Research Article| Volume 88, ISSUE 4, P199-206, December 2014

Download started.


Microbiological comparison of hand-drying methods: the potential for contamination of the environment, user, and bystander

  • E.L. Best
    Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
    Search for articles by this author
  • P. Parnell
    Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
    Search for articles by this author
  • M.H. Wilcox
    Corresponding author. Address: Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK. Tel.: +44 113 392 6818; fax: +44 113 392 2696.
    Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK

    University of Leeds, Leeds, UK
    Search for articles by this author
Published:August 26, 2014DOI:



      The efficiency of hand drying is important in preventing pathogen spread, but knowledge surrounding which drying methods contribute least towards contamination of the environment and users is limited.


      To compare the propensity of three common hand-drying methods (jet air, warm air dryers, and paper towels) to contaminate the environment, users, and bystanders.


      Hands were coated in lactobacilli to simulate poorly washed, contaminated hands, and dried. The investigation comprised 120 air-sampling tests (60 tests and 60 controls), divided into close and 1m proximity from the drying process. Separate tests used hands coated in paint to visualize droplet dispersal.


      Air bacterial counts in close proximity to hand drying were 4.5-fold higher for the jet air dryer (70.7cfu) compared with the warm air dryer (15.7cfu) (P = 0.001), and 27-fold higher compared with use of paper towels (2.6cfu) (P < 0.001). Airborne counts were also significantly different during use of towel drying versus warm air dryer (P = 0.001). A similar pattern was seen for bacterial counts at 1m away. Visualization experiments demonstrated that the jet air dryer caused the most droplet dispersal.


      Jet air and warm air dryers result in increased bacterial aerosolization when drying hands. These results suggest that air dryers may be unsuitable for use in healthcare settings, as they may facilitate microbial cross-contamination via airborne dissemination to the environment or bathroom visitors.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hospital Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Larson E.L.
        Persistent carriage of gram-negative bacteria on hands.
        Am J Infect Control. 1981; 9: 112-119
        • Lowbury E.J.
        • Thom B.T.
        • Lilly H.A.
        • Babb J.R.
        • Whittall K.
        Sources of infection with Pseudomonas aeruginosa in patients with tracheostomy.
        J Med Microbiol. 1970; 3: 39-56
        • Patrick D.R.
        • Findon G.
        • Miller T.E.
        Residual moisture determines the level of touch-contact-associated bacterial transfer following hand washing.
        Epidemiol Infect. 1997; 119: 319-325
        • Todd E.C.
        • Michaels B.S.
        • Smith D.
        • Greig J.D.
        • Bartleson C.A.
        Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 9. Washing and drying of hands to reduce microbial contamination.
        J Food Prot. 2010; 73: 1937-1955
      1. Department of Health. HBN 00-09 – Infection control in the built environment. Gateway Reference 18521. 2013.

