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2014 CFP Hand Hygiene Success: Groundwork for 2016

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A recommendation of “No Action” at the CFP (Conference for Food Protection) can be viewed as a strike out and to continue the baseball metaphor, Handwashing For Life went 0 for 7 on the issues submitted in 2014. We thought at least one would be accepted but all were presented as a foundation for 2016. In that context our efforts were well received and rewarded with calls to continue our quest for codifying hand hygiene innovations. Lively discussion demonstrated the need for changes but the system favors the status quo.

Non-voting Council Members, the FDA and CDC, sharply tilt the decision making power. A timely sound-bite can end Council discussion. Who of the regulatory Council Members are willing to vote against the non-voting regulatory Members?

Here is our interpretation of what happened, why and how each sets up for 2016.

The Hand Hygiene Committee was renewed for 2016 but with more specific charges. There was widespread agreement that the 2014 and 2010 committee charges were too broad and resulted in 4 years of “No Progress".

As a side bar to this discussion, John Marcello had some excellent advice for those thinking to chair CFP committees: “Works best if you have no skin in the game.” That eliminates a group of suppliers, heavily invested regulators and Handwashing For Life as that is all we do - identify and advocate best practice innovations in hand and high-touch surface cleanliness.

The 2016 committee will again face the same issues but hopefully those meetings can start where discussions left off at the 2014 CFP in Orlando. This includes these seven:

Issue III - 012. No standard for handwash effectiveness.
Moving the log 2-3 pathogen reduction from the annex to the Code made a whole lot of sense to the operator members as well as academia. But the buzz at regulatory levels suggested that “will never happen”. Apparently there is an unspoken FDA-CDER turf question on this suggestion and perhaps that can be detailed so as not to trip up the 2016 team. CDER, The Center for Drug Evaluation and Research, regulates hand sanitizer label claims as it is now classified as an antiseptic. It does not, however, regulate hand wash effectiveness. And it does not regulate off-label claims or comment on academia’s relevant research.

One regulator on Council III stated that she would never accept research that was sponsored by “someone who would benefit commercially”. If that feeling is widespread it is bad news for our universities and the research laboratories of many in the food safety industry. That attitude is a public health risk.

Issue III - 013. Definitions of hand wash and hand cleanse
… were seen as unnecessary. Both are about removing pathogens and operators have the option to use both but they can be cited for making the wrong choice. A standard in the Model Food Code (issue III-012) would allow operators a range of solutions, focused on outcomes. The trivializing of the issue and the call for “No Action” underscores the point that the Code is not risk-based. It is inspection-based and we believe the need to keep hand hygiene options limited is based at least partially on the FDA’s challenge to train 30,000+ inspectors on the variety of technically effective protocols - wash, cleanse, sanitize and all the combinations of the three.

Hand sanitizers alone have many uses in a foodservice environment. Chic-Fil-A, cruise lines and others use this as an important intervention to keep customer-borne pathogens out of the food flow. We expect many restaurants will follow this lead, with or without regulatory approval. If a server at a distant table without access to handsinks would like to protect herself from a sick patron, the operator could be cited if that server used hand sanitizer rather than running off to the handsink for a 2-3 minute loss of customer service time.

III - 015. Ambient Temperature Handwashing Water
Lower the handwashing minimum water temperature to 68F, eliminating the citations handed out to operators who choose to install hygienic, user-friendly, water-saving electronic faucets.
This one died from over-discussion but was nearly approved. We believe this change will be approved now that Council Members understand that the lower water temperature doesn’t compromise cleaning and that comfort and convenience are the primary drivers of staff compliance.

Late in the discussions, there was a very sensible observation that would serve to clean this language up and avoid the misinterpretations. Let the plumbing code take care of having hot water available as it is a requirement in getting the permit to operate. The Model Food Code could then focus on use-inducing comfort and convenience factors.

