Updated 22 May 2019

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

Part 1

A hot topic is the question of whether hand dryers are hygienic or is there is a safer way to dry your hands?

The other question to ask, however, are paper towels hygienic?

There are studies on paper towels from independent sources that have found paper towels and their dispensers hold a significant amount of bacteria. 

This makes sense. After all, the paper towels and dispensers are not made in sterile areas.

Plus they are located in the bathrooms, just like the hand dryers. Logically paper towels are not more sterile or hygienic than hand dryers. Neither is a harmful method of drying.

So, with the scare-monger news that hand dryers are less hygienic the question to ask is this a case of large businesses trying to influence the public decision, even if it means manipulating the "facts"?

This post provides information on the following information, in three parts:

1. Highlights why the paper towel industry is concerned about hand dryers
2. Give reasons why journalism and fake news needs to be scrutinised for allowing meaningless propaganda to enter mainstream media outlets
3. Shows videos and other scientific research explaining why there is no need to be scared of using a hand dryer
4. Provides scientific evidence that adds a balanced perspective to the paper towel and hand dryer germ debate
5. Explains the best way to keep your hands hygienic, always
6. Provides history of how the hand dryer has developed to improve hand hygiene in the washroom

Firstly, hand dryers or paper towels? Which is better?

The type of method used depends on the location and the unique requirements of the end user. Here is a summary of our comparison of using paper towels versus hand dryers:

1. Hand dryers are significantly cheaper to run annually and can save substantial costs compared to purchasing the paper towel consumables.
2. The most important aspect of hand hygiene is the hand washing process using water and soap. Once hands are washed, then its important to make sure they are fully dry before touching anything else. When using either method, the key is to ensure your hands are dry.
3. Paper towels create zero noise so are perfect for inside school classrooms and any other areas that require very low noise levels – such as libraries.
4. Paper towels are not good for the environment, as they generate a large amount of carbon to produce. What’s more, they cannot be recycled and may end up in landfill.

 

Why is the paper towel industry concerned about the hygiene of hand dryers?

The concerns

People are becoming increasing aware of the impact paper has on the environment.

Hand dryers used to be very inefficient and high energy consumers. Now, with the modern hand dryers, the dry times are comparable with paper towels. 

Interestingly, once hand dryers are installed there is no continuous revenue for the paper towel industry.

Why hygiene?

The environmental impact and cost to purchase paper towels can’t be disputed. It appears the issue of hygiene is an angle that the paper towel industry has taken to create doubt.

Hygiene resonates with a lot of people, after all, people are concerned with health.

Paper towels and hand dryers are boring topics, but the headlines can be written to create excitement and fear. Such as hygiene being an issue for hand dryers in hospitals. But the question to ask, is this a real concern? Have studies been done to prove hygiene is an issue for hand dryers.

What’s the impact on society?

We’ve noticed that the hygiene debate is diverting public opinion away from the bigger issue of the reality of climate change and those negative effects. 

When big businesses state that hygiene is an issue with hand dryers, then they are influencing public opinion to increase their profit. What’s more, they are silent about the major environmental impact of paper.

Because hand dryers use very little energy, they are better for the environment. 

They can also save businesses, schools, hospitals and workplaces a large amount of money that can be better used.

Is there a place for paper towels?

Yes of course. They create no noise so are perfect for inside school classrooms and any other locations that require very low noise levels. 

They also require no electricity to be used, so in areas that can’t or don’t have electric circuits paper towels are vital.

 

Should you believe everything you read about hand dryers and germs?

A lot has been publicised in UK newspapers such as the Telegraph and Mail regarding paper towel industry funded research into the debate of which hand drying method is the most hygienic. 

The NHS commented on these published articles here and here, which draw conclusions that they do not give adequate information in terms of validity, limitations etc to make substantial and creditable headlines and claims.

The scientific studies are littered with words like "potential" and "possible" yet media would have the world believe they are fact.

