Hand hygiene

This page gives an overview of hand hygiene in schools and its importance in reducing rates of contracting and spreading infections. We talk about hand hygiene to mean both washing and drying the hands because just washing your hands is not enough. But to wash their hands, pupils first need the right facilities and we provide a checklist and guidelines on hand drying facilities and hand sanitizing gels/foams. Our page on cleaning and hygiene outlines the importance of making sure toilets and washing facilities are fit for use. Our page on design gives guidance on washroom design and facilities.

Schools have an important role to play in teaching and encouraging proper hand washing from an early age.  Handwashing habits learnt at school can last a lifetime.

Inadequate provision of hand hygiene facilities does nothing to encourage children to follow good practice. In many cases, the spread of infections in schools is thought to be related to the poor conditions of the toilet and washroom facilities. Lack of adequate handwashing and drying facilities or lack of time is cited by most children as a reason for not washing their hands.

That’s why schools need to review their toilets and wash hand areas in terms of layout and design, the right fixtures and fittings, and making them safer and easier to use and clean while reducing the potential for contracting and spreading germs.

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Hand washing

Handwashing is one of the most important ways of preventing contracting and spreading diseases and common infections like food poisoning and diarrhoea.

Our hands may look clean but that doesn't mean they are. As they touch people, surfaces and objects throughout the day, they pick up a lot of dirt and germs (bacteria, fungi and viruses) which we spread to other places and people. In turn, we can infect ourselves and make ourselves ill with these germs by touching our eyes, nose or mouth so that they pass into our body.

But first, pupils need the basics of warm running water, soap and hand drying facilities.

Facilities must be effective, easy and quick to use, clean, and ideally attractive. Otherwise children will walk away!

Checklist for schools:

• Washbasins and hand drying facilities are adjacent to all toilets and urinals
• These are accessible throughout the school day
• All are kept clean and in working order – see our guidance on Cleaning and Hygiene
• Every wash basin has hot and cold running water. A mixer tap is preferable. Water should be set at a safe temperature (maximum 41⁰C). Advice should be taken to avoid legionella.
• If push taps are used, they are easy to operate and stay on long enough for pupils to wash their hands properly
• Liquid or foam soap dispensers should be wall mounted and within arm’s reach: usually a minimum of one per two washbasins  
• Bars of soap are best avoided as they can spread germs from one person to another
• Soap dispensers should be replenished as needed and cleaned between refills (not simply topped up). Cartridge disposable refills are considered more hygienic. Dispensers should be non-drip
• Hand drying facilities are provided in sufficient numbers and adjacent to basins to facilitate and encourage pupils to dry their hands
• If disposable paper towels are used, they are provided in wall-mounted dispensers and replenished throughout the day
• Lidded general waste bins are provided (ideally foot-operated if free-standing) and emptied at least daily
• Sanitary disposal units are provided for girls aged 8 and over within individual cubicles and are emptied and sanitised sufficiently often, by a registered company to prevent them becoming over-full or malodorous. Disposal bags or absorbent toilet paper are available within cubicles for girls to wrap used sanitary products in prior to disposal.
• Hand washing notices are displayed
• Drinking water supplies of any sort are not located in toilet and washroom areas

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Washing hands thoroughly with soap and warm, running water removes most dirt and germs from our hands. The next key step in the process is drying our hands.

Hand drying

Hand drying is as important as hand washing. Washing hands is wasted if hands are not dried properly afterwards.

Warm, moist hands are a haven for bacteria. No sooner have we washed away the germs, wet hands begin to collect them again, beginning with the tap we turn off and the handle on the door out of the toilets. Wet hands can pick up and transfer much more bacteria than dry hands or even hands not washed at all.

What are the best facilities for drying hands?

There is some debate over the most effective form of drying in washrooms. Numerous studies suggest paper towels are more hygienic than the warm air electric hand dryers found in many washrooms. What's wrong with warm air hand dryers? Warming moist bacteria is the perfect way of increasing their reproduction rate – research shows that we could end up with more bacteria on our hands than we started with!

This is bad news for schools that want to reduce paper cost and wastage as well as the mess of paper towels and the potential for washbasin and toilet blockage and flooding.

So what should a school use?

