Seeing is Believing; But You Cannot See Germs

Applied Project by Heather Dieterle

A Snapshot of Information I Received

I was not surprised to find most people prefer one way to sanitize over the other, whether in a hospital or healthcare setting. Overwhelmingly, the information I collected confirmed my initial hunch that, when available, people would rather see their attending medical professionals hand washing with warm water and soap over hand sanitizer. Yet, surprisingly, the protocol in most hospitals is the sanitizer. My intent with this project was to be able to reach out to others around the community to get their thoughts rolling on why hand sanitizer is pushed in the healthcare community. Eventually, I hope this topic will be something considered every time one puts their hand under a hand sanitizer dispenser. I hope in the future, healthcare facilities realize that hand sanitizer is not the most effective form of hand washing and does something to change it. I am very happy with the way this project turned out and hope everyone enjoys reading about all the information I collected. One thing I would change about this project is I would have started it earlier in the semester because I would have been able to reach out to more people. I believe the strengths of this project was that I was able to reach out to so many people in such a short amount of time. Also another strength I believe is that apart of this project is that I was able to get other people thinking the same sort of thing that I was which was why are hand sanitizers so prevalent in hospital and other healthcare settings!

A Little Bit About This Project

Hi everyone, I am Heather Dieterle, senior Interdisciplinary Studies major at Plymouth State University gearing up to graduate in May.

CC By Heather Dieterle

Here’s a look into what I have been doing over this semester. My applied projects name is “What’s Your Take Hand Washing or Hand Sanitizing.” however as seen above, my blog page title is “Seeing is Believing; But You Cannot See Germs.” I chose to do my applied project in a different way than most, I chose to take the approach of interviewing my interviewees as well as having them complete a survey. This page is to show the public what I have done with this semester, take a look, share your comments and share to the world.

Interview Questions:

Here’s my list of questions I will be asking some people for my Applied Project!

  1. When in a hospital do you prefer to see your nurses, doctors or any other medical professional use hand sanitizer or warm water and soap? (Non-medical professionals)
  2. When working in the hospital would you prefer to use hand sanitizer or take the extra 2 minutes to wash your hands with warm water and soap? (Medical professionals)
  3. If you had to choose which was better for your health or your patients health which would you choose, hand washing or hand sanitizing? (Non-medical and medical professionals)
  4. When washing your hands do you use the recommended time of singing happy birthday to yourself before washing off the soap? (Non-medical and medical professionals)
  5. Why is good hand hygiene important to you? (Non-medical and medical professionals)
  6. What knowledge do you have about the effectiveness of hand sanitizing? (Non-medical and medical professionals)
  7. How many times a day do you think you hand sanitize or wash your hands approximately? (Non-medical and medical professionals)
  8. How does poor hand hygiene effect your patients while in the hospital? (Medical professionals)
  9. In a clinical setting, how often should you be performing hand hygiene? (Medical professionals)
  10. Do you believe nurses, doctors or any other medical professional should be allowed to wear nail polish at the job? To you, do you believe wearing nail polish is good or bad hand hygiene? (Non-medical and medical professionals)

                                                   Interview with Lynne Bates

     The first person I had a chance to ask some questions to is my professor, Lynne Bates. Now if you follow my ePort blog posts this name my sound familiar, well you are not wrong.

    CC By Heather Dieterle

    I chose to interview this professor last semester when given the assignment to interview one professor. So anyhow, a little bit about this professor is that she works here at Plymouth State and teaches health related classes. I chose to use her to interview for my project because she has history in the medical field but is also a bystander at the same time. Here are her answers to my questions “I prefer to use warm water and soap. I want my healthcare workers using warm water and soap. Hand washing. Yes, I use the recommended time. We touch many hard surfaces throughout the day and then touch our faces even more throughout the day. Hygiene is the best way to prevent the spread of certain bacteria and viruses. I used to teach a microbiology course for nursing majors and one of our labs was to test the efficacy of hand sanitizers against pathogenic and non-pathogenic bacteria. This lab demonstrated that sanitizers are not effective against many pathogenic bacteria. 10-15 times a day I tend to wash my hands. Because health professionals move from patient to patient without good hand hygiene there can be cross contamination that occurs. Whenever you enter a new room as well as after touching a patient or anything else in that room. No I don’t think medical personnel should wear nail polish or rings or bracelets. With nail polish in place you can’t observe whether nails are clean or not.”

    Interview Questions with Kathleen Peverly

    Another person I chose to sit down and interview is Kathleen Peverly, who is the Housing Coordinator in Residential Life here at Plymouth State University.

    Kathleen Peverly Housing Coordinator at ResLife

    I chose her because I work in ResLife so I felt comfortable asking her these questions and her being okay with me publishing her answers. Kathy stated to me during the interview “Warm water and soap, it gives the appearance of being more through. Hand washing. I do not know sing or count but I am pretty thorough when I want to be. To prevent the spread of disease, germs, colds around cold season. It kills 99.9% percent of germs. True I am not sure good question yeah maybe depends on the germs so maybe not haven’t thought about it I don’t use it. 3 or 4 times a day roughly. If I were one I would want to so I don’t have a problem with it but only if it’s well maintained. Polish and acrylic nails different polish is surface doesn’t bother me, acrylic nails can get stuck underneath it. Should be wearing gloves so I don’t care what they do.

