Restaurant Business Magazine Article on Hand hygiene

Hand Hygiene – tough questions answered

Information overload has penetrated almost every aspect of managing in foodservice, and hand hygiene is no exception. Suppliers provide a myriad of options for washing, drying and sanitising, and with each option comes “research” proving that their product is superior to all others.

RB Magazine recently caught up with Larry Jackson of the Handwashingforlife Institute to get an independent perspective on what really works. Here are his answers to some tough questions:

RB: There are a lot of claims being made about product efficacy of hand hygiene products. Can foodservice operators believe all the claims?
LJ: Yes & no, my apologies for the evasive reply. We look for a number of things when assessing a product claim. It’s important to know if the research replicates the real world. This is the biggest issue with most research and can be a problem with the most reputable sources. Good lab research frequently doesn’t hold up in the real world of foodservice. Anti-bacterial soap claims are an example of good research that can be misleading. Most antimicrobial research is based on a product contact time of two minutes. How many of us wash or sanitise our hands for two minutes? The average contact time for soap is 11-15 seconds and for a sanitiser 15-20 seconds. For a foodservice operator what’s important is what gets killed in 20 seconds.

RB: So are you saying that anti-bacterial soaps do not provide the added protection claimed?
LJ: Probably not, let me explain. Regular washing works by physically removing the contaminant, it does not kill the germs. An anti-bac additive will kill germs, but, given the short washing process, the majority of killing is happening down the drain. Once down the drain; who cares? A more important fact is that over 50% of food-borne illness is caused by viruses. Norovirus is the biggest culprit and is often present by the million on contaminated hands. If an anti-bacterial agent only kills 90% or even 99% there could easily be thousands left. That’s more than enough to make you very sick.

RB: But what about claims that anti-bacterial residuals can help prevent recontamination?
LJ: An excellent question. The biggest issue we have with residual claims is that they, in effect, give employees permission NOT to wash, since the employee believes the residual “protects” them. Do you want employees to skip hand hygiene after the toilet, after working with raw meat or after a smoke break? Where do you draw the line? Beyond this behavioural issue, residuals left behind can irritate the skin, are easily overwhelmed by food soil and are ineffective against Norovirus. Our advice is: use them if you wish but you could actually be increasing the risk for an outbreak.

RB: What about the new air-dryers that incorporate anti-bacterial agents? Do you recommend these devices?
LJ: Definitely not! In fact, we strongly advocate that this equipment is removed if present. Even the newest jet-dry anti-bac technology presents unacceptable risk for contamination. It lacks the necessary friction to remove pathogens, the antibacterial filters require careful servicing and drying time remains too long. Adding to these problems is research from the University of Westminster that concludes that air drying actually increases the microbe content on hands by 50 to 200%. Quality single-use paper towels remain the best method for drying hands.

RB: So the message to restaurant managers is to restrict air-dryers to their public restrooms?
LJ: Gosh NO! The message is don’t use them anywhere. Germs deposited in a restroom are quickly spread throughout a facility by the hands of employees and customers. If employees must rely on public washrooms then make certain they wash and sanitise when they re-enter the workplace. The first rule in food safety is to keep faecal germs in the restroom. Faecal-hand-oral is by far the leading cause of cross-contamination.

RB: What about public restrooms in shopping centres, airports, parks, malls & cinemas where maintenance is a big issue?
LJ: The rationale for air-dryers is strongest where maintenance & vandalism are primary concerns. Cost reduction is also a “false” motivator for air-dryers since they promise to eliminate paper. I can understand, but I don’t respect, the decision to choose air-dryers in these situations. However, saving money makes no sense if you defeat the purpose of hand-washing in doing so. Personally I won’t use an air-dryer. In public locations the risk for illness is with the user.

RB: So in these locations you advocate not washing?
LJ: If my option is an air-dryer, I choose to use an alcohol hand sanitiser or a sanitizing wipe and avoid touching any restroom surface. Carrying a hand sanitiser is a good idea, as hand hygiene facilities are often not available. I would like to see restaurants, banks, hotels and airports make sanitisers available for their customers, a dispenser at the entrance would say they care. Local food retailers, like Pick n Pay, are making wipes available for trolley handles. A great idea, particularly if you use them on your own hands as well.

RB: But it is quite obvious that air-dryers provide environmental benefits compared to paper?
LJ: They claim to be better for the environment. I haven’t seen a full life cycle analysis of the comparison. I do know the electricity they use is in short supply and the cost is escalating dramatically. I also know paper in South Africa is made from renewable plantation trees and recycled fibre, that growing trees and making paper creates jobs and that many paper companies generate their own electricity. What is best for the environment? It would be interesting to see a full independent analysis.

