Academic journal article Journal of Environmental Health

Chlorhexidine to Maintain Cleanliness of Restroom Door Handles

Academic journal article Journal of Environmental Health

Chlorhexidine to Maintain Cleanliness of Restroom Door Handles

Article excerpt


The internal door handle of a restroom facility is usually the last contact of the hand of the user following hand washing. The Centers for Disease Control and Prevention (CDC) define hand washing as the vigorous, brief rubbing together of all surfaces of lathered hands, followed by rinsing under a stream of water (CDC, 2009). It is likely that these internal door handles can become contaminated with pathogens when handled by multiple people following potentially unhygienic activities (Wojgani et al., 2012). Due to frequent use, cross contamination may occur particularly when frequent breakdowns occur in hand hygiene. A study conducted in a secondary school of 120 students found that after using the restroom, 58% of female and 48% of male students washed their hands (Guinan, McGuckin-Guinan, & Sevareid, 1997). A study examining university students found that after urinating, 69% of females and 43% of males wash their hands, while after bowel movements 84% and 78%, respectively, do (Thumma, Aiello, & Foxman, 2008). CDC estimates that hands transmit 80% of all infections (CDC, 2013). It can be assumed that the internal door handles are likely to be exposed to pathogenic bacteria and an increased risk exists of people transmitting infections as a result of using them (Barker, Vipond, & Bloomfield, 2004). Reducing exposure to pathogenic bacteria could have a positive impact on health. Indeed, improving hand hygiene in schools has been shown to reduce absenteeism (Lau et al., 2012).

In practice, the cleaning of handles cannot normally occur between each restroom user. Cleaning episodes may be typically every six hours in institutions and public facilities although national standards do not exist. Previous work regarding the cleaning of other fomites suggests that Sani-Cloth CHG 2% wipes could be effective in the decontamination of internal door handles and in addition offer residual antimicrobial activity after repeated contacts. The wipe contains 70% isopropyl alcohol with 2% chlorhexidine (Safety Data Sheet, 2007) and has an antimicrobial residual effect (Cummings et al., 2013; Hong, Morrow, Sandora, & Priebe, 2013; Howell et al., 2013), thereby retaining cleanliness of the handles for a duration despite ongoing use. An alternative wipe is the Tuffie 5 wipe. This polypropylene wipe contains cationic acid surfactants, amphoteric surfactants, and EDTA (Vernacare, 2010).

We aimed to study the residual effectiveness of the Sani-Cloth CHG 2% wipe on internal restroom door handles in a school environment by comparing it with the Tuffie 5 wipe.


The Queen Elizabeth Hospital Research Governance Committee approved our study. The study was logged with the hospital's audit department.

We performed our study in a school of 400 pupils sharing 11 restroom facilities. It is estimated that each internal door handle in a facility has an average of 50 interactions per day. Toilet facilities are not cleaned by staff during the school day. Only a limited number of staff at the school and students involved in our study were made aware of the research, so no change occurred to the routine use of toilet facilities. Students were not instructed to wash their hands in a particular way.


This design was a double-blinded randomized crossover controlled trial. The people cleaning, swabbing, and plating were blinded to the cleaning agent used for each facility to remove any potential bias. The locations were randomized using a sealed envelope technique and the cleaning agents were swapped after 10 days to ensure that the results were independent of the location investigated.

Standard Swabbing, Transport, and Plating Procedures

A set procedure was used to control the amount of time and area swabbed for each handle. The sampler was blinded to the cleaning method used. Three drops of sterile saline were used to moisten a sterile rayon-tipped transport swab in order to improve the uptake of bacteria from the handle. …

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