Some people mistakenly believe briefly running their hands under water counts as washing. Others think washing only after using the restroom is enough to prevent the spread of illness. “I think a lot of people don’t see the importance of it,” Hicks says. “It’s a lack of education. They may not see the connection between dirty hands and getting sick.” Educating building occupants on proper hand hygiene can shift those flawed mindsets and begin moving compliance numbers in the right direction. There are five steps to getting truly clean hands, according to the ACI: 1. Wet hands with clean, running water (warm or cold) and apply soap, either in bar or liquid/foam form. 2. Rub hands together to make a lather and scrub them well. Be sure to scrub the backs of hands, between fingers, and under nails. Do this away from running water, so the lather isn’t washed away. 3. Continue rubbing hands for at least 20 seconds, which happens to be the “Happy Birthday” song from beginning to end, twice. 4. Rinse hands well under running water. 5. Dry hands completely using a clean towel or air drier. “The most important part of washing your hands is you have to have the friction with the soap on your hands for 20 seconds,” Couch says. “Even when people do wash their hands, many don’t do it for the appropriate amount of time.” Also important is washing hands at the appropriate times, which is more often than only after a trip to the restroom. The World Health Organization suggests 5 Moments of Hand Hygiene for healthcare workers: 1. Before touching a patient. 2. Before clean/aseptic procedures. 3. After body fluid exposure/risk. 4. After touching a patient. 5. After touching patient surroundings. Likewise, ACI says workers in office settings should wash up frequently, including before and after staff meetings if food is served, after touching anything in the break room, before and after lunch, after using shared equipment like a copier, and before and after shaking hands. Basically, every time the hands touch a surface, there is an opportunity for germs to spread if hands aren’t properly washed. Signage can be a helpful educational tool. In schools, where children are still learning about personal care, Sansoni recommends posting signs all around the building. In offices and healthcare settings, use signage in the most vulnerable areas, such as kitchens and restrooms. Although signs can be helpful, they are not the have-all-end-all. They can often go overlooked, Hicks warns. “We’ve become dull to most warning signs,” he says. “I worked in housekeeping for 33 years, so I know how many people don’t pay attention to signs.” To make signage most effective, experts encourage managers to create a campaign that is engaging and frequently updated. Make posters fun or interactive, refresh them often and change their locations each time. At Barnes-Jewish Hospital, Couch’s department now loads hospital computers with hygiene-related screensavers and changes them every other month.