What's the healthiest faucet for hand washing?

Michael Chotiner
Michael Chotiner

Since "touchless" faucets became widely available in the late 1980s, they were believed to be an effective tool for combating the spread of infections. We've all seen them at the airport and in other public restrooms, and they've been widely specified for construction of new healthcare facilities for more than 30 years.

Why Touchless Faucets? 
Touchless (sometimes called "electronic" or "automatic") faucets are controlled with motion sensors — "electric eyes" — that open the valve to deliver a water stream when they sense hands nearby and close it when hands are removed. They eliminate the need to grasp conventional faucet handles, through which germs can be passed around, and are frequently used as replacements for faucets with blade-type handles, which can become contaminated from splashing when microbe-laden fluids are washed down sink drains.

Touchless faucets are thought to be particularly well suited for use in long-term care care facilities, not only for infection control but also because they:

  • Encourage frequent hand-washing among residents and staff
  • Are easier for residents with arthritis in their hands to use
  • Conserve water by up to 70%

Study Finds Touchless Faucets Harbor Dangerous Bacteria 

But a 2011 study published by Johns Hopkins University has raised questions about touchless faucets: Researchers found that their internal parts tend to harbor certain bacteria, including Legionella (which causes the pneumonia-like illness Legionnaire's disease) and Pseudomonas (a leading cause of infection in hospitals and care facilities); and fungi, such as Aspergillus (a mold genus that causes sinus infections)—more so than conventional handle-operated faucets. 

The findings caused a stir among architects, engineers and operators of health-care facilities. Manufacturers of touchless faucets rushed to defend their wares. Epidemiologists and engineers held conferences. More studies were initiated and since the Hopkins study was released, there's been much speculation about:

  • Whether it's true that touchless faucets are more likely to spread disease than prevent it
  • Why touchless faucets may harbor more bacteria than conventional faucets
  • How to mitigate the risks of touchless faucets

What Experts Think Now 
Legionella and Pseudomonas are present in different concentrations in the water supply in certain areas, and grow in concentration when water sits stagnant in pipes. While the levels at which the bacteria are found in most places don't present much of a threat to healthy people, those with compromised immune systems — like many seniors — are more vulnerable to contracting Legionnaire's Disease and/or pneumonia. Not all of the more recent studies found concentrations of dangerous bacteria in touchless faucets to be much greater than in conventional faucets, but the consensus is that touchless faucets do seem to present a higher risk.

Initially researchers speculated that touchless faucets developed denser internal biofilms because their design is more complex and they contain more non-metal parts. But noting that copper tubes also develop biofilms, experts now speculate that the microbes tend to get flushed out of conventional faucets more readily because they typically allow more water to flow for longer periods.

As a significant footnote, however, it's known that faucets with aerators, which restrict water flow while increasing the pressure of the stream, harbor more microbes and actually introduce them to the air around a sink where they can be inhaled. Faucets equipped with aerators carry more risk than laminar devices, which regulate flow and pressure with parallel water streams. There's no vaporization and less splashing.

While some healthcare facilities designers have reverted to specifying faucets with wrist-blade handles or foot-pedal operators for hand-washing stations, others aren't willing to sacrifice the water conservation and ease-of-use benefits that touchless faucets offer. In healthcare facilities where touchless faucets are preferred, the best practice is to install models equipped with a timed automatic flush function. Typically automatic flush faucets turn on the water flow for a short period at least once every 12 hours to wash out microbes that may become concentrated during stagnant intervals.

New Guidelines for Hand-Washing Stations 
In response to the concerns raised by the Johns Hopkins study on touchless faucets, the American Society for Healthcare Engineering and the Association for Professionals in Infection Control & Epidemiology have proposed a new set of guidelines for hand-washing in healthcare facilities. Key points regarding faucets are summarized below:

  • General hand-washing stations used by medical and nursing staff, patients, and food handlers shall be trimmed with valves that can be operated without hands.
  • Single-lever or wrist blade devices shall be permitted.
  • Sensor-regulated water fixtures shall meet user need for temperature and length of time the water flows. Electronic faucets shall be capable of functioning during loss of normal power. Sensor-regulated faucets with manual temperature control shall be permitted.

Regular Water-System Testing Required 
Installing and maintaining standards-compliant faucets is an effective way to reduce the risk of spreading infections. It's also important to note that the Centers for Disease Control and Prevention and the Veterans Administration require quarterly testing for Legionella in the water systems of healthcare facilities. Find the guidelines for collecting specimens at www.cdc.gov.

Surprising to some, touchless faucets are often not the best answer for reducing disease transmission.

Reducing the risk of bacterial and fungal presence and infection via bathroom faucets is a strong and necessary step to help protect the seniors in your life and under your care.

Michael Chotiner is a DIY and construction expert who writes about home improvement projects for Home Depot. Michael's bathroom faucet and sink tips are aimed at providing top-notch info to homeowners and caregivers. To view Home Depot's large selection of bath accessories, you can click here.

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