RB: You obviously like hand sanitisers. Is sanitising really as good an idea as promoted by suppliers?
LJ: Not just good, it’s great. The right sanitiser, when used on hands that are clean to sight and touch, can be as effective, or more effective, as washing with soap and water. In high-risk locations we advocate that washing with soap and water be followed by sanitising. In foodservice this means on entering the work place, after the use of the restroom and after coming in contact with high risk materials like raw meat, seafood and body fluids. We also recommend when water is not available sanitising is the best alternative.

RB: Fortunately in South Africa potable water is not a problem in most foodservice locations.
LJ: Not always true. Water is not always where you need it when you need it. If a hand-wash station isn’t within 3-4 steps of a work station the employee skips washing. Commercial kitchens are busy places and if washing isn’t easy and isn’t convenient, it isn’t done. A hand sanitiser dispenser can fill the void in this situation. Operators should place a hand sanitiser within 2-3 steps of every work station. When no water at all is available sanitisers are a must. Street vendors, sport stadiums, braais & picnic events are all ideal sanitiser locations. Another option in these locations is a sanitising wipe for wiping hands and surfaces.

RB: With all the different sanitising products available what is the right one for foodservice operators?
LJ: Any sanitiser is better than nothing. Unfortunately, “nothing” is what we see too often. Seriously, here is what we recommend operators look for in a sanitiser:

