British researchers installed electronic message boards over the entrances to toilet stalls at highway rest stops that flashed different messages as people walked inside. Then they watched more than 200,000 people to determine whether those people washed their hands after using the bathroom. No, they didn’t really install hidden cameras. Instead, they used electronic monitoring devices to determine how many people went in and out of the bathroom and how many people actuated the handles on the soap dispensers.
The message boards flashed random statements such as “Wash your hands with soap,” “Don’t be a dope, wash with soap,” and “Washing hands with soap avoids 47% of disease” as people walked into the bathrooms.
The researchers then compared the frequency of handwashing between control subjects who saw no message and study subjects who saw a random message. They even asked people leaving the bathrooms whether or not they saw the messages (only 1/3 reported doing so).
In general, the most effective messages increased handwashing only by about 10%. Many of the messages had no effect at all. One message – “Soap adds a fresh touch” – caused women to wash their hands less than no message at all.
What surprised me was that the statement that made a big impact with men (and the largest impression on me) hardly had any effect on women in the study. “Soap it off or eat it later” showed no statistical effect on womens’ handwashing. I’ll let you draw your own conclusions about that.
“Soap adds a fresh touch” was one of the most effective statements at getting men to was their hands. Wimps. What’s up with British men? Maybe next they’ll do a soap commercial with men skipping through flower patches and sniffing the mountain breezes.
The statement that worked best for men and women was the Orwellian “Is the person next to you washing with soap”? Be kind of funny to go into a toilet stall, pretend that you used it, purposely not wash your hands, then try to shake the hand of the guy standing at the sink next to you while that message was flashing.
To me, pictures would be more compelling. Something like “We cultured your woo-hoo. Here’s what grew out” – along with a picture of a bunch of slimy bacteria.
If we replicate this study in the U.S. (say at a football stadium or something), I volunteer to be on the creative team coming up with poster ideas.
I cannot believe that people don’t wash their hands – ordinary folks, medical people, restaurant workers. Don’t they teach the germ theory of disease any longer? Basic hygiene taught in the home prevents so much illness. I suppose if mothers are not washing their hands routinely, they don’t teach their children, and so it goes.
If you want to encourage handwashing, start with how the bathrooms are engineered. Use a faucet that pours water into the middle of the sink, like the goose-neck variety found in hospitals. Use foot pedals so you don’t have to touch the contaminated knobs on the sink. Ditto with paper towel dispensors. I’m sure many of in the medical profession the paper towel to turn off the water and touch the door handle and shoot a basket on our way out the door, but think how much extra training we all have! If it was between not washing my hands and touching that nasty hardware, I’d elect to not wash my hands. Frankly my penis isn’t that dirty and I don’t pee on my fingers.
Uh, actually it is that dirty, and it isn’t about not peeing on your fingers. Washing your hands stops you from making other people sick with your penis germs. Probably they won’t harm you.
I agree with your comment about dirty hardware though, I love when they have sensors instead of taps. And removing the door on the bathroom altogether and just having several bends so no-one can see in is the best. In smaller buildings I don’t understand why the bathroom doors don’t open outwards, then you could just nudge them with your foot!
Uh, actually, I don’t think his penis germs are anything that will give me a cold or the flu or MRSA or SARS…esp if he showers daily and wipes front to back…yeah the thought is gross but germs on peoples’ skin isn’t what causes most of our problems.
(Aside to Whitecoat- where is Nurse K and can you get me an invite to her page- I love her but can’t get in!!)
Thanks for addressing one of my pet peeves. I am appalled at the number of ladies (some of whom look verywell put-together) who either don’t wash at all, or dangle fingers quickly and daintily under a drizzle of water before walking out the bathroom door.
The only solution to this problem is bathroom monitors. Station armed guards at the doors, let no one out until they wash!
Do what my daughter’s university biology class did. The teacher applied some kind of invisible indicator substance on students’ hands then sent them all out to the bathrooms with instructions to wash their hands as they might after using the bathroom. When they returned, she placed a special light over each of their hands and showed them all of the geographical areas they had missed in their washing.
As for the mechanics, I’m with Tom. I’d love to see foot-pedals for turning on water, and the goose-neck faucets. Since (as the owner of a walnut-sized bladder) it is not always possible to avoid the need for using a public bathroom, I at least use elbows for turning on water and getting paper towels, though thankfully we are getting more and more motion-activated water/soap/towel dispensers around here.
