecology Research Group, University of Westminster for the Association of Makers of Soft Tissue Papers.
21. Redway, K. Knights, B. Bozoky, Z. Theobald, A. & Hardcastle, S. (1994). Hand drying: a study of bacteria types associated with different hand drying methods and with hot air dryers. A study by the Applied Ecology Research Group, University of Westminster for the Association of Makers of Soft Tissue Papers.
22. Coates, D et al (1987). Survival of thermophilic campylobacter on finger tips and their elimination by washing and disinfection. Epidem. 99:255-274.
23. Patrick, D.R., Findon, G. & Miller, T.E. (1997). Residual moistuer determines the level of touch-contact associated bacterial transfer following hand washing. Epidemiology & Infection, 119, (3), 319-325.
24. Gustafson, D.R., Vetter, E.A., Larson, D.R., Llstrup, D.M., Maker, M.D., Thompson, R.L. & Cockerill, F.R. (2000). Effects of 4 hand drying methods for removing bacteria from washed hands: a randomized trial. Mayo Clinic Proceedings, 75, 705-708.
25. Ansari, S.A., Springthorpe, V.S., Satter, S.A., Tostowaryk, W. & Wells, G.A. (1991). Comparison of cloth, paper, and warm air dryers in eliminating viruses and bacteria from washed hands. American Journal of Infection Control, 19, 243-249.
26. Boursillon D. and Riethüller:Keimreduktion auf den Händen durch versciedene Händetrocknungsverfahren. Reduction of bacteria from hands with different hand drying methods Hyg Med 30 Jahrgang 2005 – Heft 5
27. Harrison, WA et al. (2003) Bacteria transfer and Cross Contamination Potential Associated with Paper – Towel Dispensing. American Journal Infection. Control. 31 (7):387 -391.
28. Mathews, J.A. & Newsom, S.W.B. (1987). Hot air electric dryers compared with paper towels for potential spread of airborne bacteria. Journal of Hospital Infection, 9, 85-88.
29. Snelling, A.M., Saville, T., Stevens, D.G., Beggs, C.B. (2007) Evaluation of a new Ultra Rapid Hand Drier in Relation to Hand Hygiene. Clinical Microbiology and Infction. 13 (suppl 1) PS486.
30. Taylor, J.H., Brown, K.L., Toivenen, J. & Holah, J.T. (2000). A microbiological evaluation of warm air dryers with respect to hand hygiene and the washroom environment. J. of Applied Microbiology, 89, 910-919.
31. Satter, S.A. Ph.D. (1994) Bacteria on Washed and Dried hands: A Critical Review of Two Unpublished Reports from the University of Westminster. Dept. of Microbiology & Immunology Faculty of Medicine, Univ. of Ottawa, Ontario Canada. 3-21.
32. Gendron L.M. et al (2011) Evaluation of bacterial contamination found on unused paper towels and possible postcontamination after handwashing: A pilot study. 0196-6553 Am. J. of Infect. Control. 2011
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