by Lisa Veeck — Hospitals health care workers wash their hands less frequently near the end of their shifts compared to earlier in the workday, according to a new study reported in Medicinenet.com. Compliance with hand-washing protocols by workers fell 8.7 percent on average from the beginning to the end of a typical 12-hour shift, according to the study, which was published online recently in the Journal of Applied Psychology.
The report, based on the study of more than 4,000 caregivers working in 35 U.S. hospitals, found that the lapse in hand washing is most likely attributable to mental fatigue. The oversight is believed to contribute to hundreds of thousands of patient infections in the United States annually.
The reason, researchers from the University of Pennsylvania contend, is that similar to how repetitive exercise leads to physical fatigue of the muscles, repeated use of the cognitive resources that allow people to control their behaviors (and desires and emotions) produces a decline in their ability to self-regulate their actions.
Did You Know?
- Paper towels were invented by Arthur Scott of Philadelphia, PA in 1907.
- Absorbent paper towels are loosely woven,which lets the water travel between the fibers even against gravity.
- “Quilted” paper towel is made by pressing shapes into the towel sheets to create air pockets that attract water and increase absorbency.
Source: Express, livestrong.com, Penn State University
Increased work demands also were associated with greater declines in hand-washing compliance rates. While the more time hospital workers had off between shifts, the more closely they followed proper hand-washing protocols.
“Demanding jobs have the potential to energize employees, but the pressure may make them focus more on maintaining performance on their primary tasks [e.g., patient assessment, medication distribution], particularly when they are fatigued,” said Hengchen Dai, a Ph. D candidate at the university who worked on the study with colleagues. “For hospital caregivers, hand-washing may be viewed as a lower-priority task and thus it appears compliance with hand hygiene guidelines suffers as the workday progresses.”
Compiling data from previous studies and extending their findings to all U.S. hospitals, Dai and her fellow researchers estimate that lower hand-washing compliance among hospital workers later in their shifts could lead to an additional 600,000 patient infections a year at a cost of US$12.5 billion annually.
The researchers contend their findings could be applied to work place compliance in other areas and industries, such as ethics in banking, safe driving behaviors in trucking, and safety standards in manufacturing. It might also apply to other areas of hygiene, such as hand drying.
Dry & Run
Even without extended work hours, many individuals short-change the hand drying process for a variety of reasons, ranging from impatience to inefficient blow dryers to lack of available towels.
Frequently underestimated compared to its hand-wetting counterpart, research supports the fact that hand drying is just as vital to maintaining good hand hygiene.
A University of Bradford study published in the Journal of Applied Microbiology found that wet hands after washing increases the spread of bacteria:
“The degree of wetness of hands appears to greatly influence bacterial transfer and dissemination to surfaces and items touched. This probably occurs not only because of the physical aspects of moisture droplets transferring between one surface and another, but also because the bacteria may be maintained in a physiological state that makes them better able to survive in the new environment.”
Researchers at Mayo Clinic agree, and contend that wet hands as especially dangerous in health care settings: “The transmission of bacteria is more likely to occur from wet skin than from dry skin; therefore, the proper drying of hands after washing should be an integral part of the hand hygiene process in health care,” states The Hygienic Efficacy of Different Hand-Drying Methods: A Review of the Evidence, published by the clinic.
To bring the idea even closer to home, take a night out at a restaurant. Even the most thorough washing cannot keep hands clean when followed by the fast “swipe dry” that leaves wet hands reaching for the bathroom door, then resting on the table and touching other surfaces, from purses and wallets to money and pens—not to mention how many of those germs were contracted before you ate your sandwich! Consider this same scenario-taking place in the restaurant’s kitchen or a health care setting, and you have the makings of a potential epidemic.
Dry Stats
According to Mayo’s, hand-drying effectiveness includes drying speed, degree of dryness, effective removal of bacteria, and prevention of cross-contamination. And according to the clinic, “Most studies suggest that paper towels can dry hands efficiently, remove bacteria effectively, and cause less contamination of the washroom environment.”
Similarly, handwashingforlife.com contends, using paper towels to dry hands after washing helps remove bacteria from hands and reduces general bacterial counts by an average of 58 percent, including germs loosened by hand washing.
Paper Towel Selection Checklist
Paper towel is recommended for hand drying for speed and efficiency. Slow dry time promotes poor hygiene practices, including drying hands on clothing and proceeding with wet hands, which endangers those with whom you come in contact.
Below are some tips to help select paper towel with the best properties for your situation.
Textured. Towels should be textured for maximum absorbency; smooth surface paper absorbs less water.
Integrity. Towels should not fall apart when wet.
Hands-free dispensers. Wet hands should only touch the paper towel.
Maintenance. Dispensers should easy and fast to load/service.
Availability. Check lead-time with supplier(s) to assure product availability when needed.
Placement. Locate dispenser(s) convenient to hand washing sink and soap.
Source: Adapted from handwashingforlife.com checklist.
As for speed, the average time to achieve 95 percent dryness is 12 seconds with a paper towel versus 43 seconds with some hot air dryers according to the site. Often, this difference is not due to poorly functioning dryers, but rather, user impatience since one of the site’s studies found few people use hot air dryers long enough to ensure more than 55 percent to 65 percent dryness.
Choosing Towel & Dispensers
When it comes to effectiveness, studies show not all paper towels are the same. For speed, cost, and efficiency in food service settings, handwashingforlife.com recommends one-ply. But not just any one-ply: “Highly absorbent, task-textured paper towels are born from paper mills that have access to high absorbency, long-fiber, high-bulk pulps. Paper mills with specialized equipment can process, form, dry, and compress these pulps into toweling that is both highly absorbent and has excellent wet strength. A properly engineered process yields a towel that is pleasant to use, dries hands quickly, and extends cleaning effectiveness.”
Finally, selecting the proper towel dispenser is also important. Hands-free towel dispensing prevents cross-contamination by eliminating the need to touch handles, cranks, dials, buttons, and other dispenser parts that can be germ-laden and thereby defeat all the good hand washing has done by immediate recontamination.
Much is made on the importance of proper hand washing, and well it should be. But teaching your customers the importance of hand drying and towel and dispenser choice is good for health and business.
ISSA Publications & Media Relations Director Lisa Veeck is editor of ISSA Today. She can be reached at lisav@issa.com, phone, 800-225-4772 (North America) or 847-982-0800.