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Outbreaks Where Food Workers Have Been Implicated in the Spread of Foodborne Disease. Part 11. Use of Antiseptics and Sanitizers in Community Settings and Issues of Hand Hygiene Compliance in Health Care and Food Industries

As Originally published by Journal of Food Protection,, April 2010

By: Dr. Ewen Todd, et. al.
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Hand washing with soap is a practice that has long been recognized as a major barrier to the spread of disease in food production, preparation, and service and in health care settings, including hospitals, child care centers, and elder care facilities. Many of these settings present multiple opportunities for spread of pathogens within at-risk populations, and extra vigilance must be applied. Unfortunately, hand hygiene is not always carried out effectively, and both enteric and respiratory diseases are easily spread in these environments. Where water is limited or frequent hand hygiene is required on a daily basis, such as for many patients in hospitals and astronauts in space travel, instant sanitizers or sanitary wipes are thought to be an effective way of preventing contamination and spread of organisms among coworkers and others. Most concerns regarding compliance are associated with the health care field, but the food industry also must be considered. Specific reasons for not washing hands at appropriate times are laziness, time pressure, inadequate facilities and supplies, lack of accountability, and lack of involvement by companies, managers, and workers in supporting proper hand washing. To facilitate improvements in hand hygiene, measurement of compliant and noncompliant actions is necessary before implementing any procedural changes. Training alone is not sufficient for long-lasting improvement. Multiactivity strategies also must include modification of the organization culture to encourage safe hygienic practices, motivation of employees willing to use peer pressure on noncompliant coworkers, a reward and/or penalty system, and an operational design that facilitates regular hand hygiene.

This is the 11th article in a series on food workers, foodborne illness, and worker hygiene. The first six described the types of outbreaks involving workers, how workers contributed to these outbreaks, infective doses, pathogen carriage, sources of contamination, pathogen excretion by infected persons, and transmission and survival of pathogens in food environments (34, 100-104). The next set of four articles considered physical barriers to contamination, glove use, and hand hygiene with different kinds of soaps and sanitizers (105-108). In this article, we examine the promotion of hand hygiene in various settings where there are many opportunities for person-to-person spread of pathogens and discuss the observed lack of compliance with hand hygiene programs in the health care and food industries. The article concludes with different strategies that can be used to encourage hand washing and use of sanitizers among employees.

Food workers have been implicated in outbreaks of foodborne illness, and hands contaminated by human or animal feces are a well-recognized mode of pathogen transfer; sneezes, coughs, infected skin lesions, and vomitus also have transmitted pathogens from workers to food, patrons, and fellow workers. Physical barriers such as food shields, utensils, and appropriate protective clothing have value but are insufficient to completely prevent contamination of food or food contact surfaces by body secretions. Thus, hand hygiene is vital for reducing pathogen spread, and although gloving can reduce the risk of food contamination, it is not a substitute for hand washing. Washing, scrubbing, rinsing, and drying are critical components of the hygiene process that removes soil encountered by workers during their regular duties both at work and at home. Because these operations take time to be effective (15 to 20 s), they are often not carried out properly. A quick rinse with water followed by shaking of hands to dry them can actually loosen any trapped microorganisms on the skin, facilitating transfer during hand contact with individuals or objects such as food contact surfaces. Poor hand washing compliance results from a combination of factors, including a lack of facilities, worker education, training, and motivation by managers. In response to the need for a shorter hand hygiene process, alcohol-based instant sanitizers (hand antiseptics) were developed years ago for use in hospitals and other health care settings. These hand antiseptics are now increasingly being used in other settings such as hotels, schools, child care centers, and other public places. These sanitizers also can increase the effectiveness of food worker hand hygiene programs, provided that hands are first thoroughly washed and free of soil. Improving hand washing compliance, deciding where and how instant hand sanitizers can be used, and improving other important food safety behaviors in food preparation environments requires an effective management plan and continual monitoring that goes beyond occasional training.


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Dr. Ewen Todd is a Food Safety Expert with over 45 years of knowledge and experience in general food safety and Food Microbiology Issues. Specifically, he has extensive experience the reporting and surveillance of Foodborne Disease, as well as development of analytical methods for identifying foodborne pathogens. As a result of his work with the industry and his knowledge of foodborne disease, Dr. Todd has influenced research programs and regulatory approaches taken by the Health Protection Branch of Health Canada. In the US, he held the position of Director of the National Food Safety and Toxicology Center and the Food Safety Policy Center at Michigan State University.

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