Background

Hand hygiene is a fundamental component of infection prevention, but few studies have examined whether hand-drying method affects the risk of dissemination of potential pathogens.

Aim

To perform a multi-centre, internal-crossover study comparing bacterial contamination levels in washrooms with hand-drying by either paper towels (PT) or jet air dryer (JAD; Dyson).

Methods

A total of 120 sampling sessions occurred over 12 weeks in each of three hospitals (UK, France, Italy). Bacteria were cultured from air, multiple surfaces, and dust. Washroom footfall (patients/visitors/staff) was monitored externally.

Findings

Footfall was nine times higher in UK washrooms. Bacterial contamination was lower in PT versus JAD washrooms; contamination was similar in France and the UK, but markedly lower in Italian washrooms. Total bacterial recovery was significantly greater from JAD versus PT dispenser surfaces at all sites (median: 100–300 vs 0–10 cfu; all P < 0.0001). In the UK and France, significantly more bacteria were recovered from JAD washroom floors (median: 24 vs 191 cfu, P < 0.00001). UK meticillin-susceptible Staphylococcus aureus recovery was three times more frequent and six-fold higher for JAD vs PT surfaces (both P < 0.0001). UK meticillin-resistant S. aureus recovery was three times more frequent (21 vs 7 cfu) from JAD versus PT surfaces or floors. Significantly more enterococci and extended-spectrum β-lactamase (ESBL)-producing bacteria were recovered from UK JAD versus PT washroom floors (P < 0.0001). In France, ESBL-producing bacteria were recovered from dust twice as often during JAD versus PT use.

Conclusion

Multiple examples of significant differences in surface bacterial contamination, including by faecal and antibiotic-resistant bacteria, were observed, with higher levels in JAD versus PT washrooms. Hand-drying method affects the risk of (airborne) dissemination of bacteria in real-world settings.

中文翻译：

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根据干手法对医院洗手间细菌造成的环境污染：一项多中心研究

背景

手卫生是预防感染的基本要素，但是很少有研究检查干手方法是否会影响潜在病原体传播的风险。

目的

为了进行多中心，内部交叉的研究，比较用纸巾（PT）或喷气空气干燥器（JAD; Dyson）进行手干燥的盥洗室中的细菌污染水平。

方法

三所医院（英国，法国，意大利）每所医院在12周内共进行了120次采样。从空气，多个表面和灰尘中培养细菌。外部监测洗手间的脚步声（患者/访客/工作人员）。

发现

英国洗手间的客流量高出九倍。与JAD洗手间相比，PT的细菌污染更低。法国和英国的污染程度相似，但意大利洗手间的污染程度显着降低。在所有位置，JAD与PT分配器表面的总细菌回收率均显着更高（中位数：100–300对0–10 cfu；所有P  <0.0001）。在英国和法国，从JAD洗手间地板回收的细菌明显更多（中位数：24 vs 191 cfu，P  <0.00001）。对于JAD与PT相比，英国对甲氧西林敏感的金黄色葡萄球菌的恢复频率高出三倍，高出六倍（均P  <0.0001）。英国耐甲氧西林金黄色葡萄球菌从JAD到PT表面或地板，恢复的频率提高了三倍（21 vs 7 cfu）。与PT洗手间地板相比，从UK JAD中回收了更多的产生肠球菌和广谱β-内酰胺酶（ESBL）的细菌（P  <0.0001）。在法国，使用JAD和PT相比，从灰尘中回收产生ESBL的细菌的频率是其两倍。

结论

观察到多个表面细菌污染的显着差异的例子，包括粪便和抗生素抗性细菌的差异，在JAD和PT洗手间中的水平较高。在现实环境中，干手法会影响细菌在空气中传播的风险。