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Hand Hygiene / Infection Control / Infection Control
November 2013 Cover Feature

Running Water, Soap And 20 Seconds

Simple steps to help cleaning operations prevent common illness outbreaks.

November 11, 2013
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The experience is universal.

When someone realizes sickness is setting in — a sudden sore throat or the first unsettling signs of the flu — he or she will frequently say, “I don’t want to be sick. I wish I knew how to prevent it!”

While there are no magic spells or effective ancient herbs, one important step every person can take to stop infection and prevent illness is actually quite simple: Wash your hands.

Hand hygiene programs and their inclusion in public buildings are especially important for cleaning and maintenance personnel due to the nature of their work.

Crowded public buildings and high-traffic restrooms are the perfect incubators where illness-causing bacteria and viruses can thrive.

By assisting with a handwashing program — and actively encouraging employees and building occupants to participate — managers and building service contractors (BSCs) can positively affect illness rates and productivity in their facilities and communities.

Covering The Basics

The U.S. Centers for Disease Control and Prevention (CDC) is the go-to resource for handwashing facts, programs, materials and ideas.

The CDC publicizes and promotes the importance of handwashing in number of ways.

In fact, the agency’s Global Handwashing Day on October 15, 2013, included a Guinness Book of World Records handwashing attempt, the Golden Poo video awards in the United Kingdom and handwashing lessons and events for 65,000 students across the state of Georgia.

According to CDC materials, the proper handwashing process requires only three ingredients: running water, soap and a way to dry hands.

The proper handwashing steps are:

  • Wet handswith clean, running water (warm or cold) and apply soap.
  • Rub handstogether to make a lather and scrub them well; be sure to scrub the backs of hands, between fingers and under nails.
  • Continue rubbinghands for at least 20 seconds.
  • Rinse handswell under running water.
  • Dry handsusing a clean towel or air drying.

For safety, the CDC recommends washing hands before and after a number of activities, but the instances most applicable to JanSan workers and maintenance personnel are:

  • Before and after caring for someone who is sick.
  • After using the toilet.
  • After touching garbage.

If soap and water are not available, the CDC instead suggests using an alcohol-based hand sanitizer that contains at least 60 percent alcohol.

While sanitizers will quickly reduce the number of germs on hands in some situations, they generally do not eliminate all types of germs, and they are not as effective when hands are visibly dirty.

Finally, the CDC’s list of good health habits meant to stop the spread of germs recommends cleaning and disinfecting frequently-touched surfaces, especially when someone is ill.

Survey Says

Bradley Corporation, a company that designs and manufactures handwashing products, has conducted a yearly Healthy Hand Washing Survey for the past five years.

“We like to keep a pulse on Amercia’s handwashing beliefs, behaviors and preferences,” says Jon Dommisse, Bradley’s director of global marketing and strategic development.

The company uses the collected data to make their products and technologies more customer focused, Dommisse notes.

This year’s survey asked 1,015 American adults about their handwashing habits in their workplace and public restrooms; participants were from around the U.S., were aged from 18 to 65 and were almost evenly split between men and women.

“Our survey indentified that, although the vast majority — 95 percent — of Americans knows they should wash their hands after using a public restroom, they are taking shortcuts in completing the task,” Dommisse explains. “Seventypercent admit they have skipped the important step of using soap. That’s 15 percent points higher than last year’s findings.”

This leads to an obvious question: Why aren’t they using soap?

“Responders said mainly because no soap was available, the sink or soap dispenser were broken or the restroom was too unclean.”

All three reasons showcase how managers, BSCs and JanSan workers can positively affect and improve occupant handwashing in their facilities.

More Americans also said they have seen someone else leave a public restroom without washing their hands at all.

This year, 81 percent witnessed a non-washing event compared to 74 percent last year, Dommisse says.

Another important survey response may also help guide professional cleaners — men continue to lose the battle of the sexes in the handwashing department, according to Dommisse.

The survey found that, while 74 percent of women say they always wash their hands in a public bathroom, only 60 percent of men say they do.

Even worse, 24 percent of men stated in the survey that handwashing is not important at all.

Based on these survey results, JanSan workers may want to take extra safety precautions and spend some additional time cleaning in men’s rooms.

Infection Connection

Dommisse states that the CDC is forthright in their communications concerning how handwashing with soap remains the number one preventer of spreading germs.

In fact, scientists believe that our hands may transmit up to 80 percent of all infections, so handwashing is key to stopping the spread of infection and staying healthy.

Dommisse says illnesses that can be spread by poor hygiene practices include diarrheal diseases, food-borne illnesses, respiratory infections, etc.