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Hand Hygiene – tough questions answered Information overload has penetrated almost every aspect of managing in foodservice, and hand hygiene is no exception. Suppliers provide a myriad of options for washing, drying and sanitising, and with each option comes “research” proving that their product is superior to all others. RB Magazine recently caught up with Larry Jackson of the Handwashingforlife Institute to get an independent perspective on what really works. Here are his answers to some tough questions: RB: There are a lot of claims being made about product efficacy of hand hygiene products. Can foodservice operators believe all the claims? LJ: Yes & no, my apologies for the evasive reply. We look for a number of things when assessing a product claim. It’s important to know if the research replicates the real world. This is the biggest issue with most research and can be a problem with the most reputable sources. Good lab research frequently doesn’t hold up in the real world of foodservice. Anti-bacterial soap claims are an example of good research that can be misleading. Most antimicrobial research is based on a product contact time of two minutes. How many of us wash or sanitise our hands for two minutes? The average contact time for soap is 11-15 seconds and for a sanitiser 15-20 seconds. For a foodservice operator what’s important is what gets killed in 20 seconds. RB: So are you saying that anti-bacterial soaps do not provide the added protection claimed? LJ: Probably not, let me explain. Regular washing works by physically removing the contaminant, it does not kill the germs. An anti-bac additive will kill germs, but, given the short washing process, the majority of killing is happening down the drain. Once down the drain; who cares? A more important fact is that over 50% of food-borne illness is caused by viruses. Norovirus is the biggest culprit and is often present by the million on contaminated hands. If an anti-bacterial agent only kills 90% or even 99% there could easily be thousands left. That’s more than enough to make you very sick. RB: But what about claims that anti-bacterial residuals can help prevent recontamination? LJ: An excellent question. The biggest issue we have with residual claims is that they, in effect, give employees permission NOT to wash, since the employee believes the residual “protects” them. Do you want employees to skip hand hygiene after the toilet, after working with raw meat or after a smoke break? Where do you draw the line? Beyond this behavioural issue, residuals left behind can irritate the skin, are easily overwhelmed by food soil and are ineffective against Norovirus. Our advice is: use them if you wish but you could actually be increasing the risk for an outbreak. RB: What about the new air-dryers that incorporate anti-bacterial agents? Do you recommend these devices? LJ: Definitely not! In fact, we strongly advocate that this equipment is removed if present. Even the newest jet-dry anti-bac technology presents unacceptable risk for contamination. It lacks the necessary friction to remove pathogens, the antibacterial filters require careful servicing and drying time remains too long. Adding to these problems is research from the University of Westminster that concludes that air drying actually increases the microbe content on hands by 50 to 200%. Quality single-use paper towels remain the best method for drying hands. RB: So the message to restaurant managers is to restrict air-dryers to their public restrooms? LJ: Gosh NO! The message is don’t use them anywhere. Germs deposited in a restroom are quickly spread throughout a facility by the hands of employees and customers. If employees must rely on public washrooms then make certain they wash and sanitise when they re-enter the workplace. The first rule in food safety is to keep faecal germs in the restroom. Faecal-hand-oral is by far the leading cause of cross-contamination. RB: What about public restrooms in shopping centres, airports, parks, malls & cinemas where maintenance is a big issue? LJ: The rationale for air-dryers is strongest where maintenance & vandalism are primary concerns. Cost reduction is also a “false” motivator for air-dryers since they promise to eliminate paper. I can understand, but I don’t respect, the decision to choose air-dryers in these situations. However, saving money makes no sense if you defeat the purpose of hand-washing in doing so. Personally I won’t use an air-dryer. In public locations the risk for illness is with the user. RB: So in these locations you advocate not washing? LJ: If my option is an air-dryer, I choose to use an alcohol hand sanitiser or a sanitizing wipe and avoid touching any restroom surface. Carrying a hand sanitiser is a good idea, as hand hygiene facilities are often not available. I would like to see restaurants, banks, hotels and airports make sanitisers available for their customers, a dispenser at the entrance would say they care. Local food retailers, like Pick n Pay, are making wipes available for trolley handles. A great idea, particularly if you use them on your own hands as well. RB: But it is quite obvious that air-dryers provide environmental benefits compared to paper? LJ: They claim to be better for the environment. I haven’t seen a full life cycle analysis of the comparison. I do know the electricity they use is in short supply and the cost is escalating dramatically. I also know paper in South Africa is made from renewable plantation trees and recycled fibre, that growing trees and making paper creates jobs and that many paper companies generate their own electricity. What is best for the environment? It would be interesting to see a full independent analysis. RB: You obviously like hand sanitisers. Is sanitising really as good an idea as promoted by suppliers? LJ: Not just good, it’s great. The right sanitiser, when used on hands that are clean to sight and touch, can be as effective, or more effective, as washing with soap and water. In high-risk locations we advocate that washing with soap and water be followed by sanitising. In foodservice this means on entering the work place, after the use of the restroom and after coming in contact with high risk materials like raw meat, seafood and body fluids. We also recommend when water is not available sanitising is the best alternative. RB: Fortunately in South Africa potable water is not a problem in most foodservice locations. LJ: Not always true. Water is not always where you need it when you need it. If a hand-wash station isn’t within 3-4 steps of a work station the employee skips washing. Commercial kitchens are busy places and if washing isn’t easy and isn’t convenient, it isn’t done. A hand sanitiser dispenser can fill the void in this situation. Operators should place a hand sanitiser within 2-3 steps of every work station. When no water at all is available sanitisers are a must. Street vendors, sport stadiums, braais & picnic events are all ideal sanitiser locations. Another option in these locations is a sanitising wipe for wiping hands and surfaces. RB: With all the different sanitising products available what is the right one for foodservice operators? LJ: Any sanitiser is better than nothing. Unfortunately, “nothing” is what we see too often. Seriously, here is what we recommend operators look for in a sanitiser: It must be effective against both bacteria and virus, particularly Norovirus. In combination with a soap and water wash a 62% level of ethyl alcohol works well. If used without washing you really should have 70% alcohol content. Choose a gel- or foam-based product. They perform best. Frequency of use is critical so pick a product your employees like. A product that is used is superior to any product that isn’t used. Choose sealed, non-refillable delivery systems. This eliminates the risk of deterioration, contamination and adulteration. All of which are common problems in foodservice. RB: You only mention alcohol, what about other active sanitising agents? LJ: The jury is out. A variety of actives are being used in sanitising products. Some research looks good, but the contact time protocol is critical. We advocate ethyl or isopropyl alcohol because documented evidence is strong and proves they are quick and effective on most pathogens. The bactericides recognised by the WHO, CDC and FDA are ethyl and isopropyl alcohol. It’s best to be safe when it comes to food safety. RB: In summary, if I have captured your comments accurately, this is your advice: Product efficacy research can be misleading so be careful with your decisions. Antibacterial soaps are no better than regular soap and may actually increase the risk of an outbreak. Air-dryers are not recommended for foodservice. In public rest rooms with air-dryers use a sanitiser or don’t wash. Sanitisers should be placed within 3-4 steps of every work station and at customer entry. LJ: A good summary. The only thing I would add is to make sure every employee is properly trained in hand hygiene. Good training should engage the employee through visualisation and personalisation techniques that improve both knowledge and skills. And, if you own a restaurant, put a sanitiser where customers can use it. It shows you care about their safety.