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Paper Towel Choices

Why poor hand washers need better paper

Single-use paper toweling is a critical component in professional handwashing, whether in restaurants, schools, the workplace or hospitals and nursing homes. The choice of drying method and materials is first driven by user habits and the risks resulting from potential failures in the hand cleansing process. Hand hygiene breakdowns are measured by some in illness outbreaks and by others in absenteeism rates.

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Chef Specs Technology To Motivate Handwashing

First to Earn Handwashing For Life's 5 Star Hand Hygiene Award

The Atrio Restaurant's Chef Peter Fulgenzi had assessed his operation's risk if they were to experience a breakdown in their handwashing system. He set safe levels on both handwashing quality and frequency. His 12 handsink stations were optimized and he completed rigorous staff training along with a tightening of hiring policies. One gap persisted in his HandsOn process control system. Handwashing compliance monitoring remained compromised by observation only. 

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Hand Hygiene Survey - Recommendations

Executive Summary:

The 12 questions, delivered in three short survey segments, were designed to raise awareness of some unaddressed sub-issues remaining from the 2012 Conference For Food Protection's Hand Hygiene Committee, charged with identifying alternate handwashing protocols.  This qualitative study was independent of the CFP process but conducted in a timeframe to capture and maintain the momentum from the May, 2012 Indianapolis session and serve as a bridge to the 2014 Committee which will be formed later this month.

Respondents were all attendees of the 2012 CFP meeting and included industry, regulatory and academia. 

The overarching goal of this study is to seek the 2014 CFP Hand Hygiene Committee's consideration of each recommendation. No direct response is anticipated. The final committee report will be presented at the 2014 session.

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A Petting Zoo and State Fair Alert

Hey kids "Stop making my animals sick!"

SaniTwice® is a welcomed intervention at the University of Minnesota's National Center for Food Protection. So many times there is no convenient access to running water to facilitate good handwashing at petting zoos and state fairs. SaniTwice is a protocol that fills that void with effectiveness and convenience.

See what John Hoffman, Senior Research Fellow, has to say in the interest of overall safety for the kids and the animals.

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Pathogens on the Prowl

Clean-as-you-go is the answer to TouchReady® Surfaces

Daily destruction of potential germ harbors has been the general protocol when attacking a restaurant's high-touch surfaces. Scheduled cleaning is an important component but deep cleaning once a shift or day allows bacteria and virus to flourish up to 24 hours. Considering the low infectious dose of norovirus and salmonella's ability to double every 20 minutes, gaps in the cleaning cycle quickly accelerate the risks.

Between the power of existing bacteria to form biofilms and the ability of virulent viruses to vacation in neglected areas for days or weeks, key surfaces require frequent attention. Bacteria and virus harbors are replenished with every new customer and every wave of service.

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Result Summary: Hand Hygiene Pre-Committee Survey #2

An independent gathering of perspectives for consideration by the 2014 CFP Hand Hygiene Committee ...

The 2014 CFP Committee charge and composition will not be finalized until the CFP Board meets in August. The intent of this independent survey is to make use of the three months where no official committee exists.

Two rounds are down.The final 4 questions will be sent in mid July. Participant suggested questions are welcomed through July 6th.

Qualitative interpretations for Survey 2 ...

  1. Solid agreement. This question came from a survey participant with considerable regulatory experience. He felt that without the FDA's signing on to a log 2 pathogen reduction as a standard, the committee could still move forward by considering it "supportive qualitative guidance."
  2. Without some agreed reference point, finding alternatives would not be feasible.
  3. Participants appear unwilling to restrict the committee charge to soap and water variables, even though evidence suggests a strong regulatory bias.
  4. Convenience plays an important role in compliance. Solutions which take the worker away from the work station are of little interest to many. Some respondents, 28.3 %, likely feel that inconvenience can be overcome with manpower and/or training adjustments.
  5. Responses are fairly clear cut. In the context of hand hygiene, removal of pathogens is equal to killing them.
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Result Summary for Survey: Hand Hygiene Pre-Committee

Hand Hygiene Pre-Committee

A special thanks to the 81 who responded. Please review round one results below.

We have 8 remaining questions available to help the CFP Hand Hygiene Committee before its re-formation in August. Round two will be sent out in early June. Please send your candidate questions.

There is a definite response pattern making these results generally easy to interpret.

Question 4 required attendance at a particular session, resulting in a high count for the "neutral" option.  Read more about Result Summary for Survey: Hand Hygiene Pre-Committee

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Handsinks & Cantaloupes: Bringing The Farm To The Fork

If anyone ever questioned why the Handwashing Only directive is important for specified kitchen handsinks, consider this "poster child" example.

