Doesn't Anybody Wash Their Hands Anymore?

Medically Reviewed by Charlotte E. Grayson Mathis, MD
From the WebMD Archives

Sept. 18, 2000 (Toronto) -- You forgot to wash your hands, didn't you? It's been only four years since the American Society for Microbiology (ASM) launched an intensive campaign aimed at getting people to wash their hands -- but already Americans have forgotten the lesson, according to a new study.

Nearly everybody -- more than nine of 10 people polled -- says they wash their hands after using a public bathroom. But spies placed in public facilities in five U.S. cities report that only two out of three people actually do so. A similar study conducted in 1996 -- before the ASM handwashing campaign -- yielded nearly identical results.

As funny as it seems to place spies in restrooms, the findings are no laughing matter. No new technology, drug or vaccine is capable of preventing more infections than the simple act of washing one's hands.

"Handwashing is of paramount public importance," says Julie Gerberding, MD, MPH, director of the Hospital Infections Program at the CDC. "Washing hands is a major public health intervention to prevent disease -- it's cheap, it's easy, and it works." Gerberding presented the study here in Toronto Monday at an ASM gathering of infectious disease specialists from around the world.

The CDC says regular handwashing reduces the spread of antibiotic-resistant bacteria. Clean hands also would go a long way toward preventing the 79 million cases of food-related illnesses that occur each year in the U.S.

Joining Gerberding in a press conference to kick off the ASM's latest handwashing campaign was clinical microbiologist Judy Daly, PhD, a professor at the University of Utah School of Medicine in Salt Lake City. "Fifteen seconds of hot water, soap, and rubbing your hands together is all it takes -- yet we are not making progress," Daly says. "The year 2000 data looks just like the 1996 data."

The study used discreet observers stationed in public restrooms at Navy Pier in Chicago, at a casino in New Orleans, at Golden Gate Park in San Francisco, at Turner Field baseball stadium in Atlanta, and at Grand Central and Penn stations in New York City. Observation of nearly 8,000 people shows that fewer men than women wash their hands (58% vs. 75%).

City-by-city differences became apparent. After using public bathrooms, 83% of Chicago residents washed while only 49% of New Yorkers washed. Atlanta men were the worst group -- only 36% washed before leaving the restroom.

The difference between men and women holds up when people are asked whether they always wash their hands in the following situations:

  • After using the bathroom at home (90% of women vs. 81% of men)
  • After changing a diaper (86% of women vs. 70% of men)
  • Before handling or eating food (84% of women vs. 69% of men)
  • After petting a dog or cat (54% of women vs. 36% of men)
  • After coughing or sneezing (40% of women vs. 22% of men)
  • After handling money (28% of women vs. 12% of men)

Interestingly, people with incomes of $35,000 or less and those with a high-school education or less are more likely than wealthier and better-educated people to say they always wash their hands in these situations.

It may actually be easier to wash one's hands than most people think. "If you have good handwashing technique, antimicrobial soap is not necessary," Gerberding says. "The goal is to physically remove germs and flush them down the drain, not to kill them."

To do this in a public restroom requires several steps -- performed in the correct order. Here's the drill:

  • Get a paper towel first, and place it within reach of the sink.
  • Turn on the water and put soap on your hands. Rub them together for 15 seconds -- as long as it takes to say the ABCs.
  • Rinse thoroughly -- this is very important.
  • Use the towel to turn off the faucet.
  • Get another towel and dry your hands -- and use it to open the door on the way out so you don't have to touch the door handle. If the bathroom has an air blower, hit the button with your elbow, not your hand.

This time, the ASM is asking all doctors to join in the public education effort. "We are really asking for a major behavioral change," Gerberding says. "To get a sustained change over time, you have to change the whole culture. We know it takes a long, sustained effort to do this."

Daly tells WebMD that it will take a grassroots effort. "This time we are really pushing community-based tools and using the Internet quite a bit," she says. More information is available on the Internet at