For a new study published in the Journal of Environmental Health, researchers from Michigan State University, watched 3,749 people attempt (or not attempt) to wash their hands after using public bathrooms located across a college town in Michigan. They found that 95% of those observed failed to wash their hands for at least 15 to 20 seconds, as required, according to CDC standards, to kill dangerous bacteria that can cause infections and illness.
The Michigan researchers found that only 5% of the 3,749 people they observed spent longer than 15 seconds “in combined rubbing, washing, and rinsing of their hands.” Even worse, 10.3% did not wash their hands at all, after using the restroom. And, 23% of those who did wet their hands did not use soap, meaning that over 33% of the sample either did not wash their hands at all or did not use soap.
The study is one of the first to take into account factors such as duration of the hand washing and whether people used soap, according to a news release on the study issued by Michigan State University.
“These findings were surprising to us because past research suggested that proper hand washing is occurring at a much higher rate,” said Carl Borchgrevink, the lead study author, who is an associate professor at Michigan State University’s School of Hospitality and Business.
“Handwashing may be your single most important act to help stop the spread of infection and stay healthy,” according to the CDC. According to a video published by the CDC, scientists estimate that up to 80% of all infections are spread by hand contact, and could be avoided by washing hands often enough and well enough.
The new study, by Carl Borchgrevink, and colleagues was published in the Journal of Environmental Health, and a free copy (PDF) of the study is made available by Michigan State University.
What is Required for Proper Hand Washing?
According to the official guide to hand washing published by the U.S. Centers for Disease Control and Prevention (CDC), to wash your hands properly requires that you:
- “Wet your hands with clean, running water (warm or cold) and apply soap.
- Rub your hands together to make a lather and scrub them well; be sure to scrub the backs of your hands, between your fingers, and under your nails.
- Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
- Rinse your hands well under running water.
- Dry your hands using a clean towel or air dry them.”
When should you wash your hands? The CDC says,
- “Before, during, and after preparing food
- Before eating food
- Before and after caring for someone who is sick
- Before and after treating a cut or wound
- After using the toilet
- After changing diapers or cleaning up a child who has used the toilet
- After blowing your nose, coughing, or sneezing
- After touching an animal or animal waste
- After handling pet food or pet treats
- After touching garbage”
The Study; Method
For their study, the Michigan State University researchers “trained a dozen college students in data collection and had them observe hand washing in restrooms in bars, restaurants and other public establishments,” located across a college town in Michigan, according to Michigan State University’s news report on the study. “The student researchers were as unobtrusive as possible – by standing off to the side and entering results on a smart phone, for example.”
About 54% of the observed hand washing (or lack thereof) occurred in restrooms off campus. About 62% of the 3,749 people observed were college aged or younger.
The research assistants placed each of the persons observed in one of three categories: (1) No Washing- left the restroom without washing or rinsing their hands at all, (2) Attempted Washing – wetting hands without using soap, or (3) Washing hands with soap.
The researchers also recorded the length of time in seconds that each person placed their hands under running water during washing, soaping, and rinsing, and other data, including environmental conditions such as whether the sink was dirty or clean and whether a sign was posted in the restroom, reminding people to wash their hands.
Most importantly, the study found that while the CDC recommends at least 20 seconds of thorough hand washing with soap and water, fully 95% of study subjects failed to meet that standard.
“Both men and women fell far short, however, of CDC-recommended hand washing durations, averaging 6.27 and 7.07 seconds, respectively,” the authors reported. “Only 5.3% of the sample washed their hands for 15 seconds or more.”
These results suggest that previous studies, which found longer average durations of hand washing based on self-reports of the study subjects, may have inflated their findings. According to the authors, this was one of the first, studies to measure hand washing by actual observation, rather then relying on self-reports of the subjects.
“Additionally, previous studies did not clearly distinguish between washing with and without soap,” the authors wrote. The new study found that of the subjects who did attempt to wash their hands, 22.8 percent failed to use soap.
“It is interesting to note that if the proportion of people who were observed using soap with washing their hands were combined with those who only used water, the hand washing rates reach the higher levels reported in other studies,” the authors noted. “This raises the question of whether hand washing compliance rates have been inflated by way of definition in earlier work,” they wrote.
The researchers also noted that about 2 percent of their sample failed to dry their hands. “[S]tudies have demonstrated that the transfer of microorganisms is more likely to occur from wet skin than from dry skin,” the authors observed.
In addition to the major results stated above, the study also produced the following interesting findings, as summarized by Michigan State University’s release about the study:
- “Fifteen percent of men didn’t wash their hands at all, compared with 7 percent of women.
- When they did wash their hands, only 50 percent of men used soap, compared with 78 percent of women.
- People were less likely to wash their hands if the sink was dirty.
- Hand washing was more prevalent earlier in the day. Borchgrevink said this suggests people who were out at night for a meal or drinks were in a relaxed mode and hand washing became less important.
- People were more likely to wash their hands if a sign encouraging them to do so was present.”
“The findings were consistent with earlier research in that a significant gender bias was found,” the authors observed. “Women wash their hands significantly more often, use soap more often, and wash their hands somewhat longer than men. Both men and women fell far short, however, of CDC-recommended hand washing durations,” they noted.
View a video about the study and its findings produced by Michigan State University and narrated by Professor Carl Borchgrevink, the study’s principal author »
“To our knowledge, our study was one of the first studies to focus on hand washing behaviors and the length of time spent washing while incorporating environmental factors and the time of observation,” the study authors observed.
The finding that 95 percent of the sample failed to wash their hands for the CDC-recommended 20 seconds, “raises the specter of significant inflation in earlier reported hand washing compliance rates,” the authors wrote. “Future studies need to measure hand washing compliance carefully.
“Additionally, our study established that restroom environmental conditions and signage are important,” the authors wrote. “Specifically, hand washing compliance was greater when restroom sinks were clean and when signs encouraging hand washing were posted.”
In conclusion, the authors wrote: “Hand washing compliance and practices as reported in this and previous studies fall short of the ideal. The public needs to be continuously encouraged to engage in proper hand washing practices.”
“In addition, careful attention to restroom environmental conditions and signage may help increase compliance,” they wrote. “Given the established gender bias, consideration should be given to the content of the messages targeting men and women. Perhaps men and women would respond differently to gender-targeted messages,” the authors suggested.
According to the Michigan State University report, Professor Borchgrevink, who worked as a chef and restaurant manager before becoming a researcher, said “the findings have implications for both consumers and those who operate restaurants and hotels.”
“Imagine you’re a business owner and people come to your establishment and get foodborne illness through the fecal-oral route – because people didn’t wash their hands – and then your reputation is on the line,” he said. “You could lose your business.”
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