The Paper Towel Versus Hand Dryer Germ Debate (Part Two)

Part Two:

This article is the second part of our three-part investigation into the germ debate between paper towels and hand dryers. We suggest you read Are Hand Dryers Hygienic? (Part One) first.

Here's a further look at the credibility of the evidence and the case against the scaremongering articles

A review of both methods stated that “from a hygiene viewpoint, paper towels are superior to electric air dryers. Paper towels should be recommended in locations where hygiene is paramount, such as hospitals and clinics.”

However:

• Although 12 studies were reviewed, they showed conflicting results in the studies comparing paper towels to hand dryers. So how could it conclude that hand dryers are significantly more unhygienic than paper towels?
• Even though the review presents a balanced view, the study they deem to be the best is an ETS (paper towel industry) funded study.
• One of the reviewers has served as an occupational health and safety consultant for Kimberly-Clark, Sydney, Australia.

This appears to show bias to a paper towel industry funded paper.  It also shows a conflict of interest from a previous employee of one of the largest global paper manufacturers.

To draw meaningful conclusions, studies need to be completely independent.  

What’s more, when independent research is carried out (like the ones mentioned in this article) the conclusion is that there is usually no difference in the hygiene levels of both methods.  

It doesn’t make for an exciting or scary headline though, does it?

A more balanced view can be seen below which is located on a Huffington Post article.  It gives a very good account of how to look at this debate as well as best practice for hand drying in general:

 

The key points from the above video:

• A lot of studies that claim paper towels are better than hand dryers are funded by paper towel companies, how trustworthy can this be?
• Paper towels are more harmful for the environment
• Wet hands easily transfer far more bacteria than dry ones
• Don’t wipe wet hands on your clothes or touch any surface before they are fully dry as you will just pick up bacteria and may as well not washed them at all
• Paper towels can actually hold bacteria, with the recycled type hosting more. This is due to paper towel holders not being sterile, as well as paper being made in a factory which is not a sterile environment
• Paper towels and high-speed hand dryers can dry your hands as effectively and as fast as each other
• If people actually washed their hands properly it doesn’t matter which method is used regarding bacteria transfer – a study showed that only 5% of people correctly wash their hands to actually get bacteria off the hands

So, if people don’t wash their hands properly is one drying method better than another for making sure bacteria is removed from the hands? No statistical difference found between cloth towels, paper towels, warm air hand dryers and leaving to dry naturally for removal of bacteria from hands.  Get them washed properly first!

Dyson have published their own response to the scaremongering which can be viewed below:

Key points from the above video:

• Studies were commissioned and paid for by the paper towel and cotton towel industry
• Washing is the key to bacteria removal, drying is then the preventative measure to make sure bacteria doesn’t spread around from place to place with germs loving to hop on a wet hand to travel and grow.
• Using a Dyson Airblade reduces the transfer of bacteria by up to 40%
• Using a hand dryer like the Dyson Airblade puts fewer bacteria in the air than taking your coat off
• Even though a vast amount of bacteria are added to the hands in some studies, a far greater amount than would even be found on the hands anyway, only a very small amount of bacteria was transferred into the air.  Levels of bacteria blown about are shown to make an insignificant contribution to bacteria that is already in the air around you all the time.
• Studies that have been commissioned by paper towel companies that show there is no difference in the number of bacteria put in the air using paper towels or Dyson Airblade’s have been published in scientific journals but not been reported in the press.
• There is just as much bacteria found on a tap, hand dryer, paper towel dispenser and door handle.
• 1 in 5 paper towel dispensers can be found empty.  If there is no paper there is no way to dry the hands.  Damp hands spread up to 1000 times more bacteria than dry ones
• Bins full of paper towels create an area full of germs.  These can overflow and create an unhygienic environment.  Hand dryers do not need this constant maintenance to keep hygiene levels up.

 

Examples of Studies that show no difference in hand drying methods

Study: Effects of 4 Hand-Drying Methods for Removing Bacteria From Washed Hands: A Randomized Trial

Abstract: “The difference was determined between the amounts of bacteria on hands artificially contaminated with the bacterium Micrococcus luteus before washing with a nonantibacterial soap and after drying by 4 different methods (cloth towels accessed by a rotary dispenser, paper towels from a stack on the hand-washing sink, warm forced air from a mechanical hand-activated dryer, and spontaneous room air evaporation).”

“Conclusion: These data demonstrate no statistically significant differences in the efficiency of 4 different hand drying methods for removing bacteria from washed hands.”

Study: A comparison of effect of three hand drying methods on washed hands

Abstract: “An experimental study on 30 subjects using multiple comparisons of six hand drying methods including 1) drying on own clothes, 2) drying with one paper towel, 3) drying with two paper towels, 4) drying with a warm air dryer while holding hands stationary for 20 s, 5) drying with a warm air dryer while hand rubbing for 20 s, and 6) drying with a jet air dryer until complete dryness was achieved.”

