AMERICA'S DIRTY LITTLE SECRET — OUR HANDS

Do As They Say, Not As They Do:
Americans vs. Handwashing

American Society for Microbiology Survey

Second Handwashing Survey Reveals
Americans Still Don't Get It

Toronto, Canada, Sept. 18, 2000 — Despite an ever increasing threat from antibiotic resistant "superbugs" and emerging new microbial illnesses, at least one third of Americans appear to have forgotten the single best piece of infection control advice Mom ever gave them - always wash your hands after you go to the bathroom.

While 95 percent of men and women surveyed say they wash their hands after using a public restroom, only 67 percent of people actually do wash before leaving the restroom, according to the results of a new survey and observational study conducted for the American Society of Microbiology's Clean Hands Campaign released here today at the ASM's Interscience Conference on Antimicrobial Agents and Chemotherapy meeting (ICAAC).

Despite increased publicity over the past several years about the importance of basic handwashing in limiting the spread of infectious disease, men and women in several American cities are even less likely to wash today than they were four years ago.

"While it may seem amusing at first, this is really a very serious issue. We really need to help the public understand the significance of these findings and the importance of handwashing," said Judy Daly, Ph.D., Secretary of the American Society of Microbiology (ASM). "The more people do their part to control the spread of infections, the less we have to use antibiotics, which lose their potency over time as bacteria develop resistance to them."

ASM's Clean Hands Campaign is designed to remind Americans that "Mom was right" — it is important to wash one's hands before and after handling food products, after handling pets, before eating, and whenever one is sick, or is around people who are. Despite the generally held belief that cold germs are spread through sneezing and coughing, the majority of transmission comes from hand-to-hand contact and transfer of germs.

"Hand washing is the simplest, most effective thing people can do to reduce the spread of infectious diseases," according to Julie Gerberding, M.D., Director of the Hospital Infections Program, Centers for Disease Control and Prevention.

Clean Hands Campaign Survey Results

The new findings about hand washing come from a national telephone survey of 1,021 adults and observations of 7,836 persons made in public restrooms in New York, Atlanta, New Orleans, Chicago and San Francisco. Observers found that those least likely to wash in public restrooms were men in Atlanta, while those most likely to wash were women in San Francisco.

Women surveyed were significantly more likely than men to at least say they wash their hands after various activities or events. For instance, 40 percent of women reported washing after sneezing or coughing, compared to 22 percent of men; 54 percent of women say they wash after petting a dog or cat, while only 36 percent of men say they do so; and 86 percent of women, compared to 70 percent of men, say they wash their hands after handling a diaper.

Clean Hands Campaign

The Clean Hands Campaign is a key component of ASM's ongoing efforts designed to spread the "importance of handwashing" message. The campaign will consist of educational materials designed for healthcare professionals and consumers including posters, a brochure, stickers and a Web site destination, http://www.washup.org for downloading information and educational materials.

ASM's initial survey and educational efforts began in 1996 with Operation Clean Hands. "Obviously Americans haven't picked up or retained the message. We believe the situation might be worse that it appears to be because some people may have spotted the observers and worried that �mom was watching.' In the absence of other people, the numbers may even have been dramatically less," said Daly.

"ASM will continue to educate the public and monitor results over time. Just as it's taken time to convince Americans to see the life-saving value of using their seat belts, we know this equally important effort will take time and we're in it for the long haul."

The American Society for Microbiology (ASM), headquartered in Washington, D.C., is the world's largest single life science society, with more than 42,000 members worldwide. ASM's mission is to enhance the science of microbiology to gain a better understanding of basic life processes and to promote the application of this knowledge for improved health, and for economic and environmental well-being. More information is available at www.asmusa.org.

HANDWASHING SURVEY FACT SHEET

SURVEY FINDINGS

More than nine in ten adults (95%) say they wash their hands after using public restrooms; however, just six in ten (67%) were observed doing so. Among the observational findings from public restrooms, the dirtiest hands are in New York. Only 49 percent of the 2,283 people observed washed their hands after using a restroom in Grand Central/Penn Station.

Conversely, Chicagoans washed their hands most often (83% of adults observed) after going to a public restroom, followed by adults in San Francisco (80%). New Orleans and Atlanta were tied at 64 percent.

Across all cities, women washed their hands more often than men (75% versus 58%). This disparity was the most pronounced in Atlanta, where 84% of women at a Braves' game washed up compared to only 36% of men.

Americans are also likely to say they wash their hands after changing a diaper (78%) and before handling or eating food (77%). However, many say they don't wash up after petting an animal (45%), coughing or sneezing (31%) or handling money (20%).

Interestingly, Americans with college degrees are slightly less likely than those without college degrees to say they wash their hands.

