Who can forget last year’s celebration of Global Handwashing Day, when it turned out that Brits wash their hands after using a gas station bathroom about as often as your doctor washes his hands before examining you? And that’s not a good thing.

OK, British researchers didn’t exactly come to that conclusion: I did, in this blog, after comparing what they found about motorists to what the academic literature says about doctors.

Now comes a survey of public bathroom hygiene in the US of A, and the good news is that even America’s worst washers are far more likely to have washed their hands than British drivers. The bad news is that the guy who just used the toilet at Grand Central Station is also way more likely to have clean hands than the guy walking up to your bed at the local hospital.

The latest survey involved researchers from Harris Interactive surreptitiously surveying more than 6,000 adults using restrooms at Atlanta’s Turner Field, Chicago’s Museum of Science and Industry and Shedd Aquarium, New York’s Pennsylvania Station and Grand Central Station and San Francisco’s Ferry Terminal Farmers Market. (British researchers, by comparison, used electronic surveillance to monitor a quarter of a million loo users along the nation’s highway system.) The research was sponsored by the American Society for Microbiology and the American Cleaning Institute.

On average, 85 percent of public restroom users in these four cities washed their hands, with Chicago’s science museum recording a sparkling 93 percent wash-up rate. In last place were New York City’s train stations, where only 80 percent of men and women washed up. However, even the worst bathroom – just 65 percent of men at Turner Field washed their hands – presented a stellar record of sterility compared to U.S. hospitals.

The Centers for Disease Control and Prevention published its first formal handwashing guidelines in 1975. Yet nearly 35 years later, a multicenter study found that baseline compliance for hand hygiene was just 26 percent in intensive care units and 36 percent in non-ICUs. A 12-month “feedback intervention” increased compliance to just 37 percent for ICUs and 51 percent for non-ICUs. Somewhat more optimistically, a group of hospitals voluntarily participating in a Joint Commission quality improvement project went from a 48 percent baseline rate of hand hygiene compliance to a sustained average rate of 82 percent.

Healthcare-associated infections cause more than 98,000 patient deaths annually in the United States, according to Infection Control and Hospital Epidemiology. On the other hand (as it were), it’s not the patients who we’re asking to wash up.

Michael Millenson is a Highland Park, IL-based consultant, a visiting scholar at the Kellogg School of Management and the author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age.”

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7 Responses for “NYC Train Station Bathroom Yields Cleaner Hands than Hospitals”

  1. Healthy Eating says:

    Healthy Eating
    This is a wonderful opinion. The things mentioned are unanimous and
    needs to be appreciated by everyone.

  2. From what I have seen in men’s washrooms in the UK handwashing is not much more than 60%. But I suspect it depends on where the washroom is located.

  3. So, if we could just get those bathroom washing citizens to have a good bedside manner AND see how many of them wash up before walking into a patients room when they have disinfected 27 times already that same shift. With over 700,000 licensed doctors, what was their rate in the public/non-hospital settings?
    I think your conclusion is misguided. The more accurate test is the reduction in nosocomial infection rates and other complicatins…which of course most everyone is now measuring. Shame on those who are not, and shame on those who have low scores.

  4. Hand washing is important. I do it before each patient and many other times during the day to protect both myself and others. The trick is to preventing irritant hand dermatitis with all this hand washing and hand sanitizing. I’m a dermatologist and I give good hand care instructions in one of my blog posts. Anyone interested can type Hand Sanitizer into the search box on my site.

  5. Cynthia RN says:

    question, I love the article and the research, but I would have liked to hear a little more detail regarding IRB approval for a study involving the placement of cameras in public restrooms or where the original research data can be located.

  6. Michael Millenson says:

    No cameras in public restrooms by the US researchers. They had people go in and pretend to be brushing their hair, etc., while observing

  7. We expect more handwashing citizens in public wathrooms as handwasing is so important.

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