In many facilities, the signs proclaim: "Employees must wash hands before returning to work." And it's a good message — The U.S. Centers for Disease Control and Prevention (CDC) reports keeping hands clean is one of the most important ways of preventing the spread of infection and illness.

But what if washing one's hands didn't remove germs, but resulted in an increased amount of bacteria? It sounds crazy but it's true — some bulk soap not only doesn't remove bacteria from hands, but adds bacteria to the soapy mix.

A study conducted at the University of Arizona by Dr. Charles Gerba, microbiologist and professor in the Soil, Water and Environmental Science department, found unsafe bacteria levels in 25 percent of 500 samples taken from open refillable soap containers in restrooms across the country. The bacteria included coliforms (present in 16 percent of the samples), Klebsiella, Enterobacter, Serratia and Pseudomonas aeruginosa — as well as E. coli. All of these are known to cause a number of different illnesses, from skin infections to urinary tract infections.

Gerba's study also revealed that bacteria levels were high in antibacterial soaps. He explains that antibacterial soaps work against "gram-positive" bacteria — which are often neutralized by penicillin — such as Staphylococci. However, these antibacterial soaps are often not effective against coliform and E. coli bacterias. These bacterias are "gram-negative" and considered pathogens that are harmful to personal health.

The average contamination levels were more than one million bacteria per milliliter of soap, a number that is 1,000 times greater than the level recommended by The Cosmetic, Toiletry and Fragrance Association. According to Gerba, this is also enough to present a genuine public health risk.

"When you put this [contaminated] soap on your hands, you're actually getting more bacteria on your hands than is in the toilet after you flush," he says.

Brian Sansoni, vice president of communication and membership at the American Cleaning Institute (formerly The Soap and Detergent Association), notes that these studies are not meant to discourage hand washing, which is a recognized factor in good hygiene and infection control.

"The most important thing is making sure the soap is there and that people use it," he says. "But if it's not well maintained, and it's contaminated, then it defeats the purpose of good hygiene."

Bacterial Playgrounds

To support his findings, Gerba shares a few horror stories about his visits to restrooms in facilities across the country. He says organizations using concentrate soaps often have a 30-gallon drum where cleaners dump soap concentrate to mix with tap water. They then pour this mixture into containers to transport to dispensers at other facilities.

"In one facility I visited, there was a layer of 'slime' in the drum, growing bacteria all the time," he says. "Even if they cleaned that container before mixing more, a biofilm is left behind that provides a haven for bacteria to grow."

That bacteria-riddled soap is then transferred to dispensers and ultimately ends up on building-occupants hands.

Less bacterial contamination may occur if custodial operations cleansed the mixing container every day with hot water and bleach, says Gerba — who notes this typically doesn't occur.

However, custodial operations would also need to clean the soap dispensers to ward off contamination, adds Darrel Hicks, director of Environmental Services and Patient Transport at St. Luke's Hospital in St. Louis, Mo., and author of "Infection Control for Dummies."

"Old-style, push-type dispensers get gunky and soap gets caked underneath," he says. "It would be hard to get someone to wipe it off all the time."

Gerba adds that even if custodial crews cleaned the dispenser, a biofilm may remain that provides a place for bacteria to grow.

"I think it's hard to fully clean the dispenser, and impractical, since they are generally refilled when they are partially empty," he says.

Sealing Out Bacteria

As the evidence against bulk soap dispensing mounts, the CDC now recommends avoiding systems that allow custodians to mix soaps and add these mixtures to partially empty dispensers.

The good news is there is an alternative. Soap dispensers with sealed refills and hands-free dispensing systems are unlikely to become contaminated. In fact, Gerba's study found no bacterial contamination in sealed (bagged, cartridge or hands-free) dispensers.

"Hospitals have known of these alternatives for some time," says Gerba. "They have banned the use of bulk soaps because of the potential to cause outbreaks in immunocompromised individuals."

Two years ago, St. Luke's added hands-free soap dispensers in the more than 500 restrooms found in the five buildings that make up its 1.2 million square foot campus.

