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Read Press Release (2003)

Contact: Barbara Hyde
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Another U.S. Airport Travel Hazard– DIRTY HANDS


American Society for Microbiology Survey Reveals That As Many As 30 Percent of Travelers Don’t Wash Hands After Using Public Restrooms At Airports.

Chicago, Illinois, September 15, 2003 – Does it take an outbreak of a frightening, potentially fatal infectious disease, like severe acute respiratory syndrome (SARS) or a gastrointestinal illness on a cruise ship, to get people to follow Mom’s advice to “wash your hands after using the bathroom?” Apparently, it may.

Results of a new survey, announced today at the 43rd Annual Interscience Conference of Antimicrobial Agents and Chemotherapy (ICAAC), show that many people still aren’t washing their hands in public places, exposing others to the risk of infection, despite recent outbreaks of infectious diseases.

Although illnesses as deadly as SARS and as troublesome as the common cold or gastric distress can be spread hand-to-hand, the survey sponsored by the American Society of Microbiology (ASM), found that many people passing through major U.S. airports don’t wash their hands after using public facilities. More than 30 percent of people using restrooms in New York airports, 19 percent of those in Miami’s airport, and 27 percent of air travelers in Chicago aren’t stopping to wash their hands. The survey, conducted by Wirthlin Worldwide in August 2003, observed 7,541 people in public washrooms in New York, Chicago, San Francisco, Dallas, Miami and Toronto.

Hand Washing Survey Results by City

John F. Kennedy Airport,
New York
O’Hare Airport,
San Francisco
International Airport, San Francisco
Dallas/Fort Worth Airport
Miami Dade County International Airport, Miami
Toronto International Airport,


In contrast to airports in the United States, the vast majority of travelers using the airport restrooms in Toronto, Canada – a city which experienced a major SARS outbreak – washed almost every time.

U.S. airport observations contrast sharply with an August 2003 Wirthlin telephone survey of 1,000 Americans, in which 95 percent said that they wash their hands in public restrooms. The same phone survey – which found only 58 percent of people say they wash their hands after sneezing or coughing and only 77 percent say they wash their hands after changing a diaper – highlights the seriousness of the problem.

In a similar Wirthlin survey conducted in 2000 for the ASM, 95 percent reported they always wash their hands with only 67 percent observed washing their hands (based on 7,836 adults). A 1996 Wirthlin survey showed 94 percent of people claiming to always wash their hands with only 68 percent actually observed doing so (based on 6,333 adults).

Spurred by the latest findings, the ASM is redoubling its educational efforts, launching Take Action: Clean Hands Campaign – a national initiative to educate Americans about health risks associated with poor hand washing habits.

“Although hand washing seems like such a little thing, it could really have a powerful impact on the way we manage the spread of infectious diseases and newer public health threats, like SARS and the Norwalk virus responsible for cruise ship illness,” said Dr. Judy Daly, ASM Secretary. “The same people that fail to wash after using restrooms go on to pick up children, handle food, greet family and use other public facilities. Hand washing can be instrumental in controlling the spread of common and more serious infections,” says Daly, Director of the Microbiology Laboratories, Primary Children’s Medical Center, University of Utah, Salt Lake City.

However, more people may be getting the hand washing message. In the 1996 and 2000 surveys, 67-68 percent of people observed in public restrooms washed up. In this survey overall, 78 percent of those observed washed their hands, although settings and populations were different and the results may be skewed by the high percentage of hand washers in Toronto.

Dr. Donald Low, Chief of the Department of Microbiology at the University of Toronto and Toronto’s Mt. Sinai Hospital, one of the lead investigators of the Toronto SARS outbreak, said he wasn’t surprised by either the almost universal hand washing at Toronto’s airport, or the low levels in other cities. “The message about the importance of hand washing was put out every day here,” he said. “And not just because of SARS – hand washing is the smart thing to do. It should be second nature for all of us.”

Low, who said that he is sure the hand washing rate in Toronto prior to the SARS outbreak was similar to that in other cities, notes that “it’s such a simple, basic important tool to prevent disease transmission. Yet people ignore this step again and again. It’s even been shown that health care workers don’t wash their hands between patients.”

“Our experience with SARS was such a wakeup call. People in the hospital here have changed their hand-washing habits. Here in Toronto, it has become a natural course of action,” Low said.

Press Release

Take Action: Clean Hands Campaign

Take Action: Clean Hands Campaign is a key component of the ASM’s ongoing efforts designed to spread the message about the importance of hand washing. The campaign consists of educational materials designed for healthcare professionals and consumers, including a brochure, poster and stickers and a web site destination, for downloading information and materials.

The ASM’s initial survey and educational efforts began in 1996 with Operation Clean Hands and continued in 2000 with the Clean Hands Campaign.

“While Americans are beginning to recognize the importance of washing their hands in public places, many are still not getting the message,” Daly says. “It’s possible that the situation might be worse than our survey indicates. Some people may have washed only because ‘someone was watching.’ In the absence of monitoring, numbers may have been dramatically different. Our message is clear: one of the most effective tools in preventing the spread of infection is literally at our fingertips.”

