Jet-air dryers should not be used in hospital toilets

September 7, 2018, University of Leeds
Credit: CC0 Public Domain

Jet-air hand dryers in hospital toilets spread more germs than disposable paper towels and should not be used, say researchers.

Writing in the Journal of Hospital Infection, they argue that the official guidance about how to prevent in hospital buildings needs to be strengthened.

At the moment, the official Department of Health guidance says air dryers can be placed in toilets in the public areas of a hospital but not in clinical areas: not because of the risks they pose for cross contamination but because they are noisy.

Mark Wilcox, Professor of Medical Microbiology at the University of Leeds who supervised the international study, said the guidance needs to focus on the infection risks given new evidence.

The new study looked at bacterial spread in a real world setting—in two toilets in each of three hospitals, which were in the UK, France and Italy. Each of the toilets had paper towel dispensers and jet-air dryers, but only one of these was in use on any given day.

Professor Wilcox said: "The problem starts because some people do not wash their hands properly.

"When people use a jet-air dryer, the microbes get blown off and spread around the toilet room.

"In effect, the dryer creates an aerosol that contaminates the room, including the dryer itself and potentially the sinks, floor and other surfaces, depending on the dryer design and where it is sited. If people touch those surfaces, they risk becoming contaminated by or viruses.

"Jet-air dryers often rely on no-touch technology to initiate hand drying. However, paper towels absorb the water and microbes left on the hands and if they are disposed of properly, there is less potential for cross-contamination."

The study, led by researchers from the University of Leeds and Leeds Teaching Hospitals Trust, was the largest of its type to investigate whether the way people dry their hands has an impact on the spread of bacteria.

This research follows a previous laboratory-based study led by the same team, which found that jet-air dryers were much worse than paper towels or traditional warm air hand dryers when it came to spreading germs.

The hospitals used in the study were the Leeds General Infirmary in Yorkshire, the hospital of Saint Antoine (Assistance Publique-Hôpitaux de Paris) in France, and the Hospital of Udine in Italy.

On each day, over 12 weeks, levels of bacterial contamination in the toilets were measured, allowing comparisons to be made when either paper towels or jet-air dryers were in use. Samples were taken from the floors, air and surfaces in each of the toilets.

The main target bacteria were:

  • Staphylococcus aureus: responsible for a range of conditions from minor skin and wound infections to life-threatening septicaemia.
  • Enterococci: bacteria that can cause difficult-to-treat infections, including in immunocompromised patients.
  • Enterobacteria: including Escherichia coli. These bacteria cause a wide range of infections, including gastroenteritis, pneumonia and septicaemia.

Across the three hospitals, bacterial counts were significantly higher in the toilets on the days that jet-air dryers were in use.

In Leeds and Paris, at least five times more bacteria were recovered from the floors when jet-air dryers were in use, compared with paper towels.

In Leeds, Staphylococcus aureus (including MRSA) was found three times more often and in higher amounts on the surface of the jet-air dryers compared with the paper towel dispensers. Significantly more enterococci and multidrug resistant bacteria were recovered from either the floors or dust of toilets when the jet-air dryers rather than paper towels were in use.

In Italy, the researchers found significantly fewer bacteria on the surface of paper towel dispensers compared with the jet-air dryers, although no significant difference on the floors.

Professor Wilcox said: "We found multiple examples of greater bacterial contamination on surfaces, including by faecal and antibiotic-resistant bacteria, when jet-air dryers rather than paper towels were in use. Choice of hand drying method affects how likely microbes can spread, and so possibly the risk of infection."

Frédéric Barbut, Professor of Microbiology at Saint Antoine (Assistance Publique-Hôpitaux de Paris), said: "The higher environmental contamination observed when using jet air-dryers compared with increases the risk for cross-contamination.

"These results confirm previous laboratory-based findings and support the recent French guidelines regarding hand hygiene, which discourage using jet-air dryers in clinical wards".

The paper 'Multicentre study to examine the extent of environmental contamination by potential bacterial pathogens, including antibiotic resistant bacteria, in washrooms according to hand-drying method' is published in the Journal of Hospital Infection on 7 September.

Explore further: Hand dryers can spread bacteria in public toilets, research finds

More information: Multicentre study to examine the extent of environmental contamination by potential bacterial pathogens, including antibiotic resistant bacteria, in hospital washrooms according to hand-drying method, DOI: 10.1016/j.jhin.2018.07.002

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not rated yet Sep 07, 2018
Multiple studies have shown that air dryers in restrooms spread pathogens yet we still find them in use even in hospitals because they are cheaper monetarily and reduce labor expenditures.

I refuse to use the things and often have to leave the area with wet hands.

No one seems to care about the extremely loud noise most of them create.
not rated yet Sep 07, 2018
I wonder if this problem could be dealt with by re-engineering the air dryers to not just dump the 'used' air into the room. Could they have sort of a box design where one would put ones hands in and the air be recirculated back through the heater again? This would disinfect it as it goes around. If that doesn't work, exhaust the air from the room, perhaps dumping it outside?
not rated yet Sep 08, 2018
There is a dyson air dryer that is something like that carbon_unit. Look up Dyson Airblade. Its still far from perfect and the edges could still easily be contaminated, but its better than most of these stupid things. Give me recycled paper towel anyday.
Whydening Gyre
1 / 5 (1) Sep 09, 2018
When faced with an air dryer and no paper towels - I use my jeans...
not rated yet Sep 10, 2018
Armpits work fine.
1 / 5 (1) Sep 10, 2018
Use paper towels from a renewable resource: trees.
not rated yet Sep 10, 2018
The dyson airblade db is a strange unit and is sort of confusing to use. You have to put your hands down into the unit in order to dry your hands. The big problem i have with that one is that people constantly touch it for some reason, especially children (who likely have the dirtiest hands), and you eventually end up touching it yourself if you aren't careful retracting your hands from it when not paying much attention.

The dyson v seems to have the same issues as most conventional air driers when it comes to spreading germs.

The dyson wash and dry at the sink is also just as bad as the standard air driers.
not rated yet Sep 10, 2018
I use the squeegee method, using thumb and forefinger of one hand to strip water off the other, several times per hand. This removes a surprising amount of water, to the point where simply swinging my hands through the air while walking a hundred feet or so will completely dry them.

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