Handwashing’s Risks and Rewards

During the 20 years following the watershed outbreak event at Jack In The Box in 1993, the industry learned a lot about hand hygiene, cross-contamination, and a new generation of pathogens.

The newcomer, E. coli 157:H7, got center stage as the country and the world watched this outbreak play out. It awakened the public as well as the industry that a foodborne illness is a lot more serious than a fleeting stomach ache.

Twenty years earlier the Norwalk virus grabbed the headlines for the first time. Since then, with its name shortened to norovirus, it has maintained the headlines by soaring to the top of the list of outbreak causing pathogens. It regularly sends cruise liners back to port, invades nursing homes, and shutters restaurants.

In 2009, the CDC launched NORS, a web-based system to collect foodborne outbreak information and CaliciNet, a network of labs to feed a national database.

The more that is learned the louder the cry for better handwashing, both in quality and frequency.

Norovirus serves well as a focal point in setting handwashing criteria in food service and retail establishments. It is one of the smallest of pathogens and among the leaders in virulence. If the hand hygiene process is effective in removing or killing this microorganism, it will be capable of handling all the other common hand contaminants.

No Standards. No Measurement.

The lack of hand hygiene standards blunts the development and implementation of enhanced hand hygiene tools. What is a clean hand? What is considered an effective handwash? Without definitions like these, product research and development is discouraged.

Obvious advancements like touch-free electronic faucets are slow to be picked up by operators where short-term cost and efficiency are measured factors in their success and handwashing isn’t. The incentive to encourage more handwashing is lacking. Efficiency trumps handwashing.

Some water saving initiatives even collide with best practice handwashing. A faucet flow of 2.2 gallons per minute (gpm) is very effective in accelerating good cleaning and thorough rinsing. Without all the information, some operators install restrictors, some down to 1.0 gpm. Now the time-short worker, frustrated by the low flow, walks away with a minimum of rinsing. It is soap residues that are a major cause of dermatitis. One sure way to minimize handwashing is to have it seen as the reason for dry, cracked skin.

A reliable electronic faucet is the better answer for those seeking water savings. This touch-free option delivers water when you need it and the flow stops while scrubbing, saving nearly a gallon of water for a single 20 second wash.

The lack of numeric standards obscures the patterns predictive of a breakdown in the system. “Is our deli running at a safe or risky level?” The sign on the restroom mirror to remind workers to wash their hands and the certifications for the persons-in-charge do little to alert the management that its handwash process is trending down and about to break. Their first indication may well be the calls from the hospital’s emergency room.

No Process. No Process Control.

In most food service and retail food establishments, process is king. It alone controls the risk, with one exception. There is no process when it comes to handwashing. Attempts are made to train employees why, when, and how to wash their hands. Training is budgeted annually. The trainers are given everything they need but no standards and no method to monitor the process.

A CDC observational study in the Journal of Food Protection found that a food worker would have to wash 8.6 times per hour to be compliant with The Model Food Code. This challenges the FDA and industry as both agree this is likely never to be achieved. Is compliance really that bad or is the Food Code overestimating many risks?