This restaurant is blessed with a handsink perfectly located at the entrance to the prep area. Wait staff pass by it to pick up nearly every order and bussers file by on their trips to the dish machine. But it's a deep sink, perfect for scrubbing the cantaloupes which are heavily used as garnishes from breakfast through dinner in a neighborhood with a full complement of senior citizens.

 Bringing The Farm To The Fork

Two health department reminder posters are not enough to keep staff from cleaning those cantaloups in a task-perfect sink, blocking the would-be frequent handwashers.

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Air Dryers Fail Critical Hand Hygiene Tests

Hand drying is a misnomer. The friction added by using a paper towel is a significant part of the "handwash". Using air dryers of any type, can leave a high level of suspended contaminants in place. The shorter the scrub step, the more important it is to use paper towels. This is especially true in restrooms where the Splash 'n Dash is the standard and residues are naturally nasty.

New research documents multiple shortcomings

Research from the University of Westminster in London England gives yet another reason to stay away from air dryers in kitchens and restrooms. They are well known for being slow and even the new air blade technology does not offer the friction factor needed in this final cleansing step. Users strongly prefer paper towels and the mere presence of air dryers may discourage handwashing all together.

Now comes this news showing pathogen breeding and having bacteria blown around the room, deposited on surfaces up to 6 feet away. This is especially troubling as we learn more about the lengthy survival times of the highly infectous norovirus on restroom surfaces, documented in Emory University research here or below.

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Day One Handwashing: Motivating New Employee Behaviors

At a food safety meeting in Las Vegas a few years ago, Frank Yiannis, Wal-Mart's VP of Food Safety, recounted his 19 year stint with Disney, asking the audience "What do you remember most in your career path?"

His answer? Day one of the new job, that immersion into the new culture.

Handwashing For Life's Day One Handwashing program leverages this reality. Entering the kitchen for the first time provides a unique opportunity to install handwashing as a job-critical priority. It is potentially a behavior-changing moment where the new employee is anxious to understand expectations and please the new boss. The Day One training personalizes and visualizes both the problem and solution.

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Seven Savers for Earth Day

Wash your hands. That’s our simple summary to celebrate Earth Day.

Poor hand hygiene is likely the single largest contributing factor to diarrhea in North America. If we want to talk about waste, let's start with diarrhea's dire damper on productivity and resource losses starting with water and toilet paper. One missed handwash can ignite a chain of illness throughout the workplace, schools, guests, patients and family.

We do know that norovirus is by far the dominant pathogen causing foodborne outbreaks, like those endured by cruise ships, schools and nursing homes. Its primary path of destruction is confirmed by the CDC to be fecal-hand-oral. We are feasting on invisible germs, in this case, virus, picked up from others via casual contact with an ill person. This contact may be via food prepared by an ill worker. The source is often a person who shows no symptoms or from a surface which shows no symptoms - it's clean to the FDA accepted standard of "clean to sight and touch". Norovirus can live for days or even weeks and remains invisible and free of odor for the whole time. (See Dr. Christine Moe's work at Emory University.)

Here are our Earth Day recommendations focused on our daily lives away from home: Read more about Seven Savers for Earth Day

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No-Water Hand Cleansing Grows

SaniTwice® out-performs soap & water handwash ... again

These three recent quotes from an operator, an industry leading food safety auditor and a passionate advocate serve as a SaniTwice update following presentations at recent meetings:

"As foodservice moves closer to the action and further from the kitchen, SaniTwice is the answer." Food & Beverage Manager

"Regulators must change their paradigm that water is available if there is a plumbing fixture somewhere in the building." Food safety auditor and former state health department executive.

"Log two pathogen reduction is easily achieved in many different combinations of chemical action, pyhsical action (friction), time and temperature." Jim Mann, Chemist & Executive Director, Handwashing For Life.

SaniTwice is now being used or considered for use at catered events, outdoor events, petting zoos, schools (during water outages), gourmet food trucks, airlines, bars, first responder situations in healthcare, cruise lines and airlines.

SaniTwice is the hand cleansing protocol for use where water is not readily available or in too small a quantity to yield a good handwash, log 2 pathogen reduction. Two rounds of research at BioScience Laboratories in 2008/9 demonstrated positive results in light to moderate soil situations (beef broth).

Three Times a Charm

A third evaluation was conducted following discussions with regulatory representatives. Their advice was to check performance on heavy soil (ground beef), providing an even greater margin of safety for this new intervention. This has now been completed and the results are reported in the following bar graphs.

This research study is yet another in a growing body of scientific evidence supporting the efficacy of the Sani-Twice approach which has been submitted for journal publication. Field tests started in the desert of the Mid-East, solving a military foodservice issue, and were followed by a successful two-year study in another desert, Las Vegas, under the guidance of the Southern Nevada Health District (SNHD).

SaniTwice solved another issue for local schools in Las Vegas by providing an alternative hand cleansing method for use during water outages.