Did you see the hand dryer petri dish?  Our response to the future of lazy journalism

We noticed a recent post of a picture that went viral on Facebook.  The “story” related to a few spores of bacteria grown in a Petri dish after exposure to the area around a hand dryer.

This post is a prime example of the media running with information that’s not backed by science and promoting fake news.  

Of course, a scary headline and a scary photo will lead to people making their own conclusions that hand dryers are bad.  

But, as the post stated, the bacteria grown was more than likely mould, which is harmless and also found in any part of the washroom not just the hand dryer.

In summary the post highlighted:

• Journalism is becoming increasingly lazy and trying to sensationalise story’s rather than providing facts
• This type of attention-grabbing headline writing has of course been around for years, however due to online capabilities and social media, it is creating a stir
• The bacteria grown in the Petri dish was more than likely to be mould and not at all harmful
• There is just as much, if not more bacteria found on your household bathroom towel or your daily clothes compare to the petri dish
• Bacteria, including toxin produces, has been found to grow in unused paper towels, yet this is never reported upon

The full post can be read here

 

The most recent studies and the misleading headlines that came from them

We read the scientific literature to analyse findings of recent studies to compare how they match up to the headlines in the media.

Here are two most recent studies and our analysis of them.

Study 1. Deposition of Bacteria and Bacterial Spores by Bathroom Hot-Air Hand Dryers

Media example

Headline: "The bacterial horror of hot-air hand dryers"
Source: Harvard Medical School

The conclusions made in the article don’t substantiate the headline. The conclusions are as follows:

• “The vast majority of the microbes that were detected do not cause disease in healthy people, with the exception of Staphylococcus aureus. Some of the bathroom bacteria, such as Acinetobacter, only cause infections in people in the hospital, or in those with weak immune systems. The others that were found are relatively harmless.”
• “In addition, air from real-world bathrooms may contain fewer bacteria than the bathrooms in the study. The sampled restrooms were located in a university health sciences building, and at least some of the bacteria came from experiments going on in laboratories within the building.”
• “Remember that your chances of picking up a serious pathogen in a restroom are small. Direct contact with other people is much more likely as a means of acquiring infection.”

Other headlines:

Headline: "Hand dryers can blow fecal bacteria onto your hands, a study found — and the researchers are now switching to paper towels"
Source: Business Insider

Headline: "Hand dryers suck in fecal bacteria and blow it all over your hands, study finds"
Source: USA Today.com

Our analysis:

• The key words in these media articles are “perhaps” and “suggests,” which shows this information is speculation and not fact
• No faecal matter was found to be blown on the hands, this was only suggested as an area to further investigate.
• A good proportion of bacteria found in the study was grown in the research facility. This skewed the results
• This is just a suggestion that if pathogens are in the air there is potential for them to be blown onto the hands by hand dryers.  However, this is air that is being breathed in all the time.
• Petri dishes exposed to hot air from a bathroom hand dryer for 30 seconds grew up to 254 colonies of bacteria (though most had from 18 to 60 colonies of bacteria). This is significantly less than that found on unused paper towels and everyday items (See the section below "How does the number of bacteria found on everyday equipment measure up to that found on petri dishes?)
• Any reference to C. difficile and “toilet plume” was purely speculative yet other headlines promoted faecal matter as being spread over the hands. The article stated that the role of this potential mode of C.difficile transmission is worthy of future study. However the references they used included those that measured air only 25cm above a toilet or next to a hospital bed. Pure speculation yet the media ran away with scaremongering stories
• This article https://qz.com/1207418/using-an-air-dryer-after-you-wash-your-hands-may-just-make-them-dirtier/, interviews another researcher from the same study who states “in general, the findings don’t present enough of a concern for everyone to switch to using paper towels. Although there may be more bacteria floating around the air, most of these potential pathogens are no match for a healthy human immune system”. 

