title: Bacterial transfer and cross-contamination potential associated with paper-towel dispensing.
abstract: BACKGROUND
  The role of hands in disease transmission is well established, and the importance of handwashing is recognized. However, the exits of paper-towel dispensers used in hand drying may be contaminated, and the functionality of handwashing equipment increasingly is being questioned.
  
  
  OBJECTIVE
  We sought to study the transfer and cross-contamination potential between hands, towels, and dispenser exits if one or more is contaminated using bacteria representative of the skin's flora.
  
  
  METHODS
  A generic wall-mounted paper-towel dispenser and a range of different paper towels were used. Volunteers with either clean or contaminated hands were asked to remove, using a range of protocols, towels from dispensers which themselves were either clean or contaminated. Previously clean surfaces were then microbiologically tested.
  
  
  RESULTS
  Recoverable bacterial transfer rates from a contaminated hand to clean dispenser exits ranged from 0.01% to 0.64% depending on the bacteria used with an even higher transfer rate for clean towels. The reverse transfer (ie, from contaminated exits to clean hands) was between 12.4% and 13.1%.
  
  
  CONCLUSIONS
  The results indicate that zig-zag transfer of bacteria between paper-towel dispensers and hands can take place if either one is contaminated. This potential should be considered in the design, construction, and use of paper-towel dispensers.
authors.affiliation: School of Applied Sciences, University of Wales Institute, Cardiff, United Kingdom.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Harrison
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Griffith
authors.forename: Troy
authors.initials: T
authors.lastname: Ayers
authors.forename: Barry
authors.initials: B
authors.lastname: Michaels
mesh_terms: D001424:Bacterial Infections / Q000635:transmission*; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000635:transmission*; D004866:Equipment Contamination; D005260:Female; D006225:Hand / Q000382:microbiology*; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D017053:Infection Control; D008297:Male; D016982:Micrococcus luteus; D010209:Paper; D012706:Serratia marcescens