Another Airport Travel Hazard -- Dirty Hands

CHICAGO -- Does it take an outbreak of a frightening, potentially fatal infectious disease like severe acute respiratory syndrome (SARS) or a gastrointestinal illness on a cruise ship to get people to follow Mom's advice to "wash your hands after using the bathroom?" Apparently, it may.

Results of a new survey announced today at the 43rd Annual Interscience Conference of Antimicrobial Agents and Chemotherapy (ICAAC) show that many people still aren't washing their hands in public places, exposing others to the risk of infection, despite recent outbreaks of infectious diseases.

Although illnesses as deadly as SARS and as troublesome as the common cold or gastric distress can be spread hand-to-hand, the survey sponsored by the American Society of Microbiology (ASM) found that many people passing through major US airports don't wash their hands after using the public facilities. More than 30 percent of people using restrooms in New York airports, 19 percent of those in Miami's airport, and 27 percent of air travelers in Chicago aren't stopping to wash their hands. The survey, conducted by Wirthlin Worldwide in August 2003, observed 7,541 people in public washrooms in New York, Chicago, San Francisco, Dallas, Miami, and Toronto. In contrast to airports in the United States, the vast majority of travelers using the airport restrooms in Toronto, Canada -- a city which experienced a major SARS outbreak -- washed almost every time.

U.S. airport observations contrast sharply with an August 2003 Wirthlin telephone survey of 1,000 Americans, in which 95 percent said that they wash their hands in public restrooms. The same phone survey - which found only 58 percent of people say they wash their hands after sneezing or coughing and only 77 percent say they wash their hands after changing a diaper - highlights the seriousness of the problem.

In a similar Wirthlin survey conducted in 2000 for ASM, 95 percent reported they always wash their hands with only 67 percent observed washing their hands (based on 7,836 adults). A 1996 Wirthlin survey showed 94 percent of people claiming to always wash their hands with only 68 percent actually observed doing so (based on 6,333 adults).

Spurred by the latest findings, the ASM is redoubling its educational efforts, launching Take Action: Clean Hands Campaign -- a national initiative to educate Americans about health risks associated with poor hand washing habits.

"Although handwashing seems like such a little thing, it could really have a powerful impact on the way we manage the spread of infectious disease and newer public health threats like SARS and the Norwalk virus responsible for cruise ship illness," said Dr. Judy Daly, ASM secretary. "The same people that fail to wash after using restrooms go on to pick up children, handle food, greet family and use the other public facilities. Hand washing can be instrumental in controlling the spread of common and more serious infections," says Daly, director of the Microbiology Laboratories, Primary Children's Medical Center, University of Utah, Salt Lake City.

However, more people may be getting handwashing message. In the 1996 and 2000 surveys, 67-68 percent of people observed in public restrooms washed up. In this survey overall, 78 percent of those observed washed their hands, although settings and populations were different and the results may be skewed by the high percentage of hand washers in Toronto.

Dr. Donald Low, chief of the Department of Microbiology at the University of Toronto and Toronto's Mt. Sinai Hospital, one of the lead investigators of the Toronto SARS outbreak, said he wasn't surprised by either the almost universal hand washing at Toronto's airport, or the low levels in other cities. "The message about the importance of handwashing was put out every day here," he said. "And not just because of SARS -- handwashing is the smart thing to do. It should be second nature for all of us."

Low, who said that he is sure the handwashing rate in Toronto prior to the SARS outbreak was similar to that in other cities, notes that "it's such a simple, basic important tool to prevent disease transmission. Yet people ignore this step again and again. It's even been shown that health care workers don't wash their hands between patients."

"Our experience with SARS was such a wakeup call. People in the hospital here have changed their hand-washing habits. Here in Toronto, it has become a natural course of action," Low said.

Take Action: Clean Hands Campaign is a key component of the ASM's ongoing efforts designed to spread the message about the importance of hand washing. The campaign consists of educational materials designed for healthcare professionals and consumers including a brochure, poster and stickers and a Web site destination, www.washup.org, for downloading information and materials.

The ASM's initial survey and educational efforts began in 1996 with Operation Clean Hands and continued in 2000 with the Clean Hands Campaign.

"While Americans are beginning to recognize the importance of washing their hands in public places, many are still not getting the message," Daly says. "It's possible that the situation might be worse than our survey indicates. Some people may have washed only because 'someone was watching.' In the absence of monitoring, numbers may have been dramatically different. Our message is clear: one of the most effective tools in preventing the spread of infection is literally at our fingertips."

The American Society for Microbiology (ASM), headquartered in Washington, D.C., is the world's largest single biological science organization, with more than 42,000 members worldwide.