**Abstract**

Human safety is a popular ongoing research area in personal hygiene. Researchers are mostly apprehensive about how to protect humans from different hazards in the environment. Thus, guidelines developed for good hand wash practices in the public restrooms have showed little or no impact on human behavior. This research examined hand wash acts in the public restrooms and proposed possible solutions to improve the practice. There are 427 people who participated in the study. Participant age ranged from 18 years old and upward: statistically, female, 63%; male, 35%; and unidentified, 2%. Descriptive statistics revealed 99.5% respondents approved restroom redesign for appropriate hand hygiene practice, while 49% suggested restroom device automation. Inferential statistics results on redesign with a Welsh t-test were statistically significant (t=1.967, df=300, p<0.0001; t=1.990, df=80, p<0.0001; t=1.9746, df=163, p<0.0001). Findings showed that hand hygiene guidelines and recommendations are insufficient to ensure proper promotion of hand wash practices in restrooms. This study concluded that good hand wash practices in public restrooms could be ergonomically redesigned to include a visual and auditory alert that reminds users to wash their hands after restroom usage and to include hand wash practice in school curriculum. The findings from this study could be applicable in restaurants, schools, and bars, to manage and control transmission of disease through direct hands contacted with infectious diseases in the restrooms.

**Keywords:** hygiene, human health, restroom, handwashing, ergonomics

## **1. Introduction**

Human hygiene is considered as one of the most effective ways of preventing diseases, and germs. Center for diseases control and prevention (CDC) associated many diseases and sicknesses to poor body hygiene [1, 2]. One key body part that requires constant and continuous hygiene to prevent human infection from germs and diseases is hands. In 2004, one of the US FDA studies revealed that food establishments were frequently out of compliance with the food code requirements for proper and adequate handwashing. In the study, the percentage of food

establishments observed to be out of compliance with handwashing requirements ranged from 34% in hospitals to 73% in full-service establishments [3]. Our world today faces alarming rates of diseases related to hygiene and the quick spread of germs via contact of improper hand hygiene. According to the CDC [4], it is established that keeping hands clean is one of the most important steps to avoid sickness and spreading of germs and diseases to others. Hand hygiene is the most effective measure for interrupting the transmission of microorganisms, which cause infection both in the community and in the healthcare setting. Therefore, using epidemiology model, transmission of diseases and germs through poor hand hygiene practices could be reduced in the society. The use of restrooms and other everyday activities regularly expose a human to germs; therefore, the need to explore other factors surrounding handwashing for hygiene purposes is essential.

The knowledge of handwashing as a measure of hand and personal hygiene is not new, as it has been successfully transferred from generations to generations. Handwashing has been linked to culture and religion, see Staub [5]. The United States of America officially recommended that healthcare workers (HCWs) should wash their hands with soap for 1–2 min before and after patient contact, see Coppage [6]. In 1975, CDC released handwashing guidelines and practice in the healthcare (hospitals) and later modified the original version in 1985 [7, 8]. Research has revealed that the revised CDC handwashing guideline has been expanded for better practice in all organizations [9–11].

While we can say training people on the handwashing routine is important and it has helped improving hand hygiene practice, the attention to hand hygiene in health and safety should go beyond educating people commonly known in the healthcare industry. According to Jang et al. [12], healthcare workers' workload, other job interruptions, and overly conservative guidelines make it difficult to adhere to hand hygiene. The same authors concluded that it is imperative to study other factors on proper handwashing practice to make handwashing hygiene a lifestyle other than a routine. The process of hand hygiene could be regarded as cumbersome and demanding for many people due to workload and other conditions like availability of toiletries, environmental and structural conditions. It is no doubt that many people know that hand hygiene what is the most effective measure to prevent microbial pathogen cross-transmission and other healthcare-associated infections but wasn't enough to get people to do it and practice the routine that leads to good handwashing practice. World Health Organization (WHO) reported that several continuous evaluations and good team methodologies have helped compliance but are yet to sustain in specific critical communities and healthcare areas [13]. The study further shows that mentoring aside other handwashing routines could be an excellent way to make hand hygiene a lifestyle.

Experts have proven that hand hygiene is the most effective measure for interrupting the transmission of microorganisms, which cause infection both in the community and in the healthcare setting. Using hand hygiene as a training measure of reducing disease is unlikely to be successful when other factors in infection control, such as environmental hygiene, crowding, staffing levels, and education, are inadequate. Therefore, the way people use restrooms and regularly exposed to germs in everyday activities makes it essential to explore other factors surrounding handwashing that could encourage hand and body hygiene in general.

The lack of appropriate infrastructure, religious beliefs, and workplace conditions were the major influencers on the low compliance to handwashing hygiene among the health professionals [14–16]. It is about time to start focusing on the influencers on low complaint rates.

**87**

*Hand Hygiene Practices in Public Restrooms: Effects and Proposed Solutions*

handwashing should be included in all organization culture.

About 1.8 million children under the age of 5 die due to diarrhea and pneumonia every year [17]. Diarrhea and pneumonia are the top two killers among children all over the world [17]. The same study showed how handwashing is the most effective way to prevent people in the world from dying through diseases and much other life-threatening conditions from hand contamination. Handwashing with soap has a strong capability to protect and shield about one out of every three young children who get sick with diarrhea [18, 19], and practically one out of five young children with respiratory infections like pneumonia [19]. Another research shows handwashing in educational institutions and access to water and soap in schools could improve student health [20, 21]. Children's exposure to proper handwashing from early life might help to improve their development in some settings [22]. If hand washing could affect children around the world this much, then, proper

If hand hygiene can be included in daily human behavior, it automatically becomes a lifestyle and not just a routine, because humans can tire of routine with time, but a lifestyle is part of human behavior that cannot be easily broken. In 2005, Jumaa highlighted areas needed for further research on proper handwashing, which include environmental conditions, people acts etc. and further concluded that cultural and behavioral issues also contributed to the poor practice of hand hygiene. This study investigated other factors influencing public's poor handwashing habits, suggested better restroom designs, and provided recommendations for

• Develop a questionnaire that captures public opinion on the use of public

• Propose a better design structure based on survey feedback and design of

This study was conducted in a university environment. The university is in Hammond and Westville, Northwest Indiana US. Data were collected through survey. The survey was a self-developed questionnaire adapted from a standardized resource online. Survey was reviewed by three experts, two health practitioners, and one safety specialist to validate the contents for the purpose of the research. The questions were presented in the form of Likert scale options. The IRB office of the university where the study was conducted approved the protocol before survey distribution. The survey was distributed via email to all students, faculty, and all the university employees. Four hundred and twenty-seven (427) participants, including 246 students, 109 university employees, and 72 faculty, participated in the study. Participants include 147 males, 270 females, and 9 people who preferred not to indicate their gender. All the participants took the same survey with the same preferences given to all. The research was divided into three parts. The first part is the questionnaire, research on appropriate solutions and redesign for appropriateness. The survey questions focused

on the toilet's settings, design, user habit, and toiletries availability.

*DOI: http://dx.doi.org/10.5772/intechopen.92306*

**1.1 Children hand hygiene**

improvement.

prototype.

**2. Working methods**

Objectives of the study

restrooms or school restrooms.

• Evaluate prototype from user perception.
