Robert Kravitz

When it comes to protecting health in long-term care facilities, nurses and housekeepers really are a team. They must continuously work together to ensure the health and cleanliness of the facility. Their success will help prevent the spread of disease, a serious problem in any facility, but especially in one inhabited by older people.

This is why both nurses and cleaning professionals should be aware of a study published in the Journal of Hospital Infections in July 2018. While it did not focus on healthcare acquired infection (HAI) prevention, the study did point out new ways HAIs and other diseases can spread in a LTCF or similar facility.  

An estimated 1.6 million to almost four million HAIs occur annually in LTC facilities. HAIs are costly to treat, with estimates running over $2 billion annually. Finding ways to prevent HAIs requires the coordinated efforts of both nurses and housekeeping workers because the fact is that most HAIs are preventable according to the Centers for Disease Control and Prevention (CDC).

One of the most useful ways nursing staff and housekeepers can help prevent HAIs and other infections from spreading in an LTCF is to know where the disease-causing pathogens are located. This was one of the underlying goals of the researchers, which in this study, focused on the possibility that electric hand dryers installed in public restrooms could spread disease. There have been similar studies like this in the past. Invariably these studies concluded that the culprit is electric hand dryers. However, this one did not.

Details of the study

This particular research involved three different hospitals in Europe.  In the restrooms of these hospitals three different types of hand drying devices were found:

•    JADs.  This type of hand dryer releases high volumes of cool air to dry hands.

•    Hot dryers.  These are the more traditional hand dryers, releasing smaller amounts of air warmed by the unit.

•    Paper towels.  Included in the study were traditional paper towel dispensers, typically installed on walls near sinks and faucets.

In the three hospitals, a total of 120 air and surface samples were collected near the hand dryers over a period of 12 weeks.  This included walls, floors, counters and fixtures. When the results came in, key findings included the following:

•    Bacterial contamination was found on all restroom surfaces tested but most specifically in those restrooms where JADs were installed.

•    The UK hospitals had the most contamination; however, this was also the busiest of all the test locations. 

•    The Italian restrooms had the least contamination but they had “markedly lower” use than the other hospitals. 

•    Overall, bacterial counts on test surfaces were “significantly greater” where JADs were installed compared to those restrooms using warm air or paper towel dispensers. 

•    In all the restrooms, varying degrees of bacteria were noted around the hand dryers and paper towel dispensers, including Staphylococcus aureus, MSRA, and Enterococci.  Higher bacteria counts were found where JADs were installed, less where warm air and paper towel dispensers were located.

•    Similarly, air sampling tests found more bacteria and pathogens collected in those restrooms with JADs versus those using warm air or paper towel dispensers.

Study discussion

It is important to note that the researchers did not recommend that electric hand dryers be removed from the hospitals. In fact, the only criticism stated in the study was that the JADs could be noisy, suggesting they should not be installed too close to patient rooms.

However, the study did point out the following:

•    Far too many people still do not wash their hands properly. The result is that when using electric hand dryers, contaminants can become airborne, eventually landing on surrounding surfaces.

•    Contaminants becoming airborne is less likely to happen when using paper towels. In the process of drying hands, many of the contaminants are absorbed into the paper towels, which are then discarded in waste containers.

•    When using the JAD system specifically, contaminants that become airborne may be inhaled, potentially spreading disease. 

Encouraging proper hand washing is an ongoing challenge. Nurses and housekeepers in LTCFs must turn their attention to ways to eliminate these pathogens from touchable surfaces. The most effective ways are through proper cleaning.  

To accomplish this, nurses and housekeepers should evaluate their present cleaning methods and systems, says Mike Watt, the head of training for Avmor, a leading North American manufacturer of professional cleaning solutions. Additionally, here some of the steps he advises nurses and housekeepers should be aware of:

  • If using cleaning cloths and a sprayer, first, clean all “touchable” areas around the hand dryers as well as paper towels dispensers if installed. The areas must be cleaned first before using a disinfectant. Cleaning removes soils so that the disinfectant can work more effectively.
  • Always start with a fresh microfiber cleaning cloth and change it frequently.  Do not reuse the cloth for other cleaning tasks.
  • When selecting a disinfectant, make sure it is EPA-registered or, in Canada, has a drug identification number (DIN). Both indicate the disinfectant has been independently evaluated and proven effective.
  • Select a noncorrosive disinfectant. This will ensure it does not damage surfaces when used.
  • Never mix two different types of disinfectants. 
  • Always dilute the disinfectant according to manufacturer recommendations, and use different microfiber cleaning cloths from the ones used to clean surfaces.

“In some cases, rinsing may be necessary,” adds Watt. “This removes any chemical residue so the surface looks cleaner and helps prevent resoiling.”

“If LTCFs have adenosine triphosphate (ATP) systems to test surfaces, areas around the hand dryers should be tested before cleaning and then tested once again after cleaning,” adds Watt. “This will evaluate the effectiveness of the procedure. Furthermore, these areas should be tested regularly. A ‘benchmark’ will evolve, so cleaning workers [will] know how frequently these surfaces should be cleaned.”  

We opened this discussion addressing the fact that in order to keep LTCFs healthy, it must be a team effort of nurses and housekeepers. Nurses are in a unique position in that they administer medical aid, but also serve as their patients’ advocate. To that end, they should be able to help institute changes that they know will help improve the wellness of those in an LTCF or any other type of medical facility.  It is clear that when it comes to the spread of disease and HAIs, both nursing and housekeeping are equally vitally important. When working together, the spread of disease can be greatly reduced, or possibly eliminated altogether.

What is an ATP System?

Adenosine triphosphate (ATP) systems are small and relatively inexpensive devices that look like a TV remote control.  They are designed to detect if living cells, including many types of potentially harmful germs and bacteria are on a surface.  However, they do not indicate precisely what living cells may be on a surface. Instead, they serve as a warning. A high ATP reading typically indicates a surface needs more thorough cleaning.


Robert Kravitz is a frequent writer for the professional cleaning industry.