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To Their Health: Hand Sanitation Tips and Techniques to Protect Your Guests

Forensic sanitarian Robert W. Powitz says, "I can still go into some commercial and institutional kitchens and find the handwashing sink as dry as dust or filled with soiled utensils, wipe rags, and in more than one case, a box of gloves (I guess that's a sign of good intentions). Even if the handwashing sink had all the necessary amenities, I remain unconvinced of its use when I see a cracked bar of soap and paper towels yellowed with age."

"During my career as a sanitarian," Powitz says, "I've participated in more than a few foodborne illness investigations. I can honestly state that in the majority of those outbreaks, handwashing, or the lack thereof, was the major factor of disease transmission."

"Ideally," he says, "proper handwashing should be habitual. Not to disparage the many companies that make up the handwashing industry, but I am not alone in saying that most of us have tried posters, stickers, cute buttons, automatically timed faucets and sensors, handwashing and hand sanitizing compounds of varying composition, colors and flavors, all in an effort to change behavioral patterns."

The Centers for Disease Control and Prevention has reported that handwashing is the most important method of preventing the spread of pathogens that cause foodborne illness. The importance of proper hand sanitation cannot be overemphasized, particularly in a world increasingly fearful of communicable disease.

"We have even resorted to giving incentives and rewards, as well as dishing out minced oaths and veiled threats when we've noticed a breach in personal hygiene. I must admit, all of these things work for a while."

"However, when enthusiasm wanes," Powitz says, "the watchful eye slackens: When the posters, stickers, incentives and good-smelling soaps become commonplace, it is most often back to the old ways. While I don't have the answer to this vexing problem, I can report on some of the successes I've seen over the years and pass them on to you as helpful suggestions."

"Make handwashing part of the kitchen operation. All too often, handwashing is treated as a separate issue and not part of food preparation. Traditionally, inspections focused on walls, floors and ceilings, with the handwashing sink, not handwashing itself, as an inspection report item. Old habits are hard to break. The establishment inspected should always ensure soap, paper towels and a covered container is sitting on and next to the sink at all times to avoid a demerit score," Powitz says.

Every kitchen must have at least one handwashing sink. Integrating the handwashing sink into the work pattern of the kitchen, rather than location of "expedient best fit" is the only way to ensure its use. But if the new handwashing sink is inaccessible, it is never used.

"Try putting the hand sink next to the time clock with a simple pipe railing directing the path of travel from punching-in to washing hands and on the same path of travel upon returning from the restrooms," Powitz says. "It's simple and effective: No one can enter the kitchen without washing their hands, including vendors and maintenance personnel. We cluster cooking equipment, so why not cluster preparation and handwashing equipment?"

High-and Low-Tech Ways to Build Handwashing Skills

"In teaching the art of handwashing, remember, this skill does not come naturally," Powitz says. "With any skill, we do not become proficient by listening to a talking head or by reading a poster. We learn by doing, by demonstration, by repetition, by precept and example. Therefore, the best teaching tools are those that involve actual handwashing and some way to see the results." Powitz says he uses two methods: one high-tech, one low-tech, but both with some visual marker as a surrogate for germs:

The high-tech method: Use a kit consisting of an inexpensive ultraviolet (UV) lamp, and an oil or powder containing a fluorescing compound, which is easily seen under UV light. To demonstrate proper handwashing techniques, the oil-containing tiny plastic fluorescent beads is applied to the hands the same way one would apply hand lotion.

After normal handwashing, the hands are inspected with the UV lamp to detect any oil that was not washed off. This demonstrates graphically the quality of one's handwashing technique, without going into any long discussion on details. If the hands glow under UV light, they're not clean period.

The only problem with this system is that the UV light may not be strong enough to effectively show residual oil when viewed in a properly lighted kitchen. To overcome this problem, use either a double-tube UV inspection lamp or simply fashion a shadow box- from a shipping carton by folding in both end flaps.

"It takes several days of consistent use to change behavior. However, if the lesson is well-learned, it's worth the effort. The fluorescing powder also can be used to see exactly 'how clean is clean,'" Powitz says.

The low-tech approach.Mix a colored spice such as cinnamon, sweet paprika or curry powder in cool cooking oil and use it in the same way as described earlier. If the hands are not properly washed, the colored spice will show up nicely around and under the nails and between the fingers. The odor from the more aromatic spices such as cinnamon and curry will linger on the hands if not completely removed. Any colored powder will work equally well. If an odor tracer is preferred, add a few drops of any essential oil, such as peppermint or spearmint.

Reinforce Good Habits

The goal is to get food handlers to habitually wash their hands before starting work and frequently during work. A timed bell (ringing at half- or one-hour intervals) to alert staff to vis- it the lavatory works well if the practice is consistent. However, if you want staff to frequently wash their hands voluntarily, consider a reward system; punishment rarely has a desired outcome. We all respond to praise and favors. Adherence to safe practices in industry is aided by use of incentives. Try it with handwashing; the results may surprise you," Powitz says.

To make a team successful, the members must also understand the full ramifications of what can happen when the restaurant is hit with a foodborne illness: loss of not only their job, but the downfall of the restaurant and many thousands of dollars in damages, if the handwashing rules are not followed. In teaching team members, fatigue is a condition that prevents learning: Take advantage of downtime to give short pieces of training or to review topics. Include participation and role-playing. While "show and tell" is good, people learn by doing. By gathering together your best people to help form a competent team, you are one step closer to serving safe foods to your customers, Powitz says.