    Interview Questions with Debbie Underwood

    Debbie is my boss at ResLife,

    Debbie Underwood Administration Secretary of ResLife

    I work under her as her right hand gal. I asked her to answer these questions because she does not have any background in the medical field so I thought she would be a good un-basis interviewee. Her answers were based off of a strict patient like person.  “I would prefer that they use warm water and soap.  I do not like the after-effect on my hands after using hand sanitizer.  I am also very sensitive to certain smells and some hand sanitizers bother me because of this. I would choose hand washing.  This is probably because I was brought up with the habit of washing my hands – we never used hand sanitizer when I was growing up. No, but I take my time washing my hands. It is known to stop the spread of germs which in turn keeps your body healthy.  There are germs on everything we touch.  Washing your hands helps stop the spread of bacteria to your body. I don’t really have a lot of knowledge about the effectiveness of hand sanitizing.  I have just read articles and seen it advertised on tv. 8 or more depending on the day and the activities I am involved in. It is probably not a good idea because nurses and doctors who are handling patients should be “clean and sterile”.  Bacteria can collect on the nail polish and also under the nails which would not be very cleanly and could spread infection to the patients they are dealing with.”

    Interview Questions with Rachel Powers

    A senior nursing student at Plymouth State is the next person I decided to sit down with and have answer my questions. I am also roommates with Rachel

    Hannah (left), Myself (middle), Rachel (right)

    so the convenience of her living with me also helped to be able to interview her. I also wanted to have her answer these questions because she has background working in the hospitals because of nursing school however she also has experience in an assisted living facility because she is an LNA. The answers she gave me are “I prefer to see a medical professional wash their hands with warm water and soap. I prefer to use warm water and soap, however it is not always possible and 9 times out of 10 end up using hand sanitizer. Hand washing for sure. Honestly, I should but I don’t.  Hand hygiene is important to be because it prevents the spread of germs to and from myself with everyone that we interact with. I have learned that washing your hands with soap and water is the most effective, however hand sanitizer is a good alternative for the time being (hence why they are all over the hospitals). Obviously one should use soap and water as well as hand sanitizer though. When I am working I hand sanitize and wash my hands probably at least 100 times a day. But when I am home probably around 3-4 times a day. It can lead to the spread of germs and increase risk of infections. Especially with patient that are infected with precautions. You should be performing hand hygiene as you walk into a room, walking out a patient room and throughout the day as well. Personally, I really don’t agree with artificial nails, but I think that nail polish is okay as long as you are still performing hand hygiene as much as you would without nail polish. For me, I wear gloves every time that I walk into a patients room so there isn’t much room for me to get germs underneath my nails that can’t be washed out.”

    Interview Questions with Hannah Durgin

    Another senior nursing student I interviewed is Hannah Durgin. Hannah is my other roommate so the convenience of finding a time to interview was also super helpful. Now because I interviewed both my roommates,

    Hannah (left), Myself (middle), Rachel (right)

    I made sure to not have them near each other while completing it so their answered were not pressured to be the same. Hannah also has much time spent in a hospital so her answers are mostly based off of the time in medical field.  Hannah stated “I would prefer to see my doctors and nurses use soap and water to wash. I would prefer to take the time to wash my hands with soap and water. But I usually don’t have time to get to a sink in between every patient so I always hand sanitize. Hand washing is better for health. I do try to wash for a good amount of time. I feel as if good hand hygiene is good because as a nurse we are going from room to room and that is a very easy way to bring germs from one room to another. And as a patient I want to know that my nursed and doctors hands are clean before they touch me. I have learned in the past that hand washing is the most effective, but hand sanitizing is a great alternative when you do not have the time. If I am at home I was my hands probably 5 times a day. If I am on the unit I am hand sanitizing probably every 10-20 minutes and washing them at least hourly. Poor hand hygiene is said to be a major route of transmission for spreading infection. I sanitize probably every 15 minutes when in and out of rooms, and I try to wash them with soap and water hourly. I feel as if nail polish can make your nails come off as dirty to a patient when the polish starts to chip. I also understand that infection can grow under your acrylics. But just regular nail polish I don’t see a problem with.”

Interview Questions with Nichole Maybay

The final person I had a chance to chat with, was my cousin Nichole. She is an Emergency Room Nurse in Norwood Hospital in Massachusetts.

My cousin Nichole with her husband Corey and 3 sons Chase, Colton and Channing

Nichole has been a registered nurse for about 10 years and she has much experience using hand sanitizer in quick responses to emergency situations. Nichole’s response to my interview questions were well thought out and very detailed. 

