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From: Food Quality & Safety magazine, April/May 2005

Hands for Hygiene

by Mark A. DeSorbo

Hand washing: A simple lapse in this important step can unleash the hounds of hygiene hell, which carry rabid bites along with reverberating barks. But whether it's singing happy birthday twice over the sink, using the latest technology or a host of soaps, gets and gloves, the bark and the bite of dirty hands can be tamed.

Remember the scene in a Seinfeld episode when the restaurateur leaves the bathroom without washing his hands?

It all starts with Jerry and his date, Audrey, sitting at a table in a restaurant owned by her father, Poppie. After Jerry is introduced, Poppie takes leave for the kitchen, saying; “Don’t fill up on the bread. I’m making you a very special dinner; very special.”

Jerry excuses himself and goes to the bathroom, and while he’s washing his hands, there’s a flush, and out from a stall comes Poppie. “Ah, Jerry, tonight you’re in for a real treat. I’m personally going to prepare the dinner for you and my Audrey,” says Poppie, as he zips up and leaves without washing his hands.

What ensues later in the episode is, of course, hilarious, but in real life, a simple lapse in hygiene can unleash the hounds of hygiene hell, which carry rabid bites along with reverberating barks.

The Hepatitis A Hound

Consider what happened at a Friendly’s restaurant in Arlington, Mass., in the summer of 2004.

According to town health officials, it was discovered that an employee there had been diagnosed with Hepatitis A - a liver disease that is not life-threatening, but highly contagious and can cause flu-like symptoms, jaundice and, in rare instances, more serious liver complications. The illness can be spread through contaminated food or drink if an infected person does not wash his or her hands after using the restroom.

The Arlington Board of Health hosted a three-day clinic to administer immune globulin shots to the nearly 3,000 people who claimed they had eaten at the now-closed restaurant between June 4 and 15, when they may have been exposed to the disease.

Later that month, lawyers from Marler Clark of Seattle, Wash., and Sabra and Aspden of Somerset, Mass., filed the class-action suit against Friendly’s on behalf of plaintiff Frederick C. Foster, a Boston resident, and many others who had been potentially exposed to the illness and would have to receive vaccines.

According to Marler Clark, Foster said he and others had missed work to get the needed inoculation and should be compensated for lost wages, emotional distress and any other medical-related expenses.

Last February, the Middlesex County Superior Court approved a proposed settlement between the two parties, determining that anyone who had received vaccination because they had either eaten food from Friendly’s between June 4 and 15, or been exposed to individuals infected with Hepatitis A from Friendly’s food, would be entitled to file a claim.

If the terms of the settlement are finalized in June, qualifying individuals will receive a lump sum of $200 from Friendly’s, according to Marler Clark. That’s at least $600,000 in damages if 3,000 people are awarded.

And even though that Friendly’s restaurant is closed, it may still have to pay $45,000 in legal fees on top of the $55,000 it has already paid to the Town of Arlington for running the clinics, which includes a $40,000 reimbursement for supplies, the hiring of nurses and overtime pay, and $15,000 for police details.

While the Seinfeld episode and the incident at Friendly’s are essentially retail sector scenarios, effects from blatant disregards for handwashing and hygiene know no boundaries or prejudice.

At the time of this report, more than 2,000 women in England had been warned that they could have contracted Hepatitis C after being treated by a gynecologist suffering from the virus, while in Tennessee, health officials continue to investigate an outbreak of Hepatitis A stemming from an infected restaurant worker.

Double Trouble

According to www.foodlink.org.uk, a London-based Web site that is managed by several U.K. health agencies, including the Food and Drink Federation, bacteria on fingertips doubles after using the bathroom. Yet up to half of all men and a quarter of women fail to wash their hands after they’ve been to the bathroom.

The site also indicated that 1,000 times as many germs spread from damp hands than dry hands, and if rings are worn, there could be as many germs under it as there are people in Europe. Millions of germs can also hide under watches and bracelets, according to the site.

With hands being the main catalyst for spreading of viruses and pathogens, an indifferent worker and a lack of hygiene infrastructure can wreak havoc on food manufacturing and distribution companies, healthcare settings as well as aseptic environments where pharmaceuticals and medical devices are made.

As was the case at Friendly’s and the unidentified restaurant in Tennessee, forgetting the act of washing ones hands can even put a company out of business.

“It can be very expensive for a company to resolve the legal aftermath of a Hepatitis A outbreak,” says Attorney Steven P. Sabra of Sabra & Aspden (Somerset, Mass.). “There are legal fees, settlement costs and administrative fees for the class action lawsuit that often result. A Hepatitis A outbreak needs to be handled very quickly and responsibly because if it drags on, it will hurt the company’s image and reputation, and that can be the most devastating cost of all.”

Marler-Clark specializes in this type of claim, and it has also filed lawsuits on behalf of the 26 people in Florida - 23 children and three adults – who visited the Ag-Venture Farm Shows of Plant City in February and March. They are suffering from illnesses stemming from E.Coli 0157:H7. Another 42 suspected cases are under investigation. While most received out-patient treatment, five children remain in Orlando hospitals - two in critical condition and three in fair condition.

