SCGhealth Blog

Balancing Environmentalism and Hygiene in Your Bathroom.

Monday, April 30, 2018

By Audrey Landers

Sometimes, keeping clean is dirty business. Walk into just about any public bathroom and you’re likely to find at least one industrial sized trash bin filled with hundreds of paper towels. Maybe there will also be a few ancient air-dryers ineffectively blowing lukewarm air. After you wash your hands you’ll try the air-dryer (it’s more hygienic, right?) but you’ll probably just end up grabbing three or four too-thin paper towels anyway, as one study found that air-dryers are woefully slow and inefficient at getting rid of excess water. There’s more than one problem with this picture.

Image from

Let’s tackle the myth that air-dryers are the more hygienic option first. Recently, a study published in the Journal of Applied and Environmental Microbiology found that air-dryers actually spread bacteria. “Well sure,” you might think, “not everyone is as diligent at washing as I am.” But I’m afraid that’s wrong too. Air-dryers don’t only spread the bacteria left on your hands after washing, they also spread all the other nasty bacteria in the bathroom. This is not the first study to suggest this. In 2015 a similar study was performed by a team of microbiologists from the University of Westminster and they found that air-dryers can blow bacteria up to three feet off the ground.

The University of Westminster study concluded that paper towels were the most hygienic way to dry your hands, though they aren’t as environmentally conscious. If you’re looking to keep your office green, then air-dryers are still the way to go. But let’s be honest here, if you’re already willing to ignore how unhygienic an air-dryer is, you may as well throw caution to the wind and wipe your hands on your pants rather than waste electricity. You can be a bit more environmentally conscious by using recycled paper towels, the production of which uses 31% less energy than the production of virgin paper towels. With recycled paper towels however, you could be sacrificing hygiene. Research has suggested that bacteria can thrive in recycled paper towels because of the starches that are used as binding.

If, like SCG Health, you work in a small office with few visitors or if you have a staff-only restroom, there is another option that may work for you. Using non-disposable hand towels is a way to keep your hand-drying hygienic and green. We keep a basket of small hand towels that are used once. At the end of the day we collect the basket of used towels and wash them. The cloth towels dry your hand quickly and effectively and allow SCG Health to cut down on unnecessary paper waste. It is important to have multiple towels, because having only one towel that is used over and over throughout the day can allow bacteria to collect

Which option is right for you?

Unfortunately, you’ll have to answer that for yourself. However, I can give you a few suggestions:

  • For small offices: reusable cloth towels are effective, clean, and can add a little bit of luxury to your office.

  • For large offices: opt for paper towels, you might feel bad about the waste, but don’t worry. It only takes about two weeks for a paper towel to decompose.

  • In emergencies: if you have absolutely no other options, then fine, dry your hands on your pants. Just don’t try to shake hands with me after.

Avoiding the Flu in the Workplace

Monday, November 06, 2017

By Audrey Landers, Intern

It is a cruel cosmic joke that the influenza season takes place during the busiest and most stressful time of the year. No one can afford to be sick during the holiday season, especially not medical office staff. Without proper precautions, the flu can infect an entire office, leaving employees trying to perform their duties through a haze of fatigue, or worse, being unable to come in at all. With a few simple steps, you can minimize the effect that the flu will have on your workplace.

Encourage Vaccination
Recent studies performed by the Center for Disease Control & Prevention(CDC) show that the flu vaccine is between 40% and 60% effective. This year, the CDC recommends injectable flu vaccines, so make sure your employees know not to get the nasal spray. You can encourage employees to get the flu vaccine by allowing them to take time during the work-day to get the shot. Have shots performed in the office by clinical staff for free or offer to reimburse shots received at a qualified location.

Encourage Good Health Habits
While your employees should already be partaking in good health habits such as hand washing, it is even more important during the flu season. Every employee should wash their hands frequently for at least 20 seconds with soap and water. Make sure all bathrooms are stocked with soap and hand sanitizer. displaying signs in bathrooms and above sinks can help remind forgetful or neglectful employees and patients about the importance of clean hands. 

Beware of Fomites
As SCG Health has discussed before on this blog, fomites are objects that have the capability to carry infectious organisms that might transfer from one person to another. While you may already be in the habit of regularly cleaning fomites such as stethoscopes and patient exam tables, other less obvious fomites are hiding right under your nose. Anything that is touched by many people in one day should be sanitized regularly. Common office items such as keyboards and computer mice are major fomites that should be sanitized regularly with a bleach-based cleaner. You should also be paying special attention to doorknobs, especially those connected to bathroom doors.

Deal with your Patient Lobbies
Lobbies full of sick patients can easily become a breeding ground for the flu. Some practices are able to avoid the spread of illness by offering separate lobbies for patients who are sick and patients who are not. If your practice cannot offer two lobbies or if you feel you need to take further precautions, you have a number of options. Having disposable face masks and hand sanitizer dispensers in patient areas can allow patients to take their health into their own hands. You can also keep sanitizing wipes on hand to quickly wipe down chairs, toys, and other items that many patients may come into contact with. Prominently displayed posters can also instruct patients on how to keep the flu from spreading by covering their mouth when they sneeze or cough.

Tell Sick Employees to Stay Home
If you can afford it, you should encourage employees who may be sick and contagious to stay home. The CDC recommends that any employee with a fever should remain away from work until 24 hours after their fever has ended without medication.