“Conclusion: This study shows that  the use of jet air dryers is the best method to eliminate bacteria on hands, whereas drying hands on one’s own clothes is the least effective.”

 

But are paper towels hygienic?

Studies on paper towel hygiene that do not receive much media attention

No, we are not saying that paper towels are harmful to you, we are just putting some perspective to the debate looking at other research that is out there. 

The studies below may be open to debate, but the fact remains that sensationalised press releases used to scaremonger about hand dryers are certainly manipulated and quickly circulated faster and more intensely than anything below, which are just as relevant to public health.

Paper towels are not made in sterile environments so why would they be free of bacteria?

Study: Evaluation of bacterial contaminants found on unused paper towels and possible postcontamination after handwashing: A pilot study

Up to hundreds of thousands of bacteria are actually located in a paper towel yet to be used, with the bacteria capable of transferring to wet hands when being used. When you look at the research aimed at hand dryers the number of bacteria found is usually in the tens to low hundreds, generally taken from a larger sampling area too. 

Study abstract: “Between 10² and 10⁵ colony-forming units per gram of unused paper towels were isolated from the different paper towel brands. Bacteria belonging to the Bacillus genus were by far the most abundant microorganisms found (83.0%), followed by Paenibacillus (15.6%), Exiguobacterium (1.6%), and Clostridium (0.01%).

Conclusion: This pilot study demonstrated that a large community of culturable bacteria, including toxin producers, can be isolated from unused paper towels and that they may be transferred to individuals after handwashing. This may have implications in some industrial and clinical settings as well as in immunocompromised individuals”

Key points: 100 to 100,000 bacteria found per gram of unused paper towel (approximately two paper towels – average per dry) – some that can be pathogenic – which can be transferred to the hands when used

Paper towel dispensers get touched when pulling out the paper.

Study: Bacterial transfer and cross-contamination potential associated with paper-towel dispensing 

Wet hands reaching into dispensers to unblock them leaves a wet, damp environment for the next user.  An environment ideal for bacteria to grow in. 

It has been shown that bacteria can be transferred from the zig zag of hands to paper-towel dispensers and back again.  This occurs when people often have trouble taking paper towels from the dispenser exit and touch the unit itself.  

In this study it states “Paper-towel exits from folded paper towel dispensers located at handwash stations in food processing facilities have been found contaminated with Eshcerichia coli.  

More recently, studies have indicated towel dispenser exits in hospitals are often not included in routine cleaning and are contaminated.” (Page 390, column 1, lines 12-17.)

“Conclusions: The results indicate that zig-zag transfer of bacteria between paper-towel dispensers and hands can take place if either one is contaminated. This potential should be considered in the design, construction, and use of paper-towel dispensers. (Am J Infect Control 2003;31:387-91.)”

Key points: The study mentioned above in the section "Should you believe everything you read about hand dryers and germs?": Environmental contamination by bacteria in hospital washrooms according to hand-drying method: a multi-centre study https://www.journalofhospitalinfection.com/article/S0195-6701(18)30366-9/fulltext doesn’t show if they tested the exit of the paper towel dispensers.  The author (Wilcox) has stated in press that people don’t wash their hands properly and a reason why the study was important.  However, the transfer of any bacteria on the hands to the paper towels via the hands entering the dispenser is possible if not washed correctly and creates bacteria transfer.

Study: University of Buffalo student study 

Article headline “UB researchers find high-speed hand dryers are six times cleaner and produce 42 percent less carbon dioxide than paper towel dispensers. The students found that six times more bacteria grew on paper-towel dispenser push-and-crank handles than on the Airblades.”

It's been found that six times more bacteria grew on paper-towel dispenser push-and-crank handles than on the Airblades. Manufacturers are bringing touchless systems with captive refills but the fact is that the majority of buyers want to buy cheap, so most dispensers must be touched to dispense paper towels.

Key points: Hand dryers are “no touch” which reduces cross contamination points.

If there isn’t any other drying method, people will use toilet paper. And paper towel dispensers are not useful if they are empty.

Article: "Research Finds Average Toilet Paper and Towel Dispensers Have More Bacteria Than Average Toilet Seat" 

Although not a link to a scientific paper the scientist has been quoted a number of times in other reports with these statistics:

“According to new research conducted by microbiologist Charles Gerba, of the University of Arizona, the average toilet paper dispenser has more than 150 times the number of bacteria than the average toilet seat.

The picture isn't improved when it comes to paper towel dispensers. These were found to have over 50 times more bacteria on average than a typical public restroom toilet seat.”

Continued in Are Hand Dryers Hygienic? (Part 3), which is the last article in this series.

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