Guidelines for Hand Hygiene Process Control

Hand hygiene through the legal prism provides the clearest and most measurable view of risk. Technology increasingly ties the ill patron to the restaurant. More people looking for foodborne outbreaks and better diagnostics at hospital ERs quickly make the connections. The legal principle of strict liability kicks in, and the operator is paying out almost every time. Owners then hope to avoid the negligence factor, a multiplier of damages.

Team Risk Assessment

Process control of any type requires a multidisciplinary approach. This is especially important for enhancing hand hygiene standards. Quality assurance commonly raises internal awareness of issues and often identifies solutions.

The flywheel of conventional thinking takes over and traditional barriers are shored up and defended. Here is where the passion and commitment of the team leader are put to the test. If operations, finance, risk management, and training join in, the solution will be free to grow and be implemented on a timely basis, delivering years of continuous improvement.

A hand hygiene process control enhancement project must be built with the same rigor of a new menu item or staff uniform change. It amounts to a mini-business plan listing objectives, required resources, payback, a timetable that includes clear and agreed milestones, and feedback systems.

Before the first meeting, the project champion is well advised to informally recruit key believers after gaining support from his or her boss. Try to keep the group small—never more than seven people. When working in groups with more than seven members, the long silence between contributions in group work sparks distractions, according to corporate effectiveness experts at Synecticsworld, based in Cambridge, Mass. Each member of this cross-functional team should clearly understand his or her role and be aware that this is a temporary coalition.

Safe Level Standards

The first meeting of the hand hygiene risk reduction team should attempt to gain consensus and verbalize the company’s need and its own internal vocabulary of risks: What is the situation now and what would we like it to be? An initial estimated timetable for the path forward is helpful at this stage.

Employee effectiveness in handwashing is a good place to start. Here a standard can be set using a simple tracer method called ProGrade, which uses a lotion sensitive to long-wave ultraviolet light (skin-safe range), sometimes referred to as black light. (ProGrade is an acronym for Proficiency Grading.)

The tracer is rubbed in like a hand lotion, ensuring full coverage. When it is washed off, hands are placed under UV light, where any missed areas emit a blue glow. This information is scored and placed in the employee’s file—usually after a few trips back to the hand sink, as the employee learns more about his or her own skin condition and the importance of a thorough hand wash.

This method highlights the need to wash for 15 seconds as the Model Food Code suggests and demonstrates why specified nail length must be maintained. It also provides a foundation to objectively implement the jewelry policy.

Our hand hygiene team now meets around a convenient hand sink with a minimum flow of 2 gallons per minute, common to professional kitchens (plumbing code). Everyone tries the method, usually multiple times, and completes rounds of self-scoring. One point is taken for spots missed and five points for a skipped area. A preliminary standard is then agreed upon. The team now has its first handwashing standard.

Day One ServeReady Training Log

To establish handwashing as a mission-critical qualification for employment, it is helpful to conduct the ProGrade protocol on day one and keep a log. This can be shared with auditors and health department inspectors to show that everyone on the floor has had at least minimal handwashing training. Records can be entered into personnel files to further establish hand hygiene as an operational priority.

Establishing Handwashing Frequency

Restaurants are wary about setting frequency minimums until they realize it is the best way to motivate shift managers and their teams. This realization is seeded during another meeting of the hand hygiene team, at which there is commonly a general concession that whatever isn’t measured is done last, if at all.