Study has important implications for minimising cross infection

A new, real-life multisite study has found that washrooms have significantly less bacterial contamination when equipped with paper towels for hand drying instead of using jet air dryers.

The study, led by Professor Mark Wilcox of the University of Leeds and Leeds Teaching Hospitals, was carried out in the UK, France and Italy, and examined the extent of environmental contamination in hospital washrooms from potential bacterial pathogens according to hand drying method. Antibiotic-resistant bacteria including MRSA and ESBL-resistant enterococci - were detected more frequently in the washrooms when jet air dryers were in use. 

“The findings will have important implications for hand drying guidance in healthcare settings,” said Professor Wilcox, “and they should be of particular interest to infection prevention and control doctors and nurses, procurement managers and all responsible for minimising the spread of cross–infection.”

The study compared two washrooms per hospital – each had paper towel dispensers and jet air hand dryers, but only one drying method was available to use at any given time. Each was frequented by patients, visitors and staff. A crossover design compared contamination levels within each over a 12week period. During the study, 120 sampling sessions in total in each of the three hospitals were carried out. Bacteria recovered included methicillin susceptible (MSSA) and resistant Staphylococcus aureus(MRSA), enterococci and enterobacteria, including ESBL (Extendedspectrum-lactamase producers) producing bacteria.


Key findings

In general, bacterial contamination was lower in washrooms using paper towels (PT) than those using jet air dryers (JAD), and total bacterial recovery was significantly greater from the JAD outer surface versus the PT dispenser at all three sites (median 100-300—vs 0-10 colony-forming units (CFU) respectively all p<0.0001). While contamination in France and UK was similar, it was markedly lower in Italian washrooms, thought to be due to a combination of a lower footfall and different cleaning practices. 

There were differences between the three locations, and significantly more bacteria were recovered from the floors of JAD washrooms in the UK and France (median 24 v 191 CFU, p<0.00001). In the UK overall recovery of MSSA was 3 times more common and 6-fold higher from JAD versus PT surfaces (both p<0.0001). 

“MRSA was recovered three times more often in UK washrooms (21 vs 7 CFU) from the JAD outer surface or on the floor beneath compared with respective PT sites,” explained Prof Wilcox of his part of the study at Leeds General Infirmary. “There were also significantly more ESBL-producing bacteria recovered from UK washroom floors during JAD versus PT use.”




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