Purpose: This research analyzes current handwash guidance by collecting and reviewing existing handwashing signs and posters, and subjects them to a quantitative analysis.
Methods: An Internet search compiled a comprehensive database of handwashing sign and posters. Keywords used in the search included: handwash, sign, poster, soap, and hand hygiene. A Google search was followed by a targeted search of US state and county health department websites. Instructions for lather time, rinse time, overall wash time, water temperature, pre-moistening of hands, drying method, technique, and total number of handwashing steps were recorded. The requirements for inclusion were minimal; the sign needed only to mention or show a picture of handwashing.
Results: Eighty-one unique handwashing posters or signs were identified. Every sign had at least one step, with the highest number of steps being thirteen. Thirty-seven (47%) signs indicated a specific lather time, with the average time being 18 s. No signs suggested more than 20 s lather, and none suggested less than 10 s lather. Twenty-four signs (30%) recommended using warm water. Two signs recommended using 100°F (37.8°C) water and one recommended using “hot” water. Sixty-two signs (77%) made a recommendation to dry hands in some manner and fifty-three (65%) suggested using a paper towel. Forty-one (51%) signs suggested one or more handwashing techniques, with the most common recommendations being to target between the fingers and the fingernails.
Significance: Our analysis reveals that handwashing sign and poster suggestions can vary quite widely. Lack of consistent signage may contribute to a lack of handwashing consistency and compliance.