        • Taylor J.H.
        • Brown K.L.
        • Toivenen J.
        • Holah J.T.
        A microbiological evaluation of warm air hand driers with respect to hand hygiene and the washroom environment.
        J Appl Microbiol. 2000; 89: 910-919
        • Ansari S.A.
        • Springthorpe V.S.
        • Sattar S.A.
        • Tostowaryk W.
        • Wells G.A.
        Comparison of cloth, paper, and warm air drying in eliminating viruses and bacteria from washed hands.
        Am J Infect Control. 1991; 19: 243-249
        • Matthews J.A.
        • Newsom S.W.
        Hot air electric hand driers compared with paper towels for potential spread of airborne bacteria.
        J Hosp Infect. 1987; 9: 85-88
        • Blackmore M.A.
        • Prisk E.M.
        Is hot air hygienic?.
        Home Econ. 1984; 4: 14-15
        • Blackmore M.A.
        A comparison of hand drying methods.
        Cater Health. 1989; 1: 189-198
        • Meers P.D.
        • Leong K.Y.
        Hot-air hand driers.
        J Hosp Infect. 1989; 14: 169-171
        • Gustafson D.R.
        • Vetter E.A.
        • Larson D.R.
        • et al.
        Effects of 4 hand-drying methods for removing bacteria from washed hands: a randomized trial.
        Mayo Clin Proc. 2000; 75: 705-708
        • Best E.L.
        • Fawley W.N.
        • Parnell P.
        • Wilcox M.H.
        The potential for airborne dispersal of Clostridium difficile from symptomatic patients.
        Clin Infect Dis. 2010; 50: 1450-1457
        • Gendron L.M.
        • Trudel L.
        • Moineau S.
        • Duchaine C.
        Evaluation of bacterial contaminants found on unused paper towels and possible postcontamination after handwashing: a pilot study.
        Am J Infect Control. 2012; 40: e5-e9
        • Snelling A.M.
        • Saville T.
        • Stevens D.
        • Beggs C.B.
        Comparative evaluation of the hygienic efficacy of an ultra-rapid hand dryer vs conventional warm air hand dryers.
        J Appl Microbiol. 2011; 110: 19-26
        • Margas E.
        • Maguire E.
        • Berland C.R.
        • Welander F.
        • Holah J.T.
        Assessment of the environmental microbiological cross contamination following hand drying with paper hand towels or an air blade dryer.
        J Appl Microbiol. 2013; 115: 572-582
        • Fuls J.L.
        • Rodgers N.D.
        • Fischler G.E.
        • et al.
        Alternative hand contamination technique to compare the activities of antimicrobial and nonantimicrobial soaps under different test conditions.
        Appl Environ Microbiol. 2008; 74: 3739-3744
      2. BS EN 1500:2013 Chemical disinfectants and antiseptics. Hygienic handrub. Test method and requirements (phase 2/step 2).

        • Ngeow Y.F.
        • Ong H.W.
        • Tan P.
        Dispersal of bacteria by an electric air hand dryer.
        Malays J Pathol. 1989; 11: 53-56
        • Huang C.
        • Ma W.
        • Stack S.
        The hygienic efficacy of different hand-drying methods: a review of the evidence.
        Mayo Clin Proc. 2012; 87: 791-798
        • Meers P.D.
        • Yeo G.A.
        Shedding of bacteria and skin squames after handwashing.
        J Hyg (Lond). 1978; 81: 99-105
        • Yamamoto Y.
        • Ugai K.
        • Takahashi Y.
        Efficiency of hand drying for removing bacteria from washed hands: comparison of paper towel drying with warm air drying.
        Infect Control Hosp Epidemiol. 2005; 26: 316-320
        • Hennessy P.
        • Strong P.
        • Morgan-Jones R.
        Environmental contamination following toilet use in the operating department.
        J Hosp Infect. 2007; 66: 90-92
        • Boyce J.M.
        • Pittet D.
        Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
        MMWR Recomm Rep. 2002; 51: 1-45
        • Anderson J.L.
        • Warren C.A.
        • Perez E.
        • et al.
        Gender and ethnic differences in hand hygiene practices among college students.
        Am J Infect Control. 2008; 36: 361-368
        • Garbutt C.
        • Simmons G.
        • Patrick D.
        • Miller T.
        The public hand hygiene practices of New Zealanders: a national survey.
        N Z Med J. 2007; 120: U2810
        • Harrison W.A.
        • Griffith C.J.
        • Michaels B.
        • Ayers T.
        Technique to determine contamination exposure routes and the economic efficiency of folded paper-towel dispensing.
        Am J Infect Control. 2003; 31: 104-108
        • Harrison W.A.
        • Griffith C.J.
        • Ayers T.
        • Michaels B.
        Bacterial transfer and cross-contamination potential associated with paper-towel dispensing.
        Am J Infect Control. 2003; 31: 387-391
        • Speers Jr., R.
        • Shooter R.A.
        Shedding of bacteria to the air from contaminated towels in paper sacks. Possible significance for operating-rooms.
        Lancet. 1967; 2: 301-302
        • Bean B.
        • Moore B.M.
        • Sterner B.
        • Peterson L.R.
        • Gerding D.N.
        • Balfour Jr., H.H.
        Survival of influenza viruses on environmental surfaces.
        J Infect Dis. 1982; 146: 47-51