Following the COVID-19 pandemic, residential care facilities have focused on reducing infection transmission risks. This has included a strong focus on hand hygiene, which is one of the cheapest and most effective ways to reduce the spread of infection to protect residents and the aged care workforce.
The Australian Guidelines for the Prevention and Control of Infection in Healthcare (NHMRC) recommends three fundamental steps for hand hygiene using soap and water.
- Wash hands with soap and water.
- Rinse hands with water.
- Dry hands thoroughly with a single-use towel using a method that does not re-contaminate hands.
A recent systematic review suggested that while staff compliance in hand hygiene performance is relatively high, there is less compliance with effective hand drying techniques.
Hand Drying Purpose and Recommendations
Appropriate hand drying following washing and rinsing is an essential step of the hand hygiene procedure. Wet hands increase the risk of microorganism transmission, and the potential risks of an incorrect hand drying process include:
- cross-infection person to person (staff hands to residents),
- occupational contact dermatitis for healthcare workers, and
- environmental contamination.
Effectiveness of Hand Drying Systems: Paper Towels vs Electric Hand Dryers
There are three main hand drying methods present in residential care settings: paper towels, warm air hand dryers and jet air dryers.
These three hand‐drying devices have a different mode of drying the hands:
- absorption (paper towels)
- evaporation (warm air dryers)
- shearing forces and dispersal into the air (jet air dryers)
They also have different potential for microbial translocation, dispersal (air movement) and environmental contamination.
- Using a paper towel for drying caused less bacterial count trends on surfaces and the air.
- Jet air dryers create > 60 times more viral plaques than the warm air dryer and > 1300 times more than paper towels.
- Bacterial counts are 4.5-fold higher for jet air dryers when compared with warm air dryers, and 27-fold higher compared with the use of paper towels.
Electric hand dryers (warm air and jet air dryers) are not recommended for use in clinical areas. Electric hand dryers generate more airborne diffusion and expand the risk of cross-contamination in contrast to paper towels.
- Paper towels produce very little air contamination at 0 m (directly below the device). Residual water was most efficiently removed from the hands by paper.
- Warm air dryers produce more downwards air movement; however, no major difference with paper towels method.
- Jet air dryers create airspeeds over 600 kph and the air movement is sideward at least 2 m distance.
Most facilities use folded paper towels from wall-mounted dispensers. However, some servery rooms and public toilets still use continuous cloth or paper roller towels. The end of cloth or paper roller towels may become a source of microorganism transmission. Also, hand dryers exceed the paper towel method for six indicators compared with five indicators for paper towels.
And the winner is…
These studies seem to suggest that disposable folded paper towels inserted into wall-mounted dispensers are best hygienic system of hand drying in any healthcare setting.
Of course, the use of paper towels may have adverse effects relating to waste disposal and environmental sustainability. Not to mention that used paper towels inside rubbish bins may be a bacterial reservoir if the disposal is not managed correctly. As always, effective infection control requires cooperation between multiple systems.
In the meantime, hand hygiene education targeting proper hand drying procedure should be strengthened. Each healthcare setting should have a Hand Hygiene competency assessment under the National Hand Hygiene Initiative to ensure their workforce is meeting all hand hygiene performance criteria. One tool that may help is the Practical Hand Hygiene Competency Audit Tool
Proper hand drying tools and techniques are a neglected part of hand hygiene. Ensuring that your facility is using the right materials in the right way is an easy, cost-effective way of reducing infections (and wet hands) in your facility.
Infection control in aged care requires constant vigilance. It’s hard to get a fresh perspective on somewhere you work every day. If need an outside set of eyes to help guide your facility to reduced infections and happier staff and residents, contact Bug Control now for an obligation-free chat.
If you work in a non-aged care setting but would like to know how you can improve your hand hygiene, head to verifyhandhygiene.com to find out how.
- Gammon, J., & Hunt, J. (2019). The neglected element of hand hygiene – significance of hand drying, efficiency of different methods and clinical implication: A review. Journal of infection prevention, 20(2), 66–74. https://doi.org/10.1177/1757177418815549
- Huang, C., Ma, W., & Stack, S. (2012). The hygienic efficacy of different hand-drying methods: a review of the evidence. Mayo Clinic proceedings, 87(8), 791–798. https://doi.org/10.1016/j.mayocp.2012.02.019
- Kimmitt, P. & Redway, K. (2016), Evaluation of the potential for virus dispersal during hand drying: a comparison of three methods. Journal of Applied Microbiology, 120: 478-486. https://doi.org/10.1111/jam.13014
- Reynolds, K. A., Sexton, J. D., Norman, A., & McClelland, D. J. (2020). Comparison of electric hand dryers and paper towels for hand hygiene: a critical review of the literature. Journal of applied microbiology, 10.1111/jam.14796. Advance online publication.
- Taylor, J. H., Brown, K. L., Toivenen, J., & Holah, J. T. (2000). A microbiological evaluation of warm air hand driers with respect to hand hygiene and the washroom environment. Journal of applied microbiology, 89(6), 910–919. https://doi.org/10.1046/j.1365-2672.2000.01122.x
- WHO, https://www.who.int/gpsc/5may/tools/who_guidelines-handhygiene_summary.pdf