While the lawsuit is still pending, Florida health officials are investigating as to how this outbreak spread. Most likely, they say, the pathogen was picked up from contact with the manure of infected animals. The owner of the petting zoo indicated that there were hand sanitizers positioned at the entrances and exits of animal exhibits at his fair, and health officials said people can help avoid infections at petting zoos by taking simple steps such as not eating around the animals and washing hands thoroughly after being near them. Ultimately, the responsibility is up to the individual.

Survey Says…

Jennifer Marcone, a spokesperson for CDC, says many foodborne illnesses and viruses, like influenza and Norwalk, are most commonly transmitted by hands, while a University of North Carolina study indicates that nothing works better in killing viruses and pathogens than washing with good old-fashioned soap and water; ¬up to a 90 percent reduction of bacteria.

But the statistics on foodborne illnesses paint a rather obscure of what’s going on in the pathogenic landscape.

“If a person becomes ill with a foodborne illness, they typically have a gastrointestinal illness for a couple of days and never see a doctor or have a culture done, so that’s why we have to estimate the burden of foodborne illness,” Marcone says. “The number of cases is difficult to quantify.”

The CDC says foodborne illness accounts for 76 million illnesses and 5,000 deaths each year, and those figures have been cited in agency documents dating back 10 years or more. The FDA says foodborne illnesses afflict between 6.5 million and 33 million Americans every year, which is also quite a range.

In a collaborative study, however, CDC, FDA and USDA indicated that cases of a particular strain of E. coli infections, one of the most severe foodborne diseases, fell below a national goal set for 2010.

The incidence of E. coli O157:H7 infections decreased 42 percent to 0.9 cases per 100,000 people in 2004 from the 1996-1998 baseline, the report said. The target for 2010 is a limit of one E. coli case per 100,000.

Salmonella illnesses fell 8 percent overall to 14.7 cases per 100,000, but only one of the five most common strains dropped significantly, the report said. The CDC called for further investigation into why some variants tend to contaminate produce during production and harvest. As evidenced by one salmonella strain that was linked to an outbreak from Roma tomatoes last year, the pathogen “is both an animal and a plant problem.”

Campylobacter infections dropped 31 percent to 12.9 cases per 100,000.

“This report is good news for Americans and underscores the importance of investments in food safety. Our efforts are working and we’re making progress in reducing foodborne illnesses,” CDC Director Dr. Julie Gerberding said in a statement. “However, foodborne disease is still a significant cause of illness in the United States and further efforts are needed to sustain and extend these important declines and to improve prevention of foodborne illnesses.”

USDA Secretary Mike Johanns agreed, saying continued reduction in illnesses from E. coli O157:H7 “is a tremendous success story and we are committed to continuing this positive trend in the future.”

“These results demonstrate that through innovative policies and strong and consistent enforcement of inspection laws, we are protecting the public’s health through a safer food supply,” he added.

More Barks and Bites

The decline in foodborne illness is good news, but there’s another twist. At the same time, however, the FDA’s recently released “Report on the Occurrence of Foodborne Illness Factors in Selected Institutional Foodservice, Restaurant and Retail Food Store Facility Types,” reveals widespread risks of Hepatitis A, cholera and other foodborne illnesses.

FDA conducted spot checks at 900 food-service organizations and found that along with outright contamination, three-quarters of full-service restaurant workers either did not wash their hands or didn’t do so adequately. Nearly a third of hospital food service workers fared the same with soap and water.

And speaking of hospitals, computer keyboards in health care facilities can harbor potentially deadly germs for as long as 24 hours.

A study conducted by Northwestern Memorial Hospital in Chicago indicates that keyboards were deliberately contaminated with vancomycin resistant enterococcus (VRE), methicillin-resistant staphylococcus aureus (MRSA) and pseudomonas aeruginosa (PSAE) bacteria. VRE and MRSA survived for at least 24 hours, while PSAE bacteria survived for an hour.

When volunteers repeatedly tapped a key contaminated with MRSA, the bacteria spread to hands 92 percent of the time. The rates were 50 percent for VRE and 18 percent for PSAE.

Doctors and nurses are supposed to wash their hands after treating patients, but it would seem that they now have to wash after plunking on a PC.

Handy Technology

Researchers found that hospital germicides effectively disinfected keyboards when applied for 5 or 10 minutes, but it’s unclear whether the chemicals are safe for computers; manufacturers recommend only mild soap and water.

Aside from soap and water, there are other media to sanitize hands, ranging from alcohol-based gels and foams to hand wipes. There are also several types of technologies that dispense these goods.

When evaluating hand hygiene products, the CDC says administrators or product selection committees should consider the relative efficacy of antiseptic agents against various pathogens and the acceptability of hand hygiene products by personnel.

“Characteristics of a product that can affect acceptance and therefore usage include its smell, consistency, color and the effect of dryness on hands,” the agency says [See sidebar.]

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