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Jet-air hand dryers in hospital washrooms shed more germs than disposable paper towels and should not be used, say the researchers.
In the Journal of Hospital Infection, they state that official guidelines on the prevention of bacterial contamination in hospital buildings need to be strengthened.
Currently, official Ministry of Health guidelines indicate that air dryers may be placed in public washrooms in hospitals, but not in clinical areas: not because of the risk of cross-contamination, but because that they are noisy.
Mark Wilcox, a professor of medical microbiology at the University of Leeds, who oversaw the international study, said the focus should be on the risk of infection, given the new evidence.
The new study examined bacterial spread in a real-life setting – in two washrooms in each of the three hospitals, located in the UK, France, and Italy. Each toilet had paper towel dispensers and air dryers, but only one was used each day.
Professor Wilcox said, "The problem starts because some people do not wash their hands properly.
"When people use an air dryer, the microbes fly off and spill into the toilet.
"Indeed, the dryer creates an aerosol that contaminates the washroom, including the dryer itself and potentially the sinks, floor and other surfaces, depending on the design of the dryer and its location. bacteria or viruses.
"Air dryers often rely on contactless technology to initiate hand drying, but paper towels absorb water and microbes left on the hands and, if properly removed, the risk of cross-contamination is low. "
The study, conducted by researchers from the University of Leeds and the Leeds Teaching Hospitals Trust, was the largest of its kind to determine whether the way people were drying their hands had an impact on the spread bacteria.
This research follows a previous laboratory study conducted by the same team, which found that jet air dryers were far worse than paper towels or traditional hot air hand dryers in spreading germs.
The hospitals used in the study were the general infirmary of Leeds in Yorkshire, St. Antoine Hospital (Assistance Publique-Paris Hospitals) in France and the Hospital of Paris. Udine in Italy.
Each day for 12 weeks, levels of bacterial contamination in the toilet were measured, which allowed for comparisons when paper towels or air driers were used. Samples were taken from the floors, air and surfaces of each toilet.
The main target bacteria were:
Staphylococcus aureus: responsible for a wide range of ailments ranging from minor skin infections and wounds to life-threatening sepsis.
Enterococci: bacteria that can cause infections that are difficult to treat, including in immunocompromised patients.
Enterobacteria: including Escherichia coli. These bacteria cause a wide range of infections, including gastroenteritis, pneumonia and sepsis.
In all three hospitals, the number of bacteria was significantly higher in toilets on days when air dryers were used.
In Leeds and Paris, at least five times more bacteria were recovered from soils when jet air dryers were used, compared to paper towels.
In Leeds, Staphylococcus aureus (including MRSA) was found three times more often and in larger quantities on the surface of air dryers than paper towel dispensers. Significantly, more enterococci and multidrug-resistant bacteria were recovered from floors or toilet dust when air-jet dryers rather than paper towels were used.
In Italy, researchers found much less bacteria on the surface of paper towel dispensers than air jet dryers, but no significant difference on soils.
Professor Wilcox said, "We found many examples of higher bacterial contamination on surfaces, including fecal and antibiotic resistant bacteria, when air dryers rather than paper towels were used. and therefore probably the risk of infection. "
Frédéric Barbut, professor of microbiology at Saint-Antoine (Assistance Publique-Hôpitaux de Paris), said: "The higher environmental contamination observed with compressed air dryers compared to paper towels increases the risk of cross-contamination.
"These results confirm the previous results obtained in the laboratory and corroborate the recent French guidelines on hand hygiene, which discourage the use of air driers in treatment rooms."
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