Gloves Versus No Gloves

Effective hand sanitation techniques are critical. Gloves should not be used as an excuse for lax hand sanitation techniques.

Gloves often provide a false sense of security to restaurant employees, as if they are magic bullets in the battle against spreading foodborne illness. Perhaps this notion hearkens to television portrayals of operating rooms, where latex gloves are accurately portrayed as standard dress. "If doctors wear them to protect patients, then if we wear them, it will protect our customers," is a common way of thinking. What television rarely shows is that gloves are only one aspect of hand sanitation in the operating room. In real life, surgeons and other operating room staff employ vigorous hand washing before donning gloves. They are obsessive about not touching any surface that will contaminate the gloves. This often escapes restaurant workers and managers.

"Bare hands or gloves, food can be contaminated either way if restaurant employees do not wash regularly and properly handle certain types of meats, poultry and seafood," says Dennis Gemberling, founder and president of Perry Group International, a hotel and restaurant management company. "The only way to ensure that food safety is practiced at all times is with regular training and guidance of each and every food handler and server," Gemberling says. Jim Mann, executive director of Handwashing For Life® Institute, said, "The proper use of tongs and wraps minimize hand contact, bare and gloved. Handling food with clean hands, bare and gloved, is also doing things right. When the status of a dirty glove trumps a clean hand, something is wrong."

"Soiling of hands is a frequent occurrence in foodservice and must be countered with frequent handwashing and glove changing," Mann says. Whoever came up with the term 'no bare hand contact' was likely a person seeking a simple and quick signal for hand cleanliness," he says. While "simple and quick" is a noble goal, it is worth little until a hand hygiene system is in place; one that can monitor bare hand cleanliness and glove changing.

"The spread of this 'no bare hand contact' concept overshadowed the development of hand hygiene systems and process control tools. Now that we have the systems option, it's time to address this gap in food safety. What gets measured gets done. The lack of hand hygiene measurements results in poor handwashing practices and unnecessary risk. It's time to fix that flaw," Mann says. "Avoiding bare hand contact is not the answer."

One Task Only

If used, single-use gloves, as the name implies, shall be used for one task (e.g., for working with ready-to-eat food only or with raw proteins only). They should be discarded at the end of each session, when interruptions occur during that session, or if they become soiled or damaged. In the latter case, that means if the worker touches his body or clothing or punctures a glove. And never, under any circumstances, should back-of-the-house staff use a worn or soiled glove. It is critical to change gloves when changing workstations or taking a break. Hands must be washed before and after using gloves. Pathogens on hands and fingernails will multiply rapidly in the dark, moist conditions.

It Takes All Types

Slash-resistant gloves are used to protect the hands during operations requiring cutting and should be used in direct contact only with food that is subsequently cooked, such as frozen food or a primal cut of meat subsequently cooked. While they offer protection for the worker, they offer limited protection for the customer, if not used appropriately. If the slash-resistant gloves have a smooth, durable, and nonabsorbent outer surface they may be used with ready-to-eat food that will not be subsequently cooked. Cloth gloves may not be used in direct contact with food unless the food is immediately cooked after being handled.

Always glove an injured hand to protect bandages covering cuts and abrasions. Bandages that have found their way into food have given rise to lawsuits from horrified customers. Carefully clean the affected area with soap and water and a disinfectant, then bandage and cover with a properly fitting vinyl glove.

Managers and Owners Need to "Walk the Walk"

The chef and owner customarily have the influence to steer the cultural tone toward the serious side of food safety. If the top tier makes it a priority, so will everyone else on down the chain of service. All managers should be certified through an approved food safety course to learn the basics of food prep, not just the business end. The processes learned should then be translated to the day-to-day operations of every employee.

A number of states require that at least one manager pass an approved food manager certification exam, such as NRAEF's ServSafe program. There are numerous local jurisdictions that require a manager to be certified as well. There are more than 100 county or city authorities that require a certified manager in the establishment. You can learn the requirements in your region at https://www.servsafe.com/ss/regulatory/default.aspx.

Always keep in mind that your goal is to raise the awareness of your entire staff about the serious consequences on your foodservice operation of not washing hands properly. Being certified is an important step.

ADDITIONAL RESOURCES:

Here's a good video from the Food Standards Agency in the United Kingdom that shows why handwashing is critical in the restaurant and how to do it properly:

Food safety coaching (Part 1): Handwashing

Use a Nail Brush

Fecal-hand-oral transmission is the most frequent pathway for the No. 1 cause of foodborne illness: norovirus. A common place for this virus is in the nail area, which is frequently missed during handwashing. In this vein, nail brushing is perhaps one of the most important, yet overlooked, steps in maintaining hand sanitation. People who wash their hands without a brush tend to wash their hands from side to side, like clapping their hands together. Put a brush in your hands and you no longer do it that way. Instead, you automatically want to scrub your nails. One study showed that where bacteria grow under the nails and alongside of the hands, a brush cleans best.

One practice is to tether a nailbrush and store it in a red pail of sanitizer solution. This process meets all the scientific standards except one: psychology. A few would-be users, even visiting health inspectors, are sometimes reluctant to manually fish out the brush from its unknown reservoir of rendered biomass. "An alternate nailbrush execution utilizes a solid-filament fused bristle brush, which can be recycled after each use or can be dropped into the dish machine, according to the Handwashing For Life Institute.