SURVEY METHODOLOGY

Part I: Observational Survey

Wirthlin Worldwide observed the behavior of 7,836 individuals (3,589 males and 4,247 females aged 18 years or older) in public restrooms (sufficiently equipped with soap, running water and towels) and recorded whether or not they washed their hands after using the facilities.

Observers discreetly watched and recorded whether or not adults using public restrooms washed their hands. Observers were instructed to groom themselves (comb their hair, put on make-up, etc.) while observing and to rotate bathrooms every hour or so to avoid counting repeat users more than once. Observers were also instructed to wash their hands no more than 10% of the time.

The research was conducted from August 24 through September 9, 2000 in public restrooms in well-known locales in five major metropolitan areas (Grand Central/Penn Station, New York City; Navy Pier, Chicago; Golden Gate Park, San Francisco; Braves' Baseball Game, Atlanta; and a casino, New Orleans).

Part II: Telephone Survey

Wirthlin Worldwide interviewed a total of 1,021 U.S. adults about their handwashing behavior in several situations.

Margin of error for a sample of this size is +/- 3 percent at a 95 percent confidence level. Results are weighted by age, gender, geographic region, and ethnicity to ensure reliable and accurate representation of the 18+ population in the continental U.S.

The research was conducted during the period of September 1-4, 2000.

COMPARISION TO 1996 HANDWASHING SURVEY

Replicating a study conducted in 1996, Wirthlin Worldwide found in August of 2000 that there is still a substantial gap between those who claim to wash their hands after using a public restroom and actual observed behavior. In 1996, 94% of adults claimed to wash their hands while only 68% were observed doing so. In 2000, 95% claimed to wash their hands, while only 67% were observed doing so. There is no statistical difference between the data from the two years.

Interestingly, however, actual observed handwashing behavior declined among men (61% in 1996, 58% in 2000; a significant difference), while there was no significant change among women (74% in 1996 vs. 75% in 2000).

HANDWASHING FACT SHEET

HANDWASHING STUDIES

A recent national survey conducted by Wirthlin Worldwide found that 95 percent of respondents say they always wash their hands after going to the bathroom. However, observations in public restrooms indicate that only 67 percent of adults do so.

It is well documented that the lack of handwashing spreads disease in health care-related settings; however, the impact of handwashing on infectious diseases among the general public in community settings had not been as extensively studied.

Several studies show that most physicians and nurses believe they wash their hands correctly; however, researchers have observed that even the handwashing technique of healthcare professionals can be inadequate (as they wash their hands only 30% of the required time between patient contact and procedures, if they wash their hands at all. (US Centers for Disease Control).

IMPORTANCE OF HANDWASHING

Disease Prevention

The CDC reports that handwashing is one of the "most important means of preventing the spread of infection;" it is the first line of defense for infectious diseases, including respiratory infections and gastrointestinal disorders, among others.

Infectious diseases remain the leading cause of death and disease worldwide as well as the third leading cause of death in the United States.

CONSEQUENCES OF POORLY WASHED HANDS

Antibiotic Resistance

In addition to preventing widespread public health epidemics, regular handwashing can reduce the spread of antibiotic-resistant bacteria. The CDC estimates the cost of treating antibiotic-resistant infections in the United States is $4 billion annually.

Food-Related Illness

Each year an estimated 79 million people in the U.S. become ill from food-related diseases each year, resulting in an estimated 5,000 deaths, according to the Centers for Disease Control (CDC). Poor hygiene, generally unwashed or poorly washed hands, contributes to many food-related illness outbreaks, according to the CDC. Hands can transfer germs from contaminated raw meat, eggs and poultry to other foods, or from an infected person to the food.

While many people are aware that you can get sick from eating food contaminated by E. coli 0157:H7 bacteria, it is not as well known that other ways of transmission, such as touching surfaces contaminated with this strain of E. coli, also can cause illness.

Food-related disease costs the United States up to $22 billion annually for healthcare expenditures and productivity losses.

Infection in Childcare Centers

According to the U.S. Department of Education (1995) 31 percent of children under age 6, almost 7 million, attend daycare outside their homes. Of all the children under age 6, 60 percent, about 13 million, receive some type of care and education from persons other than their parents. Children attending daycare are at greater risk for respiratory and gastrointestinal diseases. Furthermore, they are likely to spread these diseases to other family members and people in the community. It has been demonstrated that proper handwashing can substantially decrease the incidence of diarrhea in children attending daycare centers.

Infection from Pets

The CDC has reported an alarming number of salmonella infections, in both adults and children, that were associated with reptiles.

All pet owners need to take adequate measures after handling and cleaning up after their pets, including proper handwashing.