The D-Buggers

November 13th, 2018

 

Dirty Digits:

Hand Hygiene as a Public Health Initiative

Overview

It is 10:45am, and Mr. Bubrow just dismissed his first class of students. On his way out from the first class, he decides to use the restroom quickly. He washes, and dries his hands and touches the bathroom door knob on his way out. As the day goes on, Mr. Bubrow begins to feel ill so he finishes his work and goes straight home. As time progresses, his condition worsens and Mr. Bubrow realizes he has a flu and needs medication. He quickly gets what he needs and heads to bed. The next morning is a work day but he decides to stay home. Mr. Bubrow is absent from work for the next two days, worrying about his expenses and his students. Finally after three days have passed he decides to work, motivated by his bills and risks infecting others. Thinking back, how did he get sick? It’s most likely the case that when he used the bathroom and touched an unclean door handle, he was infected. This isn’t an aberration when using the bathroom. Good hand hygiene is a simple, cost effective way of preventing the spread of viruses and bacteria that cause illness. Through a program which encourages good hand hygiene, we can reduce the chances of students and faculty becoming ill in the coming winter months.

Figure 1: Responses to the question which titles the graph on a scale of easy (1) to difficult (5).

In a survey to students at the City College of New York (CCNY), close to half (44.5%) of the responses to the question stated it is difficult to maintain good hand hygiene on campus (see Figure 1). There is, however, an overall dissatisfaction with the bathrooms among students on campus, possibly due to their being unkempt (see Figure 11 in Appendix).

Statements from the D-Buggers indicate that they witnessed some of their peers inadequately wash their hands before leaving the restroom.  The majority of students who took the survey insist that they have a good hand hygiene but have mixed feelings about their peers (see Figure 2 in Appendix).  When it comes to hygiene, one bad apple spoils the bunch. Faculty and students may get sick from manual contact with things such as shared keyboards, door knobs, exchanged documents, and papers among other objects. Therefore, in order to improve the public health of the community, we propose an initiative to renovate the bathrooms, starting with the NAC (North Academic Center), to make it easier for persons to maintain good hand hygiene while also providing slight intervention in the form of posters illustrating good handwashing technique.

Action Plan

In our plan to reform the bathrooms at CCNY and make it a healthier environment, the D-Buggers made it their mission to visit all the bathrooms in the NAC building and keep track of how many sinks, doors and paper towel dispensers are in the bathrooms. We looked at how the bathrooms are kept in terms of cleanliness, such as the stalls, the toilets and the sinks. After witnessing inadequate hand washing time and time again, the decision was made that in order to properly maintain a healthy environment and a good hygiene practice the following changes are needed to be made.

• Installation of foot door handles to prevent touching of the knobs.
• Mounting of posters, to encourage bathroom users to keep good hygiene.
• Installation of automatic sinks, for more effective and efficient hand washing.
• Paper towel dispensers to prevent post wash exposure to germs.
• Hand sanitizer dispensers at strategic locations to supplement handwashing

We seek to initially implement this project in the NAC building, which contains about 70 bathrooms not including those in the Cohen Library.

STEP BY STEP

1. Procure the listed materials in the amount and order specified in the budgeting section.
2. Obtain contracts for bathroom renovation for installation of foot door handles, paper towel and hand sanitizer dispensers, and automatic sinks.
3. For the convenience of students, faculty, and staff, renovation on bathrooms should not be conducted on those bathrooms which are one floor apart.
4. Conduct a survey afterwards and examine faculty absenteeism pre and post renovation.

 

Budget

Item	Minimum for one unit	Products for minimum unit	Maximum for one unit	Product for maximum unit	Numbers needed for all bathrooms in the NAC	Total cost of minimum units needed	Total cost of maximum units needed
Foot door handle	29.05	https://tinyurl.com /y9tag9jv	$49.99	https://tinyurl.com /y8m529rz	70	$2,033.50	$3,499.30
Automatic flushing toilets	$197.99	https://tinyurl.com /y9vmku38	$287.04	https://tinyurl.com/ybef5752	350	$69,296.50	$100,464
Automatic paper towel dispenser	$12.00	https://tinyurl.com/y8jn94n5	$39.95	https://tinyurl.com/ydfymuax	140	$1,680	$5,593
Hygiene poster	$3.49	https://tinyurl.com/yawr3qur	$9.99	https://tinyurl.com/y794dvp2	210	$732.90	$2,097.90
Automatic sinks	$69.99	https://tinyurl.com/y7rrcy2f	$289.58	https://tinyurl.com/ybuqtmy4	280	$19,597.20	$81,082.40
Hand sanitizer	$5.39	https://tinyurl.com /yae4fpk3	$25.00	https://tinyurl.com/y8vzja5x	140	$ 754.60	$ 3,500

Promoting good hand hygiene and overall hygiene through quality of life changes is the main focus of our campaign. Even though the budget needed for renovating the bathroom looks costly, the new equipment needs very little maintenance, and will impact the not only the students, but also the facility tremendously.  The budget needed seems large but can be reduced when automatic flushing is not included as this does not help with being more hygienic since all other factors are hand free.

