Comparison of electric hand dryers and paper towels for hand hygiene: a critical review of the literature

Appropriate Hand Drying - The Missed Step of Hand Hygiene: A Qualitative Evaluation of Hand Drying Practices among Indian Health Care Workers

Hand hygiene remains one of the most effective methods of preventing healthcare-associated infections. Hand drying is the end point of hand hygiene. Hand drying after hand hygiene is less explored, and the practice varies in different facilities. This explorative study was done to know the various hand-drying methods and practices of healthcare workers in Indian settings. This was a descriptive cross-sectional questionnaire-based observational study initiated from a tertiary care setup in Uttarakhand. Healthcare workers over 18 years of age directly involved in patient care were enrolled. A semi-structured questionnaire with both open-ended and close-ended questions was used with snowballing sampling technique. Statistical analysis was done using Statistical Package for Social Sciences (SPSS). Out of the eligible 395 respondents, 62.8% were female. The mean age of the respondents was 31.34 ± 8.44 years and average working hours were 8.87 ± 2.97 (range 4-24) hours. Only 72.7% did hand hygiene always before touching a patient. Nurses were more compliant about hand hygiene than doctors (P < 0.0001). A total of 82.8% were aware of appropriate hand-drying methods. Staff in the Intensive care unit Intensive care unit (ICU) setup were more aware of hand drying practices (P = 0.033). A total of 21.8% wiped their hands on their clothing to dry their hands. This was more in staff from paraclinical departments (P = 0.001). A total of 35.7% used handkerchiefs to dry hands. Resident doctors used handkerchiefs more than senior doctors or nursing staff (P = 0.01). A total of 49.9% of respondents spent less than 10 seconds in hand drying. Hand-hygiene knowledge is high among healthcare workers in India, but the knowledge of appropriate hand-drying practices is lacking. There is wide variation in the practice of hand drying. Better hand drying guidelines and incorporating hand drying as the essential endpoint of the hand hygiene ritual are warranted.

Impact of different hand-drying methods on surrounding environment: aerosolization of virus and bacteria, and transfer to surfaces

BACKGROUND

In recent years, hand drying has been highlighted as a key step in appropriate hand hygiene, as moisture on hands can increase the transfer of micro-organisms from hands to surfaces and vice versa.

AIM

To understand bacterial and viral aerosolization following hand drying, and study the transfer of micro-organisms from hands to surfaces after drying using different methods.

METHODS

Groups of five volunteers had their hands pre-washed with soap, rinsed and dried, then inoculated with a concentrated mixture of Pseudomonas fluorescens and MS2 bacteriophage. Volunteers entered an empty washroom, one at a time, and rinsed their hands with water or washed their hands with soap prior to drying with a jet dryer or paper towels. Each volunteer applied one hand successively to various surfaces, while their other hand was sampled using the glove juice method. Both residual bacteria and viruses were quantified from the washroom air, surface swabs and hand samples.

FINDINGS

P. fluorescens and MS2 bacteriophages were rarely aerosolized while drying hands for any of the drying methods studied. Results also showed limited, and similar, transfer of both micro-organisms studied on to surfaces for all drying methods.

CONCLUSION

The use of jet dryers or paper towels produces low levels of aerosolization when drying hands in a washroom. Similarly, all drying methods result in low transfer to surfaces. While the coronavirus disease 2019 pandemic raised concerns regarding public washrooms, this study shows that all methods tested are hygienic solutions for dry washed hands.

Assessment of the effect of hand dryers used in shopping malls on hand hygiene

BACKGROUND

Hand drying is one of the most important factors affect hand hygiene. This study was conducted to investigate the effect of hand dryers used in the restrooms located on the food court floors in shopping malls in Turkey on hand hygiene.

METHODS

Hands were washed for at least 20 seconds by following hygienic hand washing procedures of the World Health Organization. Swab samples were taken from the wet hands after hand washing, then from the dry hands, which were dried under the hand dryers and from the air blowing part of the hand dryers. Samples were cultured on agar plates that were directly exposed to the air-blowing part of the hand dryers.

