Hand-to-hand contact is often responsible for the spread of such infectious illnesses as flu, pneumonia, diarrhea, salmonella, E. coli and antibiotic-resistant methicillin-resistant Staphylococcus aureus (MRSA). Each of these can be quite serious. Every year, roughly 5,000 people die from food-borne illnesses and MRSA is now responsible for more deaths in the United States each year than AIDS.

The most effective way to prevent the spread of bacteria is hand washing. In fact, one recent study found that washing with soap can reduce pneumonia-related infections in children under the age of five by more than 50 percent.

“Hand washing and cleanliness prevents the spread of bacteria, and in public facilities that’s critical,” says Tom Gore, director of facility services and energy manager for Brenham Independent School District in Texas. “The cleanliness of the facility and the people in it are important parts of managing a facility.”

Not only is hand washing effective, it is also incredibly easy. The proper technique is to wet hands with warm water, apply soap, lather, then scrub vigorously for 20 seconds (enough to sing “Happy Birthday” twice) before rinsing. Finally, dry hands completely.

Everyone knows hand washing is important but that doesn’t mean they always do it. In fact, although 92 percent of adults claim they always wash their hands in public restrooms, observational studies consistently find that as few as 50 percent actually do so. Custodians can help end that disconnect by providing the proper products, placing them in the right spots and educating consumers on how and why to use them.

The Right Stuff

At its most basic, hand washing requires only water, soap and towels. Nonetheless, the jan/san market is flooded with hundreds of items dedicated to this simple practice.

There are liquid, foam and bar soaps in a wide range of colors and scents, as well as antibacterial varieties. Soap dispensers are available in pump, push-button and hands-free models. Alternatives to soap also exist, including antimicrobial wipes and alcohol-based sanitizers. There are also several ways to dry the hands, including cloth, paper and air, and each has its own dispenser, which are also available touch-free.

Choosing the right products can mean the difference between hand washing compliance and defiance. When it comes to soap and towels, it is important to choose a style that balances budgetary concerns with customer desires.

Finding the right products can be a matter of trial and error, according to Candy Hammer, facilities services supervisor for Issaquah School District 411 in Wash. The district decided to focus on hand washing two years ago after the nation saw MRSA outbreaks in schools.

“It took us a while to determine which products would work best, which are cost effective, and which the kids and employees would like,” Hammer says.

The district conducted side-by-side tests of three environmentally friendly soaps from two manufacturers for a year. The janitorial staff offered their input on which was easiest to stock, which worked best and which the users preferred. The district ended up switching from pink lotion soap to foam soap in a push-button dispenser. It also switched its paper towel dispensers from levered to mechanical hands-free in an effort to reduce cross-contamination.

“It wasn’t something that happened very fast because I wanted to make sure it was right,” Hammer says. “A test is the only way you can find out if it is really working.”

Switching products meant all of the district’s 3,600 dispensers had to be replaced. It was free, however, because Hammer got the soap dispensers from a vendor with which she has a longstanding relationship and she signed a three-year contract with another distributor for the paper towel dispensers.

Paying more for the new soap is worth it, Hammer says, if it will drive hand-washing rates up. And that’s exactly what happened. In fact, compliance is up about 50 percent based on soap usage.

“We saved a lot of money with the pink lotion soap because the kids weren’t using it,” Hammer says. “Now I get more washes per container with the foam soap, but the kids are actually washing their hands so I’m using more product. It may cost more, but I know the kids are washing their hands all the time now.”

Issaquah also introduced hand sanitizers to promote hand washing in areas outside the restroom. Alcohol-based sanitizers can be more effective than soap and water at killing germs and the Centers for Disease Control (CDC) recommends choosing waterless sanitizers that contain at least 60 percent alcohol. Also good are antimicrobial wipes or towelettes, which are as effective as soap and water but not as good as sanitizers.

Location, Location, Location

Just as important as the products offered is where they are located. In the restroom, soap should be within an arm’s reach of each sink. Dryers or paper towel dispensers should also be near the sinks and at a height appropriate to the users (nearer to the ground in an elementary school, for example).

If a person can’t reach the soap, they won’t use it. Likewise, they may avoid washing if getting a paper towel involves dripping water everywhere.

“It makes a big difference where and how accessible these products are,” says Randy Gray, director of plant operations for Ashley Regional Medical Center in Vernal, Utah. “Once you get into the habit of washing your hands, then you will look for what you need to do so. But until you get into the habit, soap and towels need to be placed where they are easy to see and use.”

In new construction, it is possible to put sinks wherever needed, such as break rooms or classrooms. Most companies, however, must make do with what exists. To promote hand hygiene in environments where time or location makes it difficult to wash hands, cleaners can provide hand sanitizers.

A study of 6,000 school children found that those who use hand sanitizers throughout the day, in addition to hand washing, experienced 20 percent fewer absences due to illness. In the hospital, the CDC estimates that an intensive care unit nurse can save one hour during an 8-hour shift by using a hand sanitizer.

In an effort to reduce absenteeism, Brenham Independent School District added hand sanitizers and antimicrobial wipes to its arsenal about five years ago. Facility executives started by placing hand sanitizers in the nurse’s station and in gym locker rooms. A year later, the principals asked to have the sanitizers placed in food service lines as a stopgap measure for students who don’t have a chance to wash their hands before lunch.

“We still get requests to put them someplace where we hadn’t thought of before and we honor that,” Gore says. The most recent request was for the chemistry lab. “It’s proof that people are using it.”

The district also places antimicrobial wipes in every classroom. This allows students to clean their hands before touching communal surfaces, such as a computer keyboard or mouse.

“A few years ago they were cutting up paper towels to clean the computer screens,” Gore says. “Now we have an alcohol-based wipe that they can use to clean the computer and their hands at the same time. It’s win-win.”

See The Signs

Housekeeping departments can take a more proactive role in hygiene than simply stocking supplies by educating their customers on the how and why of hand washing. One of the easiest and least expensive ways to do that is with posters.

“Signs placed in the right location offer a quick reminder to staff,” says Robert R. Devonshire Jr., building maintenance supervisor for the County of Lancaster, Penn., which also offers hand-washing demonstrations at its annual wellness week. “Keep it simple and obvious.”

The Soap and Detergent Association offers free downloadable brochures and posters on its Web site, www.cleaning101.com. Many state and local health departments offer comparable literature. For example, Issaquah School District gets its posters from the King County Health Department, which regularly updates its messages and designs.

The school district hangs signs in the cafeterias reminding the students to wash their hands after eating and every restroom has a poster with hand-washing instructions. Elementary schools get signs with cartoons and secondary schools have signs with simple facts. Even the teachers get reminders in their lunchrooms and restrooms.

“Signage and products are equally important,” Hanmmer says. “The product is secondary. The most important thing is getting them to wash and these signs help remind them.”

Providing great products and educating users can really pay off. Thanks to its efforts, Brenham Independent School District has avoided major absenteeism for the last five flu seasons. Fewer illnesses is good for the students’ health and for the school’s funding, which is based on average daily attendance.

“It’s hard to quantify a lack of disease or whether what we’re doing is the cause,” Gore says. “But we do have a plan and we are trying to help the people we are responsible for and do what we can to prevent the spread of disease.”

Becky Mollenkamp is a freelance writer based near Des Moines, Iowa.