By Patrick Boshell Abstract

Infectious diseases continue to be a health challenge and economic burden within our communities. Though effective hand hygiene education is critical, there has been a steady decline in hygiene promotion, especially in the home.

The impact of poor hand hygiene habits is linked to increased occurrences of illness, absences, and their associated costs. A renewed commitment to “shared responsibility” in our homes and classrooms may be one of our most important infection prevention strategies.

Main Article

Hand hygiene at home, school and within our communities plays an essential role in helping to reduce the spread of infectious diseases. However, there has been a steady decline in the promotion of hygiene practices in modern homes, mainly due to changing family demands and structure (Scott, 2013). Children are usually taught to wash their hands when they are young, but reinforcement of hand washing by parents often decreases when children reach school (Guinan, 2002).


Studies demonstrate that poor hand hygiene practices can contribute to an increase in community-based infections including gastrointestinal, skin and respiratory infections (Scott, 2013). Additionally, there has been a steady increase in the global burden of infectious diseases, resulting in an estimated 13 million deaths annually (Scott, 2013). Between 1980 and 1992, deaths attributed to infectious disease increased by 22% (Scott, 2013). This is a cause for concern as we continue to see a decline in hand hygiene promotion and education.

Students have Poor Hand Hygiene Habits

A recent study in the American Journal of Infection Control looked at the impact of poor hand hygiene by college students (Prater, 2016). Specifically, the study linked poor hand hygiene practices to increased occurrences of infectious diseases, medical visits and absence from class and work. College and university campuses have a high risk for the spread of infectious diseases, as students live in close proximity, are exposed to both environmental and indoor pathogens and travel frequently on campus and within their communities.


Teaching ranks as the ‘top germ profession’ compared to other occupations, due to the high bacterial count per square inch in schools. (Landro, 2009). In fact, surfaces that teachers regularly touch contain up to 10 times more bacteria per square inch than those of other professions (Landro, 2009). Touch screens, in particular, create the perfect medium to host pathogens, due to the combination of warm temperatures and unclean hands (Rolfe, 2016).

Though most students in the study claimed to wash their hands frequently, the results indicated 57.7% of the hands surveyed were colonized with all types of microbial contaminants, which could be linked to increased occurrences of infectious diseases, absences, and medical visits (Prater, 2016). Researchers found that hand hygiene could be significantly improved when students followed CDC handwashing guidelines. The researchers concluded, “It is critical to promote education on proper hand washing in colleges, in grade schools, and at home to improve health and learning outcomes (Prater, 2016).”

Effect of a Comprehensive Hand Hygiene Program

Similar to colleges and universities, elementary and high schools have a predisposition for the transmission of microorganisms and cross contamination. In the United States, the number of lost school days annually from kindergarten through to 12thgrade is 164 million, which averages 4.5 days a year per student (Guinan, 2002). A survey revealed that 83% of teachers think absenteeism is the main problem they face in school (Guinan, 2002). Additionally, 96% of parents list infection prevention as an extremely important part of a school health program (Guinan, 2002).

A recent study indicated that hand hygiene compliance amongst elementary aged children is 58% after using the washroom, except soap usage averages 28% for girls and only 8% for boys (Guinan, 2002). This lack of effective hand hygiene practices often leads to acute gastrointestinal illness in elementary school-aged children (Guinan, 2002).

Five elementary schools in Pennsylvania participated in a study, which combined classroom learning, fun videos, hands-on practice, take home pamphlets and hand sanitizer in the classroom. Absenteeism data collected over 3-months showed a 50.6% improvement (Guinan, 2002). In addition to the health benefits, this reduction in absenteeism resulted in a savings of $167 per student and a projected annual savings of $24,300 for the school (Guinan, 2002).

Recommendations for Hand Washing at Home and at School

The CDC (2015) provides these practical hand washing guidelines:

When to wash your hands:

  • before and after preparing food
  • before eating food
  • after using the toilet
  • before and after caring for someone who is sick
  • after handling pets, their food or treats
  • after touching garbage

How to wash your hands:

  • scrub your hands with soap and water for 20 seconds
  • rinse your hands under clean, running water
  • dry your hands with a clean towel (or air dry them)

Hand Hygiene Promotion is a Shared Responsibility

According to the CDC, hand washing is the single most effective way to prevent the spread of disease. Teaching children appropriate hand hygiene habits can result in the decrease of infections, absenteeism, and associated costs. Many experts agree that for hand hygiene promotion to be effective in changing behaviours, we need to ensure a family-centred approach (Scott, 2010), starting with the home and reinforced in the classroom, community and through popular media.

With the popularity of social media, easy access to the Internet, and increased use of entertainment education, it is becoming easier to reach children and reinforce these healthy habits with more traditional reminders both at home and in the classroom.

Educators and parents agree, having shared responsibility in the promotion of hand hygiene is one of our most important infection prevention strategies.


  1. CDC, (2000). Why is Handwashing Important? Center for Disease Control. Retrieved August 16th, 2016 from
  2. CDC (2015). When and how to wash your hands. Retrieved August 19, 2016 from
  3. Guinan, M. (2002). The effect of a comprehensive handwashing program on absenteeism in elementary schools. American Journal of Infection Control. Retrieved August 12, 2016 from
  4. Landro, L. (2009). Afraid of germs? Don’t even think about becoming a teacher. The Wall Street Journal. Retrieved August 12, 2016 from
  5. Prater, K. (2016). Poor hand hygiene by college students linked to more occurrences of infectious diseases, medical visits, and absence from classes. American Journal of Infection Control. Retrieved August 12, 2016 from
  6. Rolfe, T. (2016). Touchscreens: The mosquito of the digital age. Retrieved August 12, 2016 from
  7. Rosen, L. (2010). Spreading the handwashing message: An alternative to traditional media campaigns. American Journal of Infection Control. Retrieved August 12, 2016 from
  8. Scott, E. (2013). Community-based infections and the potential role of common touch surfaces as vectors for the transmission of infectious agents in home and community settings. American Journal of Infection Control. Retrieved August 12, 2016 from
  9. Scott, E. (2010). Prevention of the spread of infection: The need for a family-centred approach to hygiene promotion. American Journal of Infection Control. Retrieved August 16th, 2016 from

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