Looking back, I honestly think my mother could have worked part time for the Centers for Disease Control and Prevention. She was always telling me to wash my hands, then made sure that I did. There was an official list of activities that required “before, after, and both” washing.
The CDC has offered advice on handwashing to the general public. It is the CDC’s position that the most important thing you can do to keep from getting sick is to wash your hands. By frequently washing your hands, you wash away germs that have been picked up from other people, or from contaminated surfaces, or from animals and animal waste. You also can spread germs directly to others, or onto surfaces that other people touch. Then, before you know it, everybody around you is getting sick.
Recently, the results were released for a two-part handwashing study conducted this year by the American Society for Microbiology and the Soap and Detergent Association. The first part was an observation study of adults who used public restrooms in six locations in four large American cities. The second part included telephone interviews of adults across the United States, and inquired about the handwashing behaviors of these people.
A total of 6,336 adults (3,206 men and 3,130 women) were observed in public restrooms. A judgment was made as to whether hands were washed or not. Observers, who discreetly watched and recorded activities, were instructed to groom themselves while observing and to wash their hands no more than 10 percent of visits. Observers rotated restrooms to avoid watching and recording activities of a person more than once.
Observations were made in six different locations in four cities: 1) Atlanta (Turner Field); 2) Chicago (Museum of Science and Industry and Shedd Aquarium); 3) New York City (Penn Station and Grand Central Station), and 4) San Francisco (Ferry Terminal Farmers Market). All observations were made from Aug. 18-21.
A total of 1,013 adults age 18 or older (486 men and 527 women) were interviewed by telephone about their handwashing behaviors. To assure that the group sampled was representative of the entire American population, the data obtained were stratified by region and weighted by education, ethnicity, and gender. Sampling error was thought to be plus or minus three percentage points.
More than 91 percent of adults reported they always wash their hands after using public restrooms. However, observation determined that only 83 percent actually did. More than 90 percent of women observed washed their hands while only 75 percent of men actually did. Lowest compliance rates occurred at Turner Field where 26 percent of the people visiting a restroom failed to wash. Women had higher rates of handwashing than did men - 83 percent versus 63 percent. A similar disparity occurred at Penn Station with 92 percent of women washing as compared to only 64 percent of men observed. Higher overall rates (greater than 88 percent) were observed in San Francisco and Chicago.
The telephone survey indicated a large majority (greater than 91 percent) always wash their hands after using a public restroom. The percentage decreased to 83 percent when responders used a bathroom at home, before eating food (77 percent), and after changing a diaper (73 percent). Even lower levels were reported after petting a dog or cat (42 percent), and after handling money (21 percent). Only 32 percent indicated washing their hands after coughing or sneezing. Unfortunately, colds and influenza are spread more often by hands than through airborne transmission, such as sneezing.
In its 2003 Guidelines for Infection Control for Dentistry, the CDC stated that hand hygiene (e.g., handwashing, hand antisepsis, or surgical hand antisepsis) substantially reduces potential pathogens on hands and is considered the single most critical measure for reducing the risk of transmitting organisms to patients and dental health-care personnel. Indications for hand hygiene in dentistry include: 1) when hands are visibly soiled; 2) after barehanded touching of inanimate objects likely to be contaminated by blood, saliva, or respiratory secretions; 3) before and after treating each patient; 4) before donning gloves; and 5) immediately after removing gloves.
OSAP, the Organization for Safety & Asepsis Procedures, is dentistry’s prime source for evidence-based information on infection control and prevention, and human safety and health. Additional information concerning hand hygiene and glove usage is available on the OSAP Web site at www.osap.org.
Dr. Charles John Palenik is an assistant director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik is the co-author of the popular “Infection Control and Management of Hazardous Materials for the Dental Team.” He serves as chair of the OSAP publications committee. Questions about this article or any infection-control issue may be directed to [email protected].