An investigation of the hand hygiene behaviours of the general population when using public restrooms

Abstract

In recent years the burden of non-communicable diseases has been a major public health concern. However, communicable diseases continue to be a major threat. Collectively, communicable diseases are a leading cause of morbidity and are the second leading cause of mortality worldwide, mainly affecting young children, the elderly or those in general poor health.

Good hand hygiene practice and compliance is known as being one of the most effective methods in preventing the spread and prevalence of communicable diseases throughout the environment by removing communicable pathogens from the surface of the skin. Despite this, most research has found that hand hygiene practice and compliance is poor. The review of the literature highlighted gaps in knowledge, with previous research focusing predominantly upon healthcare settings, with scant attention afforded to hand hygiene when using public restrooms. Public restrooms are known to harbour a range of communicable diseases that are readily transmitted from person-to-person via physical touch in such physical environments.

This research aims to investigate two different aspects of hand hygiene behaviour, namely the hand hygiene practice and compliance of the general population when using public restrooms. This includes identifying the general population’s knowledge of hand hygiene practice and compliance in the context of communicable disease transmission, and their attitudes towards practicing hand hygiene. It also includes measuring the hand hygiene practice and compliance of the general population when using public restrooms. A mixed-methods research design consisting of a questionnaire survey and indirect observation using thermal-imaging cameras were used to collect empirical data. Members of the general population who were the chosen research subjects in this research that frequented a local University campus used as the sole research location were surveyed over a 30-day period. Thermal observation of members of the general population when using a male and female set of public restrooms located in the same research location was carried out over a 60-day period which included a pre and post-intervention period. Both qualitative and quantitative elements of the data analysis were conducted using SPSS (v.25).

Several key findings emerged from the research which have reference to future policy development and for addressing the rising prevalence and spread of communicable diseases amongst the general population. Firstly, this research observed that there is a low level of adequate hand hygiene compliance amongst the general population when using public restrooms, which contradicted the good level of knowledge and attitudes towards hand hygiene established via the questionnaire survey. Other, significant differences between self-reported and observed hand hygiene behaviour, practice and compliance were identified, including that overall hand drying compliance is less than handwashing compliance, both in terms of knowledge of its importance and general practice.

Additionally, most members of the general population stated that the presence of another person in the public restroom would not affect their hand hygiene practice and compliance which contradicted the observed findings where the hand hygiene compliance rate was lower when individuals were alone than when another person was present. Also, females were found to have a higher level of hand hygiene knowledge, practice and compliance compared to males highlighting that there are gender differences.

Built environment factors including the design and layout of public restrooms may also influence practice and compliance; as differences in the usage of hand hygiene amenities (soap, method of drying) were also found.

Some of the barriers to and reasons for poor and non-hand hygiene compliance identified included the lack of time spent washing and drying hands amongst the general population and the lack of a standardised definition of hand hygiene practice and compliance which is applicable to the general population. Preferences amongst females in particular for the use of toilet paper for drying may suggest that the lack of hand towels coupled with the noise and length of time it takes to dry hands properly when using the hand dryers may be further barriers to hand hygiene compliance.

Many different types of hand hygiene intervention designed to improve practice and compliance have been developed and tested in the past to varying effect. The most common typed of hand hygiene interventions used in both healthcare and non-healthcare settings include posters and signage. Interventions are required to improve hand hygiene behaviour along with greater clarity on the proper method of good hand hygiene practice and compliance.

This research observed the efficacy of hand hygiene posters in improving compliance, suggesting that new and continued hand hygiene interventions are required. This includes interventions that are designed in consideration of the barriers to, and reasons for poor hand hygiene practice and compliance, that use behavioural cues to improve compliance and are multimodal in their delivery and implementation.

The main finding of this research is that many members of the general population either do not wash their hands after using the toilet in a public restroom or do so poorly. This is probably a significant factor for the rise and prevalence of communicable disease amongst the general population.

Date of Award	Oct 2019
Original language	English
Supervisor	Marie Vaganay Miller (Supervisor) & Neale Blair (Supervisor)