RESULTS

It was found that total coliform bacteria were 0.000 colony-forming unit (CFU)/petri in wet and dried hand, 3.437 CFU/petri in blown air and 5.250 CFU/petri in swab samples. Staphylococcus aureus was found to be 0.125, 64.125, 26.375, and 388.750 CFU/petri, respectively. Total bacteria count was found to be 0.687, 48.750, 35.625, and 595.000 CFU/petri, respectively. S. aureus and the total bacterial load were higher in the blower outlet of the hand dryers than washed hand, blown air and dried hand (P < .05). The bacteria count in the unfiltered hand dryers was higher than that in the filtered hand dryers (P < .05).

CONCLUSIONS

Using hand dryers would negatively affect hand hygiene even if hands were washed following hygienic hand washing procedures.

A review of HTM 01-05 through an environmentally sustainable lens

Patients deserve to be treated in a safe and clean environment with consistent standards of care every time they receive treatment. It is essential that the risk of person-to-person transmission of infections be minimised, yet it is also essential that planetary harm (and therefore public harm) is minimised with respect to resource consumption, air pollution, environmental degradation etc.In 2013, the Department of Health introduced the Health Technical Memorandum (HTM) 01-05 providing dental practices with advice on patient safety when decontaminating reusable instruments in primary care. This paper provides a commentary on HTM 01-05 and similar decontamination guidance. We believe all decontamination documents needs to reflect the so-called 'triple bottom line' - the finance, social cost and impact on the planet.The authors provide an environmental commentary on a number of items mentioned in decontamination documents, including autoclaves (including the use of helix tests), disposable paper towels, undertaking hand hygiene, using a log book, plastic bag use, the use of personal protective equipment, remote decontamination units, single use instruments, single use wipes, disinfection chemicals (for example, sodium hypochlorite) thermal disinfection and wrapping of instruments.It is hoped, in the spirit of the ever-increasing numbers of papers published to highlight how healthcare (and dentistry) could become more sustainable, that these critiques will be taken in the spirit of providing a beginning of further discussion from an environmental perspective.

Aerosols and Bacteria From Hand Washing and Drying in Indoor Air

Effective hand drying is an important part of hand hygiene that can reduce the risk of infectious disease transmission through cross-contamination of surfaces by wet hands. However, hand drying methods may also cause aerosolisation of pathogenic microorganisms if they are present in washed hands. This study investigated experimentally the impact of washing hands and different hand drying methods on the concentration and size distribution of aerosols and bacteria in indoor air. In this experiment, aerosol and bacteria concentrations were measured in indoor air while volunteers rinsed their hands with water or washed with soap and water prior to drying them with paper towels or jet air dryers. Results showed that the concentration of aerosols and bacteria in air increased with people walking in the room and washing hands, with a further increase during the hand drying process. The concentration of aerosols decreased with particle size, with maximum concentrations after drying hands of 6.63 × 10⁶ ± 6.49 × 10⁵ and 2.28 × 10⁴ ± 9.72 × 10³ particles m⁻³ for sizes 0.3 to <0.5 and ≥5.0 μm, respectively. The concentration of bacteria in indoor air after drying hands increased to a maximum of 3.81 × 10² ± 1.48 × 10² CFU m⁻³ (jet air dryers) and 4.50 × 10² ± 4.35 × 10¹ CFU m⁻³ (paper towels). This study indicates that the increase of aerosols and bacteria in air after drying hands with jet air dryers or paper towels are comparable and not statistically different from concentrations associated with walking and washing hands in the same environment. This work can support the development of hand hygiene practices and guidelines for public washrooms.

Hand Hygiene, an Update

Hand hygiene by health care personnel is an important measure for preventing health care-associated infections, but adherence rates and technique remain suboptimal. Alcohol-based hand rubs are the preferred method of hand hygiene in most clinical scenarios, are more effective and better tolerated than handwashing, and their use has facilitated improved adherence rates. Obtaining accurate estimates of hand hygiene adherence rates using direct observations of personnel is challenging. Combining automated hand hygiene monitoring systems with direct observations is a promising strategy, and is likely to yield the best estimates of adherence. Greater attention to hand hygiene technique is needed.