This blog post was written as part of the CDC’s blog-a-thon to spread influenza vaccine awareness. To learn more about current influenza vaccine recommendations, you can check out our previous post or head over to the CDC’s website to learn everything you need to know.

CDC Blog-a-thon

Keep an eye out for the #FluStory Twitter storm on December 6 and be sure to share your #FluStory to help spread awareness.

Fashion & Fomites: Attire in the medical office matters

Tuesday, January 12, 2016

By Jennifer Searfoss

Not long ago, my best friend who is a pediatric hematologist, lamented about wearing heels during clinic. I was somewhat horrified by the thought that she runs around seeing patients in uncomfortable shoes, but we both agreed that looking your best for patients and colleagues is an important part of patient perceptions and professional decorum.

What was new to me was she explained that she no longer wears the "doctor coat" and she altered her wardrobe to include many more fashionable three-quarter length sleeve blouses and tops. Why? It's because certain fashions, like long-sleeves, are fomites.

I want to jump to my homework.

Photo credit: GraphicStock © 2016.

Fomites explained
A fomite (plural is "fomes" but that doesn't sound fun at all) is any object or substance that can has the capability of carrying infectious organisms that may be transferred from one individual to another.

Skin is considered a fomite, but so is hair, clothing, linens, office furniture and supplies. And you can bet what the top fomites are!

Virus Surfaces
Parainfluenza virus Desks, phones, computer mouse
Respiratory syncytial virus Countertops, cloth gowns, rubber gloves,
paper facial tissue, hands
Influenza virus Towels, medical cart items
Coronavirus Phones, doorknobs, computer mouse,
toilet handles (23), latex gloves, sponges
Norovirus Carpets, curtains
Rotavirus Phones, toilet handles, sinks, water fountains,
door handles, play areas, refrigerator handles,
thermometers, paper, cotton cloth, latex, glazed tile,
Hepatitis A virus Drinking glasses, cotton cloth, latex, glazed tile
Astrovirus Paper
Source: Boone, SA & Gerba, CP. "Significance of Fomites in the Spread of Respiratory and Enteric Viral Disease." Appl. Environ. Microbiol. March 2007 vol. 73 no. 6 1687-1696.

Causes for fomites

It's not just about having a policy about employees washing their hands.

Most clinicians learn in school to change the paper on the examination table. But how many times is their stethoscope or in-room blood pressure cuff sanitized? And what about those coats? My own father's practice stopped doing clinician laundry and his response was to stop wearing the tell-tale white coat. His actions makes sense for so many reasons. A 2008 study found that coats are significant vectors – with 18% carrying methicillin-resistant Staphylococcus aureus (MRSA). The study found that with self-laundering, doctors hadn't washed their coat in more than a week and 17% having not washed their coats in nearly a month.

And what about those darn handheld devices that clinicians use during their day? It's estimated that less than 8% of healthcare workers disinfect and routinely clean their mobile devices. The investigators found that the top pathogens on mobile devices are coagulase-negative Staphylococci and Staphylococcus aureus (some was MRSA). Read the study.

Another study by on orthopedic surgeons found that 44 out of 53 (88%) cell phones tested had pathogenic bacteria. The good news is that disinfection efforts are effective; only 8% had bacteria after treatment. But disinfection needs to be frequent as infection was back in 75% of tested phones within a week. Read the study.

A slightly more dated study surmised that the ongoing heat put off by cell phones makes them an excellent environment for pathogen growth. With the constant handling by medical professionals and subsequent placement in pockets, purses and brief cases, these fomites are a big vector to carefully consider and evaluate solutions. Read the study.

Preventing fomites in your office
Starting out in public health, this was one of my favorite aspects of my career choice. Being the sleuth and determining through epidemiological investigation on what is the vector for infection makes me feel like Dr. Holmes. And it leads to improvements in quality care.

The numerous studies investigating white coat pathogen transmission to patients found that the long-sleeves and pockets were the main region with containments. The take away is to encourage clinician and support staff to wear short-sleeved, pocket-less attire that is frequently washed.

The orthopedic surgeon cell phone study noted above used a simple disinfection wipe to clean the phones. Another study found that alcohol wipes and bleach removed 100% of the methicillin-resistant S aureus from iPad screens. Pretty simple to find an antibacterial wipe. It's harder to get them consistently disinfected without an office program.

Another recent study showed that for hospitals, ultraviolet-C radiation (UV-C) and surface disinfection may be one of the most effective techniques to get rid of unwanted bugs. The December 2015 study published in the American Journal of Infection Prevention showed that the Southern California Hospital at Culver City using an outside contractor reduced hospital-acquired infections over 34% and c-diff 46% with the UV-C room and surface disinfection. Great study but may not be cost-effective for a medical office.

So here are some questions to ask yourself about your medical practice

  • Do we have an employee policy on employee hand-washing?
  • Do we have an employee policy on employee attire that encourages short-sleeves and pocket-less attire?
  • If we have white coats in the office, should we launder them more frequently? Should we have white coats?
  • Do we have an employee policy on employee sick leave and attendance when ill? What about employee flu shots; do we pay for them; should we?
  • Do we have an infection control program and monitor employee handwashing and frequent disinfection of areas that clinical staff touch?
  • How do we handle employee owned handheld devices? Should we have a disinfection program to promote frequent cleaning of the devices?

Your resources
Centers for Disease Control & Prevention Hand Hygiene Online Resource – includes a web-based education course, promotional posters for your office, screen-saver for your computers, and more.

Recommended reading - Infection prevention in hospitals: The importance of hand hygiene.

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