III - 016. Hand Cleaning While Drying - The paper towel advantage
This one was moving to a positive closure when the NRA pointed out that it would cause economic hardship to convert to having a paper towel option present at all hand drying stations used by employees. To us, we see little economic hardship in adding the paper towel drying option considering it is strongly favored by users and having only air dryers can be a deterrent to handwashing.

The more we learn about norovirus, the more we realize it is coming in the front door with customers. We feel paper towel availability encourages better and more frequent handwashing, reducing the likelihood of norovirus outbreaks.

III - 017. Hand Cleanse-Sanitize Protocol, No-Wash Glove Changing
Sunday night’s CFP reception won over some new believers. The food line had meat being cut and served by a well-gloved individual who had no realistic place to wash hands between glove changes should a change be required.

SaniTwice’s cleanse-sanitize sequence is obviously effective and increases public health at fairs, petting zoos, schools, trade shows and many situations in the hospitality, healthcare and the military. This is clearly better than using just hand sanitizer yet enough regulators still over-value the presence of an inconvenient vessel of water, delivering a trickle rather than that specified in the Code - a 2.0 gallon per minute flow.

We sense that the FDA doesn’t want to see alcohol hand sanitizers in restaurants as it complicates their observational audits. We wish they would provide a counterpoint to this assertion so we could objectively seek a ® Corporation's Signol product).">win-win solution. Nothing will match handwashing as long as we don’t define its minimum effectiveness within the Model Food Code. This will again be tackled by the 2016 Hand Hygiene Committee.

We hope the CFP Executive Committee provides that group with a specific waterless hand cleansing charge and instructions to complete this first rather than throwing in all-things hand hygiene that allows the Chair to devote prime meeting time to less contentious committee charges.

III - 020. Double Barrier Glove Changing
This too came close to passing thanks to this video  that made the use very clear.
Again, over-discussion soon led to a comment from regulatory that went something like this: “Here we are trying to avoid a hand wash when everyone knows the real problem is not enough handwashing.” Well, that was enough to kill it and be voted another “No Action”.

I - 033. Expansion of Scheduled Inspections
This was a particularly fun one with many ramifications, particularly for new attendees. It was a classic short course where everyone in the Council got along but then came the State Delegates with their opportunity to register a less-informed but powerful voice.

The vast majority at the Council level were in favor and two regulators carried this on to approval. Later that night in a closed-door session, Delegates gathered and reviewed the issues on which they would be voting. Expansion of Scheduled Inspections was targeted over a concern that those operators who struggle to keep their permit, the frequent offenders, would ban together and demand only Scheduled Inspections, eliminating the ability to integrate with unscheduled visits. Would the CFP process be better served if the Tuesday Night Extractors, the potentially low-information voters, had a chance to learn more, perhaps from the issue submitters?

Sure enough, the Washington DC Delegate took the floor and extracted the recommendation to expand. He claimed that the word “encourage” was too strong. He offered no acceptable language as an alternative. Another regulator piled on saying that no acceptable language was provided. He, a lawyer, then gave suggested language at a time not fitting the Robert’s Rules flow. Jim Mann, defending the issue, then asked him to repeat his acceptable wording as it was acceptable to him as well. That got a laugh but a “No Action” vote. The DC dissenter also said this was a state matter and didn’t require the “feds” looking over their shoulder.

Next time … a carefully word-smithed issue should be presented where the expansion of Scheduled Inspections is clearly offered to only those worthy via a track record of consistent successful audits and advocated only as an option while retaining the ability to designate unscheduled Inspections at any time for any reason.

Overview: The CFP process is good especially for the multi-unit, multi-State operators seeking consistency and workable standards. States and local jurisdictions are best at applying the standards as they are closer to real situations and better understand the options for best practice operators. Less is more when it comes to Code language. When the Code is over-prescriptive, local interpretations still thrive.  The more words the more open to derailment, especially when legal interpretations intersect. Concerns over legal interpretations divides the Code in two: The Written and the Unwritten.

We need to find ways for the innovative restauranteurs and field inspectors to have more say in the action, to support innovation and not restrict potential advances by having the needs of the frequent-offender limit the progress of industry and regulatory leaders.

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