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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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H1N1/Swine Flu: Handwashing, Hand Cleansing, Hand Sanitizing & …

Keeping clean hands clean with a documented surface cleanliness system.

H1N1 has moved quickly around the world earning the designation of pandemic. Clean hands are once again the primary protection as North America braces for outbreaks in schools and the many away-from-home environments.

An effective defense against H1N1 starts with an assessment of your facility and the people who use it. Everything learned in fighting norovirus applies although keeping ill employees off the premises is considerably easier than keeping ill customers away.

While H1N1 is a respiratory disease, studies and experience have shown that donning masks outside healthcare settings offers little protection against direct airborne transmission.  The Society of Healthcare Epidemiologists, the Infectious Disease Society and the World Health Organization recommend precautions based on transmission by droplet infection rather than airborne infection. In other words, this virus is transmitted more from surfaces and hands than directly via the air. 

Pathogen Pathway

Aside from keeping your distance, which isn’t always viable, what can you do to lower the risk of H1N1 transmission among your employees and customers? 

As the H1N1 virus is contagious beginning 1 day prior to the onset of symptoms, the following precautions are imperative each and everyday, whether or not you see signs of illness:

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Catered Handwashing by The Trickler Method

Event handwashing is often handicapped by the lack of running water. Summer fairs and church events are familar examples. Health departments around the country are contacted regularly by event planners looking to conform to local codes.

Most local codes flow from the FDA's Model Food Code where water, any amount of water, trumps the alternatives. This has evolved to what we now call The Trickler Method where a small amout of water is trickled out of a vessel to wet hands, wash and rinse. It is hard to capture the trickler method in actual use as it rarely is.

If it is used, along with likely poor cleaning comes few uses per container of water and poorly rinsed hands are a major source of dermatitis. Fortunately, operators now have an alternative with documented effectiveness. SaniTwice® is the no-water solution for ServeReady® Hands.

Below are four examples of approved "handsinks" for The Trickler Method, photographed in Illinois.

The Trickler Method

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Champions Crowned at an Alternative March Madness

The Handwashing For Life® Olympics staged in Washington DC

Held in conjunction with the 10th annual Food Safety & Security Summit, this year's venue was visited by two former title holders, both multiple winners. From the left are Michele Samarya-Timm from the Franklin New Jersey Health Department and Kristen Machicek from Pappas Restaurants, better known to some as Pappadeaux Seafood Kitchen and Pappasito’s Cantina. They are joined by Handwashing For Life's Chef/Trainer Dion Lerman.


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Hand Washing Gets Top Billing from CDC

America's top public health official addresses concerns ...

Three Real Threats

By Dr. Julie Gerberding

Today's headlines are packed with threats we never thought much about in earlier days -- dangers involving food, infections and a possible influenza pandemic. How do we keep our concerns in check and at the same time take sensible steps to protect ourselves and our families?

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HandsOn™ System

HandsOn<sup>™</sup> System

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

SaniTwice® for Catered Events

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

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

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