by Charles John Palenik, MS, PhD, MBA
The Centers for Disease Prevention and Control offers advice to the public concerning handwashing. The CDC calls handwashing the single most important measure we can take to prevent spreading illness to others. In its 2003 Guidelines for Infection Control in Dentistry, the CDC stated that hand hygiene — which includes handwashing, hand antisepsis, and surgical hand antisepsis — substantially reduces potential pathogens on hands. It is considered the single most critical measure for reducing the risk for transmitting organisms to patients and dental health-care personnel.
The American Society of Microbiology and the Soap and Detergent Association recently announced the results of a two-part study it sponsored concerning handwashing. The first part was an observational study of adults using public restrooms in six locations within four American cities. The second part of the study involved telephone interviews of adults in the United States concerning their handwashing behaviors. The study was identical to one conducted in 2005 and readily allows comparisons.
Observation of handwashing involved 6,076 adults in public restrooms and occurred in Atlanta (Turner Field), Chicago (Museum of Science and Industry and the Shedd Aquarium), New York City (Grand Central and Penn stations), and San Francisco (Ferry Terminal Farmers Market).
Observers discreetly recorded handwashing activity. Observers were to “look busy” by grooming themselves (e.g., combing their hair, putting on makeup) and rotate locations every hour. Observers were not to wash their hands often because this could affect handwashing behavior.
Observations from the public attractions fell into four categories: male washers (2,038), male nonwashers (1,027), female washers (2,647), and female nonwashers (364). Overall, 77 percent washed. This was down from 83 percent in 2005. The decline was largely due to males. Male washers fell from 75 percent in 2005 to just 66 percent. There was a slight decline among females from 90 to 88 percent in 2007.
Location affected handwashing compliance. The highest percentage of nonwashers was at Atlanta Braves baseball games (28 percent) and at Penn and Grand Central stations (25 percent). These locations also were problematic in 2005.
In the second part of the study, researchers conducted 1,001 telephone interviews. To better assure the presence of a representative sampling of the American population, stratification by census region and weighting by gender, education, and ethnicity occurred.
Of those interviewed, 52 percent were female with 28 percent being younger than 35, 39 percent were ages 35 to 54, and the remaining 33 percent were 55 and older. Educational background varied widely with 13 percent having attended some high school, 32 percent were high school graduates, 28 percent had some college attendance, 17 percent were college graduates, and 9 percent had a postgraduate degree. In terms of income, 43 percent had annual household incomes of $50,000 and more, 18 percent made less than $20,000 a year, while the remaining 39 percent was divided equally within intermediate income levels.
Interviewers asked: “I am going to read you a list of activities, and I would like you to tell me how often you make it a practice of washing your hands. How often do you wash your hands after petting a dog or cat? Before handling or eating food? After coughing or sneezing? After using a public restroom? After handling money? After changing a diaper? After using the bathroom in your home?”
Similar to 2005, roughly nine in 10 (92 percent) of adults indicated they always wash after using public restrooms; however, only 77 percent of the observed actually did. For the other scenarios, the percentage of people who always or usually washed their hands went up slightly or remained the same. The always (usually) responses for petting a dog/cat were 42 percent (14 percent), before handling/eating food 78 percent (13 percent), after coughing/sneezing 34 percent (27 percent), after using a public restroom 92 percent (5 percent), after handling money 25 percent (19 percent), after changing a diaper 73 percent (5 percent), and after using the bathroom at home 86 percent (9 percent).
In all cases, women reported higher levels of handwashing than did men. The number of women and men that reported handwashing after food handling/eating and when using restrooms were the same. Performance did not usually improve with age. Compliance often decreased for those age 55 or older. More education did not universally improve stated performance, especially when dealing with a pet or when handling money. Usually, higher incomes do not result in better handwashing, especially when handling money.
Dr. Charles John Palenik is the director of Infection Control Research and Services at the Indiana University School of Dentistry. He is the co-author of the popular “Infection Control and Management of Hazardous Materials for the Dental Team.” In 2003, he was chairman of the Executive Board of OSAP. Infection control questions may be directed to [email protected].