 

Study 2. Environmental contamination by bacteria in hospital washrooms according to hand-drying method: a multi-centre study

In relation to this study, it’s important to note the following:

1. Conflict of interest statement: M.H.W. has received honoraria from the European Tissue Symposium (ETS) for microbiological advice and lectures, and travel expenses to attend meetings. F.B. has received honoraria from ETS for microbiological advice and travel expenses to attend meetings.
2. Funding sources: The ETS funded the project; conception, design, results analysis, and manuscript preparation were carried out by the authors.

This was a study funded by the ETS, a representative of the major companies of the paper towel industry and used scientists who have received rewards for providing work for the paper towel industry.

Media example

Headlines: “Jet air dryers spread viruses and bacteria from unclean hands, study finds”
“Dryers can create an "aerosol that contaminates the toilet room" when people do not wash their hands properly before using them.”
Source: Sky.com

Our analysis:

1. Staphylococcus aureus has been used to glorify the media articles, with them stating that there are three times more of this bacteria in a bathroom with a hand dryer than a paper towel. “Three times” sounds a lot but the actual levels found were “low, “very low” or “no” by the authors of the study when comparing hand dryer and paper towel bathrooms.
2. The methods were very biased towards testing hand dryers:
1. No mention was made of where the paper towel dispenser was situated relative to the wash basin – closer to the sink so less drips on the floor?
2. No measurement of the amount of bacteria around where the paper towel was deposited – yet samples taken from the floor of the hand dryer which is a “no touch area.”
3. Most bacteria relating to the hand dryer was on “no touch areas”; the hand dryer itself and the floor. (It doesn’t matter where sample was taken from, they are not touched at all).
4. The study gives no idea of where the sample on the paper towel dispenser was taken from – was it the opening of the paper towel dispenser where contamination has been found (see below)? Or was it just the outside casing of the dispenser?
3. The hands were not tested and there were very low amounts of bacteria in the air. Air amounts of bacteria were the same in both conditions, yet conclusions from the media stated that the hand dryer created an "aerosol".  This conclusion potentially came from previously flawed research. See the Dyson video below
4. The study states that “c.difficile was not recovered from any samples in any country”. But wouldn’t this have been found as was suggested in the study referenced above that "toilet plume" can reach the hand dryer? - see Deposition of Bacteria and Bacterial Spores by Bathroom Hot-Air Hand Dryers above.
5. The study concluded “It is possible that different behaviours before hand-drying could affect the extent of environmental contamination. For example, people about to use a JAD (jet air dryer) may shake their hands (dispersing water droplets) to remove excess water. We found higher bacterial contamination from JAD surfaces and floors, which is consistent with such behaviour, but this contamination could then be increased due to the way the dryers function.” The scientist admits limitations in their methods yet collected samples from areas they say is a natural source of water dispersal from the user, nothing to do with the hand dryer. They also speculate on the function of hand dryers, which wasn't assessed in the methods.
6. All sample locations were totaled for bacteria counts to present their findings (even though it was biased towards where samples were taken from around the hand dryer). This made bacteria counts seem higher in the hand dryer washroom, but as stated it included areas that people do not touch e.g. the floor and the case of the hand dryer.
7. The waste bin area where paper towels end up was not tested. If the floor and the casing (no touch areas) around the hand dryer are considered hygiene issues then why not this area of contamination? Perhaps this would have created a larger bacteria count for the paper towel days of the experiment?
8. The study doesn’t show if they tested the exit of the paper towel dispensers, which have been shown to be a contamination point - Bacterial transfer and cross-contamination potential associated with paper-towel dispensing - or just a random part of the casing. Again, perhaps this would have created a larger bacteria count for the paper towel days of the experiment?
9. The media have said that bacteria is spread because we do not wash our hands properly, suggesting that this is why this study is important.  However, as you will read below, bacteria can zig-zag transfer from hands to paper towel dispenser exit and back to hands.  So, this is a problem for any washroom, not just those with hand dryers.

Continue with Are Hand Dryers Hygienic? Part 2 

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