“Personally, I prefer to wash my hands with warm water and soap. I don’t care for the feeling the hand sanitizer leaves on my hands and I feel like I have to wash then despite knowing that hand sanitizer is an acceptable alternative for hand washing when your hands are not visibly soiled or contaminated. Also, in order for hand sanitizer to be effective it needs to be alcohol based an should contain at the minimum 60% alcohol concentration. During these awful winter months my hands don’t like the alcohol based sanitizer! I would choose hand washing. Washing your hands with soap and water is the best way to reduce the number of microbes/bacteria on your hands in most situations. Yes, most often I use the ABC song and tell my kids to do the same. Hand hygiene is important to me in both my medical and every day life because cleaning your hands is extremely important to prevent colds, influenza and food-borne illnesses.  Many illnesses and infectious processes are passed/spread solely by unclean hands. Alcohol-based hand sanitizers can help in inactivating many types of “germs”when used correctly and in ideal situations. However, soap and water are more effective. Sanitizers are meant to supplement, not replace, good old-fashioned soap and water washing. There are new studies that question the long term effects of hand sanitizers and the generalized safety of using some of the ingredients that are in a lot of these alcohol based hand sanitizers. I don’t think I can put a number on it. I work in the emergency room and I’m constantly washing my hands before and after patient care as well as before and after handling any sort of medication, handling any food, being in and out of the bathrooms, as well as just washing them when it feels necessary! At home I’m a mom of  three little boys, so hand washing is also very frequent! Proper Hand hygiene is the primary source of reducing hospital acquired infection. There is a lot of evidence that shows following the strict guidelines recommended by the CDC pertaining to hand hygiene reduces the risk of cross-transmission of infections in clinical settings. Poor hand hygiene can cause patients to become more sick. Hand hygiene should occur when you’re heading into and leaving a patient’s bedside. If your hands are visibly soiled the obvious recommendation is for you to wash with soap and water. Otherwise hand sanitizer is acceptable. The other obvious times to use hand hygiene would be when using the bathroom, helping patients with the bathroom, as well as before and after handling any food. I believe that most evidence and guidelines support not wearing artificial nails and either not using nail polish or making sure the polish is intact.  ultimately I think it’s a personal decision however if people in the medical profession choose to use nail polish I do think that it needs to be intact and not chipping. In most circumstances patient care is done with gloves on however professional standpoint I think it’s either all or nothing.”


Hand Washing VS. Hand Sanitizing Survey

I will tell you the truth about this survey is that I did not expect to get many responses at all, however I was truly shocked on the first day. Only eight hours after releasing the survey to my PLN Twitter, personal Facebook, and personal Twitter I had received 71, yes 71 responses. In awe, I left the survey open for two more days and decided to close it today April 12, 2018 with 98 responses. I am extremely grateful for all the people who took the time out of their personal days to take my five question survey.

So, let’s get into the meat of this survey. I wanted to create a survey such as the one I did because I am very passionate about giving the best care possible to patients in the hospital. With this survey my purpose was to get my feet wet in the area of hand washing vs. hand sanitizing to see what people think is best, and what they want to see in a hospital before diving deeper into my research article.

CC By: Heather Dieterle

Question one: As a patient would you rather have your medical professional use hand sanitizer or wash their hands before giving you care? As seen in the image to the right, the answer hand washing was the option chose 77 times out of 98 putting it at a 78.57% of the responses.

CC By: Heather Dieterle

Question two: Without looking at any research which do you believe is more effective at getting rid of germs and bacteria? I bet you can guess what the majority vote was, yes that is correct hand washing. This response scored 85 out of 98 responses which creates it as a response percent of 86.73%.

CC By: Heather Dieterle

Question three: Do you personally prefer using soap and warm water or hand sanitizing when completing your own hand hygiene? With percent responses of 84.69% and 15.31% washing with soap and water won over hand sanitizer or I don’t ever wash my hands.

CC By: Heather Dieterle

Question four: Whenever you contaminate your clean hands with something, do you go wash your hands? Two of these answers were very similar being always and sometimes so I was not surprised to see that the responses were very close in that sometimes had 52 responses coming in at 53.61% and always had 42 responses coming in at 43.3%. These answers might have been hard to depict for some people given that the question is vague about the contamination.

Question five: When washing your hands do you use the recommended time of 15 seconds? The response answers to this

CC By: Heather Dieterle

question were not too far apart from each other. The most answered answer was I don’t count so I don’t know which had 48 responses with 48.98% however yes came in at a close second with 38 responses and 38.78% and lastly no had 14 responses (I appreciate those who were honest) and at 14.29%.

Completing this survey truly made me raise the question even more as to why hospital staff are required and pushed to use hand sanitizer upon entering and exiting a patients room. Also why they would not take the extra couple minutes to fully wash their hands. It’s clearly noted in this survey how those feel about hand sanitizer, why are we not giving the extra step of making patients happy and comfortable. There comes a time when there are emergencies and hand sanitizer is much faster in a situation where you need to be quick so hand sanitizer would be the answer in that type of situation.


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