The following is our own basic assessment of generally available hand drying facilities:

Electric hand dryers

Traditional warm electric hand dryers

• a study in 1998 found that they take on average 43 seconds to get hands reasonably dry (too long for most of us)
• there are concerns about their hygiene as they may greatly increase bacteria on hands as
  1) warm moist bacteria increases their reproduction rate
  2) rubbing moist hands under warm air increases the number of bacteria on the surface of hands - the figures we have found on this increase are horrific!

The more modern warm air jet-air dryers

• these dry hands much more quickly
• they use warm air which increases the risk of bacteria increase on our hands
• rubbing our hands together while drying increases the bacteria on our hands
• there are concerns that during drying they blow microbes around the washroom and onto the user and other people in the washroom.

The new ultra rapid, cold air, air sheet/air blade hand dryers:

• they can dry hands in as little time as it takes to dry hands with a towel (about 10 seconds)
• they are touch free to use
• as these dryers do not heat up the air this reduces the increase in bacteria reproduction rate on hands
• as there is no rubbing of hands this can reduce bacterial transfer from hands compared to warm air hand dryers
• the dyers are largely enclosed reducing the amount of microbes blown around during drying
• cheaper to run than warn air dryers and avoids the on-going cost of paper towels

Other forms of drying

Cloth towels

• Individual reusable towels – to be avoided due to the transfer of germs from one person to another and because damp towels can harbour germs
• Roller towels (one loop of towel) – to be avoided as these are basically the same as individual reusable towels, just joined together
• Linen roller towels (clean section kept separate from used section) – our public health experts do not recommend these but, if used, should be part of daily inspection/monitoring and should be changed if visibly dirty, wet, have been pulled off the wall, are hanging down or have come to the end of the roll

Disposable paper towels
These are considered the best option, especially with regard to reducing bacteria on hands, but do create problems with cost, mess, disposal and re-stocking.

So what do we recommend for schools?
From the evidence we have seen, we can only recommend either disposable paper towels or the ultra-rapid cold air air sheet dryers.

The location of toilets and hand wash areas may be a consideration. Where noise will be a problem electric hand dryers may not be suitable. But their noise can provide welcome aural privacy for pupils! Hand dryers can help mask embarrassing noises in the toilet cubicles.

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Hand sanitiser gels/foams

Fear of infection outbreaks in schools has encouraged the use of hand sanitiser gels or foams. This is due, in part, to time constraints, lack of facilities for conventional handwashing, and handwashing facilities not sited adjacent to eating areas. In most medium to large schools it is simply not feasible for all the pupils to wash their hands before eating, however desirable that might be.

Hand sanitisers don't require water so are a good and quicker alternative to soap and water, and serve when soap and water isn't available.

Hand sanitisers are a useful addition to soap and water in schools. Floor mounted or wall mounted dispensers can be sited in sufficient numbers at the entrance to eating areas and outside toilets where pupils have to touch a door handle to exit (and consequently may pick up and transfer contamination). They may also be useful in teaching areas.

However hand sanitisers are not appropriate for use when hands are visibly dirty or have touched blood as they do not remove organic material. But they do disinfect clean-looking hands, helping to prevent transmission of infectious microorganisms. They require an on-going budget allocation and regular encouragement, without which their use may decline. A member of staff posted by the dispensers outside the dining hall to remind pupils to use them will help compliance; this can be done after initial installation and then periodically.

Sanitisers are simple to use:

• Apply enough of the product to the palm of  the hand to wet hands completely
• Rub hands together, covering all surfaces, for up to 25 seconds or until they're dry

There has been debate over which is better, alcohol-based or alcohol-free hand sanitisers.  In the past, alcohol-free hand sanitisers tended to significantly under-perform alcohol or alcohol rubs as germ killers in clinical studies. More recently, advanced formulations have been developed, some of which have been shown to out-perform alcohol. Alcohol has also been found to decrease in efficacy after repeated use 

Hand hygiene promotion for pupils
There are lots of available programmes and ideas for hand hygiene promotion. Click here for a few simple lesson ideas for encouraging pupils to wash their hands.
Studies of handwashing in schools have found that handwashing compliance amongst pupils and staff largely falls once hand hygiene promotion has finished. Hygiene compliance is also lower when children are not supervised. This suggests that hygiene education needs to be an on-going and proactive activity.

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Hygiene and infection control in schools with scientific references
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