Going Touchless is a High-Tech Solution to Hand Hygiene Compliance

The researchers used a generic wall-mounted paper-towel dispenser and a variety of different paper towels. Volunteers with either clean or contaminated hands were asked to remove, using a range of protocols, towels from dispensers which were either clean or contaminated. Previously clean surfaces were then microbiologically tested. The investigators found that recoverable bacterial transfer rates from a contaminated hand to clean dispenser exits ranged from 0.01 percent to 0.64 percent, depending on the bacteria used with an even higher transfer rate for clean towels. The reverse transfer, from contaminated exits to clean hands, was between 12.4 percent and 13.1 percent. The results indicate that zig-zag transfer of bacteria between paper-towel dispensers and hands can take place if either one is contaminated, and should be considered in the design, construction, and use of paper-towel dispensers.

The investigators write, “This study has shown that even ‘manual pull’ disposable folded towels and towel dispensers that are considered ‘hands free’ or touchless can become contaminated if the surfaces at the dispenser exit are touched. This usually occurs when the paper towel is not cleanly delivered to a user, and this varies considerably depending on the compatibility of paper towel and dispenser combination. The total number of bacteria isolated from the dispenser exits after freeing a jammed towel with a contaminated hand was relatively low but should be viewed within the context of the number of times per day this activity may need to be carried out. It is also important to note that in some cases, although the minimum infective dose can be variable, only small numbers of pathogens, especially for intestinal disease, may be required to cause illness. A number of these pathogens are known to cause outbreaks in hospitals, therefore, even the low estimates obtained in the present study still allowed for sufficient bacteria to be transferred for them to exceed the minimum infective dose for a number of human pathogens. This was particularly true of the numbers transferred from wet, contaminated hands to dry towels remaining in the dispenser. The type of contamination demonstrated in this study, coupled with the survival potential of some pathogens causing hospital acquired infections, could also assist in the spread of organisms within the hospital environment. There was an even greater transfer of both the resident and transient bacteria to the towels pulled or remaining within the dispenser. Paper towels with damp patches or spots may, in addition to being aesthetically unappealing, present an infection risk.”

The Rise of Touchless Technology

Supporters of touchless technology frequently point to a study by Larson et al.¹³ that compared the frequency of use of manually operated and touch-free dispensers of alcohol sanitizer installed in the emergency department and an intensive care unit of a large pediatric hospital for two, two-month periods for each type of dispenser. Counting devices installed in each dispenser and direct observations were used to determine actual frequency of and indications for hand hygiene. Larson et al. found that the touch-free dispensers were used significantly more often than were the manual dispensers. The means for the number of episodes of hand hygiene per hour were 4.42 for the touch-free dispensers and 3.33 for the manual dispensers (P = .04); the means for the number of episodes per patient per hour were 2.22 and 1.79, respectively (P = .004); and the means for the number of uses of the dispenser per day were 41.2 and 25.6, respectively (P = .02). However, the overall compliance rate was 38.4 percent (2,136 episodes of hand hygiene per 5,568 indications for hand hygiene).