62 percent alcohol

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Respect for the Qu’ran in Foodservice Hand Hygiene Training

Ethnic considerations along with language proficiency must be factored into foodservice hand hygiene training programs. All food handling staff must be aware that “Failure in hand hygiene systems is the number one contributing factor in foodservice outbreaks.” according to Jim Mann, executive director of the Handwashing For Life Institute. Dr. D. Pettit of the World Health Organization (WHO) reflects a supporting view in his healthcare work where he considers hand hygiene as the most effective tool in preventing cross-contamination and lowering HAI, hospital acquired infections.

Within the foodservice industry, public health officials, lead by the Centers for Disease Control and Prevention, agree that regular handwashing is the most effective defense against the spread of foodborne illness.  It is the responsibility of foodservice management to offer effective hand hygiene facilities complete with best practice protocols, products and training in order to keep their customers and workforce safe

Handwashing training involves not only education, but also behavior modification and constant reinforcement.  Training is challenging even with a receptive group of trainees, however, adding the extra obstacle of differing cultural and religious attitudes into the mix, makes influencing attitudes and changing behaviors an even tougher task.

According to a 2008 study conducted by the WHO, hand hygiene is strongly influenced by religious faith and potentially affects compliance.  Although this and other published studies focused on healthcare settings, one can assume that religion and culture influences hand hygiene in the foodservice sector in a similar fashion.   With a growing influx of immigrants from India, Pakistan and the Middle East, Muslim religious and cultural traditions must be taken into consideration when formulating best practices in hand hygiene within the foodservice industry.

Islam places great emphasis on physical and spiritual cleanliness.  The Qu’ran offers specific instruction on when and how hand cleansing should occur.  These include before prayer (5 times a day), before and after meals, after using the toilet, after touching a dog, shoes or cadaver, and after handling anything soiled.  Compared to most other religions, these rules are quite specific and stringent.  More importantly, these rules are followed by the majority of Muslims, not just those who consider themselves ardent followers or overtly religious. One reason for such compliance is that hand hygiene patterns are usually established within the first 10 years of life and become ingrained behavior.  With such specific instructions from the Qu’ran and a high rate of compliance, one would assume hand cleanliness among Muslim workers within the healthcare and foodservice setting would not be an issue.  However, although Islam teaches its followers that cleanliness is vitally important, other Muslim practices may increase the risk of cross contamination and illness transmission.

A common popular belief in the Muslim (and Hindu, Jewish and African) culture is that the left hand is considered unclean as it is used for hygienic cleaning, while the right hand is used for eating. Although toilet paper is widely accepted and used, culture dictates that Muslims should clean their private parts after bathroom use with their bare left hand.  This practice is obviously problematic, as even vigorous post-bathroom hand washing often doesn’t remove all potentially illness-causing pathogens.  Additionally, many Muslims don’t like to use utensils to eat and prefer to use their bare hands.  Again, although the Qu’ran instructs individuals to wash before and after eating, it is almost impossible to wash away all risk.  Perhaps the greatest obstacle foodservice and healthcare management may face when trying to ensure compliance with hand hygiene standards within the Muslim workforce, is their reluctance, and often refusal, to use the gold standard in convenient hand disinfection - alcohol based hand sanitizers.

Alcohol hand sanitizers are considered an adjunct to handwashing and are increasingly used in both foodservice and healthcare to maintain hand cleanliness standards between wash cycles. Using hand sanitizer without a preceding handwash, preferably with a nailbrush, is totally unacceptable after defecation or any use of the restroom.

Although the Qu’ran specifically forbids the use of alcohol, it permits the use of any manmade substance to reduce illness or contribute to improved health, including alcohol used for disinfection.  In fact, the Muslim Judicial Council of South Africa has issued written permission regarding the use of alcohol not produced as a result of fermentation for the specific purpose of disinfecting the hands.  In addition, due various health concerns during Hajj (religious pilgrimages to Mecca and Medina), in 2002 the World Muslim League in Mecca issued a fatwa allowing the use of alcohol based hand sanitizers. During this year’s Hajj, Saudi Deputy Health Minister Dr. Ziad Memish reiterated that Saudi senior religious leaders deem alcohol-based sanitizers acceptable. Despite these fatwas and their documented approval of alcohol based hand sanitizers, many Muslims still adhere to their conservative beliefs that all alcohol is unacceptable.  Not only is the smell of alcohol on the skin disturbing, some fear that the alcohol in the sanitizers may be inhaled or absorbed into the skin causing intoxication.

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HandsOn<sup>™</sup> System

5 steps to convert underwashing to under control. Set and track your risk-based ServeReady® Hands and TouchReady® Surface standards.

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SaniTwice<sup>®</sup> for Catered Events

Uncompromized hand cleanliness for those serving food at venues without running water.

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