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Norovirus-Focused Handwashing in Restaurants (Part one)

Defining a safe level for handwashing frequency

Norovirus outbreaks commonly raise this question: What is a safe level for handwashing frequency?

If we look to the FDA for answers, the Model Food Code wisely avoids getting over prescriptive, considering all the variables.

The CDC conducted a valuable observational study using the Model Food Code as its benchmark. They concluded 8.6 Handwashes/Employee Hour (HW/EH) were required to be code-compliant, a total of 69 Handwashes per 8 hour shift

This led to other questions: Is the Model Food Code already over-prescriptive or truly risk-based? Would this level of handwashing be in conflict with customer service? In general, a level of 8.6 HW/EH is seen as too much to ask of employees. Regulators generally agree.

More effective use of tongs and wraps can lower the need for handwashing but the basic issue remains. Some situations, like following restroom use, clearly demand a good handwash. A casual touch of the face or hair is a lot less risky yet the Code specifies the same handwash for both. Is that risk-based or inspection based?

A frequency rate target of 8.6 HW/EH discourages reasonable, attainable compliance improvement. It protects the status quo. "Don't let perfect be the enemy of good."

We believe the Food Code in this case should prioritize the risks by establishing categories of High, Moderate and Low. Operators then set up a controllable process based on risk, a process to which they are committed. We will be discussing this at CFP 2014 and will likely propose this change at CFP 2016. Read more about Norovirus-Focused Handwashing in Restaurants (Part one)

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2014 The Year of the … Norovirus?

Last year's fast start on the Norovirus season caused concern from the CDC, FDA and all food safety savvy operators. This year two of the largest cruise liner outbreaks ever sent two ships back to port early with over 900 vomiting passengers. Once again the focus is on guest handwashing and the cleaning of shared surfaces, now recognized as a major guest-to-guest hazard.

Norovirus or Winter Vomiting Disease. Vomitus or Diarrhea. Fecal or Faecal. Contaminated Hands or Surfaces. Foodborne or Person-to-Person. We hear a lot of conflicting distractions. The six simple truths about norovirus are these: Read more about 2014 The Year of the … Norovirus?

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Martha Misses

Martha Stewart, like so many celebrity “demonstration” chefs, likely missed a handwash and paid a price, “spending days in bed.” We hope she is luckier than some where the salmonella retreats to slowly work on a weakened joint and ends up as a later-in-life knee replacement: New York Post Article »

For those demonstration chefs working in environments full of lights but short on running water, try the hand sanitizer based SaniTwice® protocol.

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The 5 Handwashing Hurdles

Twelve years of formal and informal research have provided the Handwashing For Life Institute with a long list of reasons and excuses for low handwashing rates. Operators seldom know their specific frequency rate but generally feel it is well below what they would like.

This long list has been distilled into The 5 Handwashing Hurdles. An explanation of each is available here.

Please take a moment to share your opinion as to which hurdle or hurdles you think are most responsible for lower than desired foodservice handwashing rates.

Take Survey »

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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.
Read more about Result Summary: Hand Hygiene Pre-Committee Survey #2

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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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