Benefits

In a college setting, presenteeism among students is probable. Presenteeism is defined in an article published in the Journal of Occupational and Environmental Medicine as showing up to work (or college in this instance) despite being sick. We drew this conclusion because college students have a financial investment in their education which incentivizes such behavior. In the article mentioned earlier it was reported that the implementation of a simple hand hygiene program (involving interventions and hand sanitization) reduced, over the course of many years, health care claims of workers by 20.9% compared to the control group (Arbogast et. al, 2016). This not only illustrates a benefit to the institution through possibly reducing health care costs of college, but this result bespeaks to an improvement of health at the location in which it was implemented. Therefore, the community as a whole stands to benefit from the bathroom upgrades.

While the program implemented by the study supplied workers with hand sanitizer to workers at their desks (Arbogast et. al, 2016), we hope to emulate the results through the strategic placement of hand sanitizer dispensers near restroom exits. The interventions to the community are to come in the form of a sign encouraging hand washing. Because the restrooms at the target workplace had signs in place before the study was conducted, it is hard to tell how their inclusion affected the outcome. However, they could serve as a first intervention to the City College community in improving hand hygiene.

Summary

Good hand hygiene is an essential yet often marginalized part of personal hygiene. We need our hands to do a variety of things and may forget about the things we’ve touched, causing illness. Thus, encouraging hand hygiene while making it easier to maintain is a cost effective way to bolster public health. While the upgrade costs are initially detering, the eventual payoff in reduction of healthcare claims of staff over a given period should outweigh the upgrade and maintenance costs. After the bathrooms are upgraded, a post renovation survey can be conducted to measure community satisfaction. Also, there are QR codes posted on the doors of recently upgraded bathrooms which students and faculty can use to make suggestions. Costs due to healthcare claims should be examined closely after the renovation project is done. Should the project be a success, the D-Buggers will look to expanding into other buildings, probably the Marshak Science Building.

Biographies

 

Marino Echavarria is a second-year mathematics and computer science double major at the City College of New York currently working as a research assistant to Professor Ronak Etemadpour. Prior to his position as a research assistant Marino was a math tutor for the calculus sequence at the City College Gateway Academic Center. He is a dedicated, knowledgeable listener capable of effective communication in written and spoken form. His interests include writing, reading, and playing games with a focus their design, like Tetris.  

 

Paul Fernandez is a computer science major at the City College of New York. Some prior work experience he has is working as a cashier at a supermarket, working at an arcade, and other various small jobs. He refers to himself as a hard dedicated worker and a kind person overall. One of his skills are, although he does not know how, whenever he is in a tough situation he manages to persevere through and overcome it. Interests include outdoor activities, playing games, and meeting new people.  

 

Najeeb Al-Awadhi is a sophomore student at the City College of New York majoring in computer engineering with a minor in mathematics. He worked as a division advisor, cash-wrap supervisor and development trainer at Uniqlo, a retailing company. In addition, he worked as administrative assistant before joining Uniqlo. Najeeb is a hardworking, efficient and reliable person. He enjoys reading, learning, swimming and pondering.

 

Anthony Campana is a sophomore-student majoring in computer science at the City College of New York. He is currently a chess teacher for various elementary schools around the Manhattan area. Previously, Anthony was a receptionist at a senior nursing home. He seems himself as being hardworking, dedicated, dependable, and reliable. In his pass time he enjoys cooking, reading, and hiking.    

 

References

Arbogast, J. W., Moore-Schiltz, L., Jarvis, W. R., Harpster-Hagen, A., Hughes, J., & Parker, A.    

(2016). Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices. Journal of Occupational and Environmental Medicine, 58(6). doi:10.1097/jom.0000000000000738

 

Wisconsin Department of Health Services, Division of Public Health. (2015, August). Disease

Fact Sheet [Flyer]. [Madison, WI]: Wisconsin Bureau of Communicable Diseases, Communicable Diseases Epidemiology Section.

 

Appendix

Figure 2: Responses to the question Most of my peers have good hand hygiene.

 

Figure 3: Responses to the question I  have good hand hygiene.

 

Figure 4: Responses to the question how important do you see hand washing to be in preventing illnesses.

 

Figure 5: Responses to the question which of the following are illnesses which can be prevented by hand washing.

 

Figure 6: Responses to the question Are you likely to wash your hands often when you or your peers are sick.

 

Figure 7: Responses to the question Hepatitis A is one of the correct answers to the previous question. Did this come as a surprise.

 

Figure 8: Responses to the question Common infections caused by germs passed from one person to another include diarrhea, vomiting, and viruses.

 

Figure 9: Responses to the question which improvements do you think are the most important..

 

Figure 10: Responses to the question I am satisfied with the bathrooms at CCNY.

 

Figure 11: Responses to the question using hand sanitizer is a better and more effective way of washing your hands.

 

 

(see this link for images of the figure in the assignment, hard to bring them to this site: https://docs.google.com/document/d/1EUnHBdozmV7N4ARvUmqgoz39R2Lb2O9xxrn6lmuuZs4/edit?usp=sharing)