The American Society for Microbiology (ASM), headquartered in Washington, D.C., is the world’s largest single biological science organization, with more than 42,000 members worldwide.

Its members work in many different settings, including education (research institutions, undergraduate and graduate institutions, and medical, dental and veterinary schools), industry (pharmaceutical, food and agricultural, biotechnology, environmental, and pollution control companies and hospitals), and federal and state governments (research laboratories and public health).

Hand Washing Survey Fact Sheet

Survey Findings

• Ninety-five percent of adults say they always wash their hands after using public restrooms; however just 78 percent were observed doing so.

• Among observational findings from public restrooms located in major airports, the dirtiest hands were in New York. More than 30 percent of people using restrooms in New York airports did not wash their hands after using facilities.

• In contrast to airports in the U.S., the vast majority of travelers using the airport restrooms in Toronto, Canada – a city which experienced a major SARS outbreak – washed almost every time.

• Across all cities, women washed their hands more than men (83 percent vs. 74 percent). This disparity was most pronounced in Dallas where 92 percent of women traveling through Dallas/Fort Worth Airport washed their hands, compared to only 69 percent of men.

• Americans also say they are likely to wash their hands before handling or eating foods (80 percent) and after changing a diaper (75 percent). However, many do not wash after petting a dog or cat or after coughing or sneezing.

• One quarter of Americans perceive the possibility of illnesses such as SARS to be at least somewhat threatening; the same number say they have increased the frequency of their hand washing to combat illnesses.

Survey Methodology

Part I: Observational Survey

• Wirthlin Worldwide observed the behavior of 7,541 adults (4,046 males and 3,495 females) in public restrooms at major airports (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 percent of the time.

• The research was conducted from August 4 – August 18, 2003 in public restrooms at major airports in six metropolitan areas (John F. Kennedy Airport/New York City, O’Hare Airport/Chicago, San Francisco International Airport/San Francisco, Dallas/Fort Worth Airport/Dallas, Miami International Airport/Miami and Toronto International Airport/Toronto).

Part II: Telephone Survey

• Wirthlin Worldwide conducted 1,000 telephone interviews with adults about their hand washing habits.

• The research was conducted between August 22-26, 2003.

Hand Washing Fact Sheet


• A recent survey conducted for the American Society of Microbiology (ASM) in the U.S. and Canada found that in some instances, almost one third of people who use public restrooms while passing through international airports fail to wash their hands. The survey, conducted by Wirthlin Worldwide in August 2003, observed 7,541 people in public washrooms in New York, Chicago, San Francisco, Dallas, Miami and Toronto.

•In contrast to U.S. findings, the survey found that in Toronto, which experienced a well-publicized outbreak of SARS, 95 percent of those using airport restrooms washed their hands.

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

•Several studies show that most physicians (95 percent) and nurses
(90 percent) believe they wash their hands correctly; however, researchers have observed that even the hand washing technique of health care professionals can be inadequate.

Importance of Hand Washing
Disease Prevention

•Hand washing is one of the simplest and “most important means of preventing the spread of infection,” according to the Centers for Disease Control and Prevention (CDC). In fact, hand washing is the first line of defense against infectious illnesses, particularly those that are commonly spread by hand-to-hand contact, including common colds, flu and numerous gastrointestinal disorders.

•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

Infectious Illnesses

•While new and frightening conditions such as SARS grab headlines, flu – and pneumonia, its most common complication – IS the fifth leading cause of death among Americans over the age of 65 and the sixth leading cause of death among all Americans. The CDC estimates that 20-26 percent of Americans are infected with the flu during flu season, which typically lasts from November to March. Of these 50,000-70,000 die each year.

•The National Institute of Allergy and Infectious Diseases (NIAID) estimates that Americans suffer a staggering one billion colds each year, and those colds are caused by more than 200 different viruses. According to the World Health Organization (WHO), 8,437 people worldwide became sick with severe acute respiratory syndrome (SARS) this year. Of those people who became sick, 813 died as a result of the disease.

•Hand washing may be one of the public’s best defenses against the spread of both common and rare, even life-threatening, diseases such as SARS, and against gastrointestinal infections caused by the Norwalk virus, which has recently plagued the cruise ship industry.

Food-Related Illnesses

•As many as 76 million people become ill each year from food-related illness in the U.S., resulting in about 325,000 hospitalizations, and approximately 5,000 people die, according to the CDC.

Failing to wash, or insufficiently washing hands, contributes to many food-related illness outbreaks. 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.

•There are more than 250 foodborne illnesses. Food-related disease costs the United States up to $5-$6 billion annually for health care expenditures and productivity losses.

Infection in Childcare Centers

•According to the most recent data from the U.S. Department of Education, 60 percent of children under age six, almost 13 million, attend daycare outside their homes. Children attending daycare are at greater risk for gastrointestinal diseases and they are likely to spread these diseases to other family members and people in the community.

• It has been demonstrated that proper hand washing 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 associated with reptiles, in both adults and children.

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

Antibiotic Resistance

• In addition to preventing widespread public health epidemics, regular hand washing 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.


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