The Germ City Hand Washing Program: Clean Hands, Healthy People

NON-TECHNICAL SUMMARY: Hand washing is the single most important barrier to the spread of foodborne disease according to the Centers for Disease Control. Hand washing is a key, often-overlooked behavior that is important for food safety, disease prevention, and personal health. Yet, most Americans underestimate the potential seriousness of foodborne illness and its correlation with hand washing practices. Children as well as adults self report hand washing behaviors that scientists fail to observe during observation of food safety related behaviors. There is a clear need to communicate risk and enhance consumer motivation for hand washing and personal hygiene that makes lasting behavior change possible. Most people do not wash their hands as often or as well as needed. Research studies support the need for behavior change, effective hand washing education, research, and improved evaluation. The Germ City Hand Washing Program is a science based program that increases awareness of risk of poor hand hygiene and its' relationship to food-borne illness while improving the effectiveness and frequency of hand washing.

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APPROACH: Our program is multi-faceted and integrated with education, research, and evaluation with a special research focus on finding answers to the critical question of why people fail to practice effective hand washing behaviors. Education and extension activities will be conducted in schools, fairs, and community events along with the development and implementation of effective evaluation. Outreach and marketing activities will result in local program sustainability. The focal focal point of the Germ City Hand Washing Program is a large,lightproof tunnel constructed of non-toxic materials. It is fully wheelchair accessible. After applying a special hand lotion with a pigment that is UV light sensitive, participants traverse the black-lighted tunnel. They are able to see "pretend" germs on their hands. After hand washing, participants revisit the tunnel assessing their effectiveness. Immediately, they are able to see whether they have or have not practiced effective hand washing. "Germ City" offers a unique method of reinforcing awareness of health benefits while allowing participants to practice behaviors that work and receive immediate feedback.

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PROGRESS: 2001/09 TO 2004/09<BR>
Project Report: Germ City: Clean Hands, Healthy People is a science based program to increase the risk awareness of poor hand hygiene and its relationship to foodborne illness while improving effectiveness and frequency of hand washing. Education and Training: Programming was delivered to youth and adults in AL, HI, ID, WV, and WA during education and Extension outreach activities. Presentations were conducted in classrooms, senior centers, after school-Head Start programs, healthcare facilities, tribal health centers, foodservice operations, fairs, and festivals. Audiences were diverse reflecting a commitment by collaborators serving their respective state populations. Evaluation and Data Collection: Evaluation was conducted with 179 elementary 4th graders and 172 middle school 8th graders students in WA, AL, HI, WV, and ID at ten sites. A pre-and post-hand evaluation form with a four-point Likert scale to rate the cleanliness of the front and back of the right hand was developed. Both the researchers perception of hand washing effectiveness and the child's perception of hand washing effectiveness were assessed. Children answered questions about hand washing behaviors and teachers completed a questionnaire about benefits of the Germ City Program. Demographic data was completed on each school. The evaluator, from West Virginia University imputed, analyzed and interpreted the data. Review of Activities and Sequence: The elementary and middle school research component of the project was completed. On-going program delivery continued by project partners. Website development continues by Washington State University Extension: www.germcity.wsu.edu. Washington State University and University of Hawaii have an extension to complete activities in 2005. Communication to Stakeholders: Project collaborators conducted presentations-posters for the National Association of Environmental Health Association Conference, Priester National Extension Health Conference, CYFAR, University of Arizona Food Safety Conference, and the International Fairs and Expositions Association meeting. Presentations have been accepted for the National Science Teachers of America Conference and Directors of Health Promotion & Education National Conference on Health Education and Promotion in 2005. Program Sustainablity and Growth: The Germ City Program continues to grow in WA, WV, AL, HI and ID. Additionally, Extension programs in TN, VT, AZ, and CA as well as Western Illinois University, WV State University, and the Lane County, OR fair have initiated new programs linked to food safety and health. Currently, there are 52 Germ City units in 11 states involved in on-going program delivery. Volunteers have been important for program development, delivery, and evaluation. Parents, teachers, student peer educators, school nurses, infection control specialists, and public health educators in a variety of community settings have been involved in marketing the Germ City Program and conducting outreach and Extension education program activities assuring community sustainability.
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IMPACT: 2001/09 TO 2004/09<BR>
Germ City has a significant impact on children's hand washing skills. Four to six weeks after the initial presentation-assessment, with no new instruction, there was improved hand washing effectiveness confirmed by independent observations of educators-researchers and students. Assessments of the right hand included evaluation of fingernails, knuckles, back of wrist, between fingers, fingertips, palm, and front of the wrist after applying a uv-light sensitive lotion and performing a normal hand wash. Pre-and post-testing was completed with 351 matched pairs of students in the 4th and 8th grades. Self reporting conducted during post-testing, showed significantly more students reported they had washed hands before eating dinner the night before and after they last went to the bathroom than during the initial Germ City presentation. Evaluation showed that Germ City works well with 4th and 8th grade students and boys and girls. The results were better, however with 8th grade students and, to a lesser extent, better with girls. Teachers reported that the activity was informative, interactive, and creative. Teachers also reported that they observed a greater awareness on students part regarding the need to wash their hands as well as a greater awareness of the frequency and thoroughness of hand washing. Teachers were asked to identify barriers to implementing the Germ City Program and for suggestions in marketing the program to other teachers. Their suggestions will be incorporated into on-going programming.