Dommisse provides the following examples:

  • It is estimated that washing hands with soap and water could reduce diarrheal disease-associated deaths by up to 50 percent.1
  • Researchers in London estimate that if everyone routinely washed their hands, a million deaths a year could be prevented.2
  • A large percentage of-food borne disease outbreaks are spread by contaminated hands. Appropriate handwashing practices can reduce the risk of food-borne illness and other infections.3
  • Handwashing can reduce the risk of respiratory infections by 16 percent.4

Specifically looking at public restrooms, scientists at the University of Colorado in Boulder examined the microbial biogeography of public restroom surfaces in 2011 and found 19 bacterial phyla invading these areas, Dommisse states.

Some bacteria were found on toilet seats and floors, but much of the bacterial exposure in public restrooms occurs during the handwashing process.

In fact, the exteriors of soap dispensers contain more bacteria than toilet seats.

This is another example of how cleaning workers and managers can address a trouble-spot and decrease infection risks in a restroom.

Finally, speaking of germ aversions, Dommisse says the survey also found that 76 percent of Americans are most concerned about somebody not washing their hands in restaurants vs. only 65 percent worrying about a hospital or healthcare office.

Healthcare Help

While survey respondents may be less worried about handwashing in the healthcare setting, scientists and healthcare workers are definitely concerned.

According to the CDC, approximately 2 million patients acquire a hospital-related infection every year, and roughly 99,000 die from their infection.

Klaus Nether, center solutions development director with the Joint Commission Center for Transforming Healthcare, says the group recently created a program specifically to address hand hygiene, and infection control, in the healthcare arena.

Working with eight healthcare organizations across the United States, the commission developed a measurement system so that each location could measure employee wash in/wash outs using the same parameters.

Employees who were expected to wash in/wash out at the facilities included laboratory workers, nutritionists, dieticians and environmental employees.

At the beginning of the project, the eight organizations were at 47.5 percent compliance with wash in/wash out procedures; after the project, they finished with 81 percent compliance and maintained it for 11 months, according to Nether.

As the project looked at the issue of hand hygiene in these facilities, it measured the issues that were identified as contributing factors, Nether says.

During the project, over 20 different hand hygiene factors were found, and the list included:

  • Inoperable or empty soap dispensers
  • Broken sinks
  • A lack of accountability
  • Distractions and forgetfulness
  • Issues with wearing gloves.

Based on the specific issues at each location, targeted solutions were developed and a control plan was created to sustain hand hygiene improvements over time.

Using their findings, the commission created a Targeted Solutions Tool that can be created specifically to help individual healthcare organizations decrease healthcare associated infections and increase hand hygiene compliance in approximately 12 weeks, according to Nether.

“There is a correlation with hand hygiene and health acquired infections, so one of the organizations that actually implemented the targeted solutions tool … they actually saw that as their hand hygiene compliance rates went up, their blood stream infections actually decreased by 66 percent,” Nether states.

Encouraging Handwashing

Based on his company’s survey findings, Dommisse offers a few tips for further encouraging workers and occupants to wash their hands.

Since a clean and organized restroom may lead to an increase in handwashing, Dommissee recommends durable handwashing fixtures and well-maintained and stocked restrooms.

“Make sure garbage is picked up, countertops are clean, floors are dry and use air fresheners to keep a good-smelling environment,” Dommisse says. “So, not only is a hand hygiene or handwashing program a good idea, it’s also a good idea for building maintenance staff and management to be hyper-aware about the condition of their restrooms.”

Another applicable advance would be touchless fixtures; these are gaining importance because they reduce the number of touchpoints in germ-laden restrooms.

These fixtures help users avoid touching restroom surfaces, reduce the transmission of germs and bacteria from users’ hands and improve overall hygiene as users leave the restroom and enter other parts of the building, Dommisse states.

Today, touchless faucets, soap dispensers, hand dryers and towel dispensers are available.

The CDC offers materials that facility managers and BSCs can use to encourage handwashing and hygiene as well.

The agency’s website ( contains numerous downloads including checklists, videos, podcasts, posters, fact sheets and social media resources.

As the U.S. moves deeper into cold and flu season, JanSan operations and departments can utilize cleaning improvements, handwashing tips and educational materials to help prevent absenteeism, boost occupant health and improve worker output in their facilities.


1World Health Organization (WHO)
2Curtis V, Camicross S. Effect of washing hands with soap on diarrhoea risk in the community: A systematic review. Lancet Infect Dis. 2003;3(5):275-81
3World Health Organization (WHO)
4Rabie T, Curtis V. Hand washing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health. 2006;11(3):258-67

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