Paging Dr. Semmelweis…
No time to read the comments now and so I’ll just say…How stupid and gross some people are!!! And selfish!
I wonder what percentage of these people are food handlers.. the ones going to make your meal?
Love your idea!
at least use elbows for turning on water and getting paper towels
With your elbows?!? You must be really gymnastic. How on earth do you pick up a paper towel with your elbows? I use my back to open the door (I just back into the restroom rather than touch the door with my hand), but I don’t use my elbows for anything.
I first get a paper towel ready to grab. Then I use my unwashed hand to twist the knobs to turn on the water. After I wash my hands, I get the towel and dry my hands, using the towel, if necessary, to obtain a second towel. With the second towel I turn off the water and use it to open the bathroom door. Then I either do the rim shot thing Tom described, if I think I can do it, or I carry the towel out with me and find a trash can right away. The best restrooms have a trash can right by the door, so no basketball skills required. Just open the door, hold it open with your back, and drop the towel into the can.
And what is the deal with bathroom lavatory faucets? The vast majority of them dispense water just baaaaaaaaaaaaaarely past the edge of the bowl, making it all but impossible to really get your hands under the water without touching the bowl itself. I vote for Tom’s solution, not just in public restrooms, but in homes, as well. Whether or not your sink is newly cleaned, I don’t want to touch it with my hands.
I’m reminded of the joke about a comment at a urinal…
“I see you’re a chemist.”
“Why, yes. How did you know?”
“You washed your hands *before* you came to the urinal.”
Go ahead. Touch the handles, touch the doorknob. When you’re done, use alcohol or acogel; that’s what that stuff is for.
Never mind what your immune system is for.
Being on chemo several years ago helped me learn how to turn off even most of those home-type knob faucets with my elbow. (I also learned how to push elevator buttons with my elbows and open pull doors with my forearm.) I hate the restrooms that have knob faucets and air blowers instead of paper towels. If you’re not going to supply paper towels in a public restroom, you need to install motion sensors or faucet handles that people can easily operate with their elbows.
I am the only one who is laughing during an open book test because of your post. I love reading your blog!
Christopher Miller, MPH
MHA Candidate 2010
Student Physician
ATSU Class of 2014
Should I leave my credentials?
I went to an amusement park that had a step-on control for the sink. (It was a round all-around sink…was it disney or 6flags?) …anyways people were eager to use it, and one second and everyone was done. It was 55 degrees outside and the water had one freezing setting.
I remember a friend of mine, a sensitive fellow who uses a karate-style kick to trigger a urinal flush and several layers of paper towel to open the bathroom door on leaving, tell me that on his first day in a new job he’d just walked into the bathroom when the door to a stall opened and le grand fromage of the whole company walked out, spotted the new guy, shouted “Welcome aboard!” and held out his hand. I can’t remember what my friend did, but to the more fastidious among us, this is the stuff of which nightmares are made.
TGT
That reminds me of the Seinfeld episode with Poppy when he uses the bathroom and doesn’t wash his hands. Jerry refuses to eat the pizza and says “Poppy is a little…..sloppy.”
Why are some people slobs in a public restroom?
I assume they start out clean in the morning.. but then through the day..toilet paper on the floor, urine on the seats and floor and sometimes worse..and even unflushed toilets.
Why?
I *HATE* some public restrooms.
If I don’t have a choice and have to use a messy one.. I will clean the seat and area..even with a soapy paper towel and dry. I know some people just pee over the pee and leave. but I don’t want people thinking I left that disgusting mess.
Seriously..why are some people such pigs?
And even worse …when you realize too late that the toilet paper was sitting on the floor or left loose and so you don’t know where it’s been and then as a woman you have to wipe and hope you don’t get an infection. I try to always have something with me but best laid plans…
Men definitely have it easier then women.
Sorry I digressed WC… but I’ll tell you… forget washing your hands.. after using some bathrooms ..I wish I could take a shower.
Really..if each person would take a minute to clean up after themselves it would be clean and if each person would just wash their hands thoroughly..oh what a wonderful world it would beeee1
“We’ve cultured your WOO-WOO?!!!” Spoken like a true ED doc! But none the less, wash your *@!% hands!
Just one more reason to keep hand sanitizer in your purse, backpack or car and use it often to keep yourself protected from germs