Technique to determine contamination exposure routes and the economic efficiency of folded paper-towel dispensing


      Handwashing and hand drying are key elements of infection control. Paper towels are generally accepted as the most hygienic means of drying hands and are often distributed from generic dispensers. Effective dispensing of towels is of importance economically and may influence infection control objectives if hands become contaminated during hand drying. In this study, a method to identify potential exposure routes for hand contamination and evaluate the efficiency of paper-towel dispensing is described and applied to 5 different folded paper towels using a generic wall-mounted dispenser. A total of 18 male and female participants of varying heights participated in pull testing of 400 paper towels each, in controlled hand-drying simulations. All events having the potential for hand contamination, including towel jamming, towels falling onto the floor, and incidental contact of paper exits, were monitored and documented. There was considerable variation in dispensing efficiency between different towel brands. One towel (Z) had significantly (P <.05) superior dispensing properties from the generic dispenser. Participants of a shorter height obtained a lower incidence of dispensing malfunctions using all towel products and type. The results indicated likely contamination exposure routes and wastage levels for each towel type. Environmental service managers and infection control practitioners should carefully consider, for economic and infection control reasons, the siting and design of towel dispensers and the types of towel purchased. (Am J Infect Control 2003;31:104-8.)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Centers for Disease Control and Prevention
        Guideline for hand hygiene in health care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
        MMWR Morb Mortal Wkly Rep. 2002; 51: 1-45
        • Garner JS
        • Favero MS.
        CDC guidelines for handwashing and hospital environmental control, 1985.
        Infect Control. 1986; 7: 231-243
        • Larson E.
        A causal link between handwashing and risk of infection? Examination of the evidence.
        Infect Control Hosp Epidemiol. 1988; 9: 28-36
        • Paulson DS.
        Foodborne disease: controlling the problem.
        J Environ Health. 1997; 59: 15-19
        • Michaels B
        • Gangar V
        • Ayers T
        • Meyers E
        • Curiale MS.
        The significance of hand drying after handwashing.
        in: Culinary arts and science III, global and national perspectives. Worshipful Company of Cooks Centre for Culinary Research at Bournemouth University, Bournemouth (UK)2001: 294-301
        • Blackmore M.
        Hand drying methods.
        Nurs Times. 1987; 83: 71-74
        • Doyle MP
        • Ruoff KL
        • Pierson M
        • Weinberg W
        • Soule B
        • Michaels B.
        Reducing transmission of infectious agents in the home, part II: control points.
        Dairy, Food, Environ Sanit. 2000; 20: 418-425
        • Ngeow YF
        • Ong HW
        • Tan P.
        Dispersal of bacteria by an electric air hand dryer.
        Malays J Pathol. 1989; 11: 53-56
        • Madeline P
        • Tournade F.
        Hand drying by means of disposable products and hot air.
        Le Prevention Bucco dentaire. 1980; 4: 24-25
        • Gould D.
        The significance of hand-drying in the prevention of infection.
        Nurs Times. 1994; 90: 33-35
        • Kohan C
        • Ligi C
        • Dumigan DG
        • Boyce JM.
        The importance of evaluating product dispensers when selecting alcohol-based handrubs.
        Am J Infect Control. 2002; 30: 373-375
        • Hattula JL
        • Stevens PE.
        A descriptive study of the handwashing environment in a long-term care facility.
        Clin Nurs Res. 1997; 6: 363-374
        • Griffith CJ
        • Malik R
        • Cooper RA
        • Looker N
        • Michaels B.
        Environmental surface cleanliness and the potential for contamination during handwashing.
        Am J Infect Control. 2003; 31: 93-96
        • Michaels B
        • Smith B
        • Pierson M.
        Pathogenic and indicator bacteria associated with handwashing and drying contact surfaces.
        J Food Prot. 2001; 64: 95
        • Grandjean E.
        Fitting the task to the man: an ergonomic approach.
        4th ed. Taylor and Francis Inc, London (UK)1988
        • Block SS.
        Disinfection, sterilization, and preservation.
        4th ed. Lea and Febiger, Pennsylvania (PA)1991
        • Larsen EL
        • Early E
        • Cloonan P
        • Sugrue S
        • Parides M.
        An organizational climate intervention associated with increased handwashing and decreased nosocomial infections.
        Behav Med. 2000; 26: 14-22
        • Auditor General
        A clean bill of health? A review of domestic services in Scottish hospitals.
        Audit Scotland. 2000;