"Consumers are looking for fewer things that they have to touch in restrooms," Hicks says. "We went with hands-free dispensers so that there is nothing to touch in order to sanitize and wash your hands."

The wall-mount, touchless dispensing systems release soap as a foam. Hicks says he likes these types of dispensers because there's nothing to touch, eliminating contamination worries. There are also systems available that use factory-sealed cartridges that quickly snap in place, as well as units utilizing factory-sealed bags and fresh nozzles for every refill.

"These systems are easy to refill," says Hicks, who points out custodians simply open the unit and snap a refill in place. "Occasionally we have problems with mechanisms failing, and if changing the batteries doesn't fix things, we repair the mechanism, which all of our custodians are trained to do."

Often, the reason behind using bulk soap lies in the belief that it costs less. While these soaps can be less pricey — especially if users add more water than recommended — Hicks points out St. Luke's has actually saved money since changing dispensers.

"It costs a little more upfront," he says. "But I tracked it the first year, and we saved approximately 30 percent overall."

There is a cost to replace the touchless unit's batteries. But Hicks is quick to point out a long battery life makes this a non-issue. The batteries cost approximately 80 cents a piece and each unit takes two.

"Depending how heavily the restroom is used, these batteries can last a year or more," he says. "That's $1.60 a year. I think that's pretty good."

Because hand sanitizers also can become contaminated, Hicks recommends organizations use touchless hand sanitizer dispensers as well. However, he advises housekeeping operations pay close attention to National Fire Protection Association (NFPA) guidelines when adding these units.

"We had to take some down because the NFPA dictates how many liters of alcohol-based sanitizer we can have in a smoke compartment," he says. "We are currently working with our soap and hand sanitizer distributor to develop a product that better meets NFPA codes."

Lessons Learned

When switching to a new soap dispensing system, Hicks urges paying attention to what he calls "lessons learned" at St. Luke's.

Because soaps can damage the surfaces around dispensers, he recommends placing catch pans underneath them.

"The units themselves do not drip," Hicks says. "But if people pull away too quickly, the soap splashes on walls, counters and floors. I've heard stories of hand soap eating away floor finish. If you have flat paint in the area, it will damage that as well. The walls should be coated with washable paint."

Hicks also suggests putting tiny flags similar to mailbox flags on top of every unit. This helps building occupants alert custodians when a dispenser is out of soap or operating incorrectly.

"When housekeepers see the flag up, they know there's an issue with the dispenser that must be addressed," he says.

Sansoni stresses regular maintenance is a key element, no matter what dispensing solution is used. Dispensers need to be maintained on a daily basis — and even more often in busy or high-traffic restrooms.

He recommends housekeeping operations work with suppliers to select appropriate systems and train staff to maintain them. The best products, he says, are those that are both easy to use and maintain.

"If a dispenser isn't easy to use, people won't use it," Sansoni explains. "And if it isn't easy to maintain, it won't be properly maintained."

Finally, Hicks advises that custodial departments pay attention to the time of year when changing soaps, especially in cold winter climates. The cold makes people's hands more sensitive to soap changes.

"There is a certain amount of skin hardening that people's hands go through when adapting to new soap," he explains. "In the winter, people's hands become red and chapped, so it's not a good time to switch soaps. We ended up installing hand lotion dispensers to keep people's hands hydrated after we made the switch."

However, in the years since the switch, Hicks has noticed some very positive results. Medical health professionals wash their hands more than 30 times a day, a practice that can dry out their skin making it ripe for infection.

"We used to have eight to 10 incidences of bad hands every year, and it has pretty much gone to zero," he says.

The take-home message in all of this is that janitorial operations need to take a closer look at their facility's bulk soap dispensers.

After all, says Sansoni, "If the soap becomes contaminated, and someone gets sick, it's the facility's reputation that is on the line."

Ronnie Garrett is a freelancer and photographer based in Fort Atkinson, Wis.