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Cleanliness is Next to Effectiveness
Handwashing Compliance Can Lead to Improved Food Safety
by Anna Starobin, MD
Employee handwashing is considered to be among the most effective ways to help control the spread of illnesses in foodservice operations. Although this point is generally accepted as fact, proper handwashing practices are often inadequate for a variety of reasons.
Frequent, thorough washing of the hands is often inconvenient, time consuming and irritating to the skin. If the handwash sink and soap dispenser are inconveniently located, employees will be less likely to wash their hands at the appropriate times. Additionally, employees recognizing when to wash their hands mainly comes as a result of proper training. In order to overcome these and other factors that have caused handwashing compliance levels to remain low, standards and products must be developed and implemented by the foodservice industry to specifically address handwashing practices.
Hand Care Regulations Nothing New
In the 19th century, Dr. Ignaz Semmelweis became the first to document that handwashing is among the most important factors for reducing the spread of illnesses.1 Today this belief is commonly accepted in all areas of public health, including the healthcare and the foodservice industries. In fact, poor personal hygiene is the second leading cause of foodborne illness outbreaks, only behind bacterial agents.2 With handwashing emphasized as a major component of personal hygiene in the U.S. Food Code, a good handwashing program is needed for proper food safety.3
It has been estimated that nearly 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths can be attributed to foodborne illness each year in the United States alone.4 In studies conducted between 1988 and 1992, the Centers for Disease Control and Prevention (CDC) reported that the second leading cause of foodborne disease outbreaks was the poor personal hygiene practices of food handlers. In this study, the CDC defined good personal hygiene practices as proper and adequate handwashing, prevention of hand contamination, access to adequate handwashing facilities and drying devices, and hand care products.5
The major microorganisms responsible for food-related outbreaks listed in the 2005 FDA Food Code include Hepatitis A virus, Salmonella typhi, Shigella spp., Norwalk and Norwalk-like viruses, Steptococcus pyogenes, and Staphylococcus aureus.3
Workers in foodservice industries must wash their hands several times an hour to meet the requirements for illness prevention as set forth by several agencies, including FDA and the CDC. These documents discuss cleaning procedures, frequency, required facilities, hand soaps and hand sanitizers. Additional state and local regulations may require use of antimicrobial hand care products.
Compliance Remains Low
The facts relating to the need for adequate handwashing practices and the regulatory guidelines are well known, yet compliance remains alarmingly low due to a variety of factors.
According to an FDA report compiled in 2000, workers throughout the healthcare industry were the most compliant with an average 80 percent demonstrating good personal hygiene practices. The report also showed that workers in the food retail industry (grocery stores) exhibited 78 percent compliance. In contrast, workers in the quick service (fast food) and full service restaurant industries averaged only 55 percent compliance.5 Additionally, the FDA issued this report asserting that 30 to 45 percent of restaurants, supermarkets and hospitals were out of handwashing compliance. The study cites improper handwashing as the main reason for non-compliance.5
The difference in compliance levels can be attributed to several factors. Typically, there is extensive education and training in the healthcare industry, and handwashing is stressed as an integral part of the healthcare regimen. Because healthcare personnel work with patients on a daily basis, they generally have a better understanding of the importance and methods of disease prevention.
Meanwhile, the initial education and training for workers in the foodservice industry is often limited. High turnover rates and the lack of any formal training in disease prevention can lead to lower compliance levels. Yet raising compliance levels for handwashing protocols could still be achieved in this industry by providing hand care products that are less irritating, more moisturizing and convenient to use, as well as adding compliance monitoring systems.
Proper Handwashing Tools and Techniques
In the 2005 Food Code, the FDA defines proper handwashing techniques as using a good hand soap, rubbing hands vigorously for at least 15 seconds, paying special attention to areas near and under fingernails, and thorough rinsing under clean running water.3 The 2005 Food Code also recommends that hand wash sinks be conveniently located within easy reach of the employee. The sinks must not be obstructed by equipment or other items that may interfere with employee access, and there should be an adequate flow of warm water.3 A warm water temperature at handwash sinks significantly influences compliance levels and efficacy, and is more effective than cold water for removing soils encountered in kitchens.
Typical soils found in the food service area are beef tallows, which melt between 95° and 104° F, and butterfat, which melts around 86° F.
Liquefied oils are easier to remove from a surface. Therefore, if the water temperature is just high enough to melt the oils, the hand soap will be more effective. In addition, individuals are more likely to thoroughly wash their hands in water that feels comfortable.7 The 2005 Food Code recommends a minimum temperature of 100° F (38° C).3
The strategic placement of an appropriate soap dispenser above the hand wash sink also influences the success of any hand hygiene program. If the dispenser does not operate easily, or is unreliable, the effect on hand cleanliness can vary dramatically. A dispenser or hand care product that promotes the proper frequency and duration and simplifies handwashing is an added benefit to any food safety program.
During hand washing, hand soaps not only remove soils, but also the natural oils that protect the skin. Variations in the loss of these natural oils are affected by the frequency of handwashing, the temperature of the water and the rinsability of the soap from the surface of the hands. Hand soaps that do not rinse easily are more likely to leave soap and soil residues that can increase the potential for skin irritation. Environmental factors such as atmospheric and climatic changes may also affect skin dryness, which is exacerbated by the presence of soap residues on the skin. For instance, during winter months or in areas with low humidity, the skin loses moisture, causing dryness and cracking which can ultimately lead to skin irritation and dermatitis. Additionally, individuals differ in their skin’s sensitivity to various chemicals. In order to address all these issues, hand care products should be fortified with ingredients that replenish the natural skin protectants necessary to retain acceptable moisture levels and decrease irritation potential.8
A successful hand care program, which is designed as part of a food safety initiative, should include reinforced training that promotes handwashing. Products must be formulated to meet the current regulations and have the necessary antimicrobial efficacy. Other important characteristics affecting the success of a hand care program are the product’s cleaning effectiveness, mildness and rinsability, as well as the selection and location of appropriate dispensing systems and handwash sinks. Each of these factors contributes to user satisfaction, which can improve hand washing compliance and food safety by helping to minimize cross contamination.
Anna Starobin is the microbiology program leader at Ecolab’s Kay Division in Greensboro, N.C. Reach her at firstname.lastname@example.org. Additional contributors to the article are Joe Thekkekandam, Ph.D., Ecolab Kay Division, and Jennifer Mayhall, Ecolab Kay Division.