Handwashing for Life

Overcoming Underwashing

Tracking Norovirus in Foodservice

The trail of invisible hand-prints supports touch-free and demands higher surface cleanliness standards.

tracking norovirus in foodservice

Cleanliness standards are a critical element considered in designing and selecting equipment for both kitchen and customer space. However, these standards are dominated by noble words rather than science-based facts. Easy to clean is one common standard and the second is Clean to sight and touch. These verbal descriptors seemingly served us well in a world of stainless steel, smooth, easy-to-clean designs and easier to control bacteria.

Unfortunately, the more we learn about foodborne outbreaks caused by virus, particularly norovirus, we are discovering our clean surfaces need closer scrutiny and higher standards. The infectious dose for norovirus may be ten times lower than its bacterial partners in crime. Does that mean removal of soil must be ten times more thorough? What it means for sure is operators need a standard well beyond sight and touch.

Where Hands Go…Go Noro.

Tracking hands around a food facility, both staff and customers, defines the trail of potential norovirus cross-contamination. This is something that was confirmed if not originally defined by the CDC (Centers for Disease Control) in their studies of cruise ship outbreaks.

Norovirus is second only to the common cold in prevalence and outstrips all other foodborne outbreak pathogen sources by ten to one (Mead, et al,1999). It commonly originates in the restroom, either at home or away from home, and starts its journey to food contact surfaces, one touch at a time. There it can live days or possibly weeks, resisting cleaning and attempts at sanitizing (Iskbaeva, et al, 2005), waiting patiently for an exchange to someone via a touch or a transfer to ready-to-eat food.

HACCP theory helps build an effective norovirus defense by asking operators to first prioritize risks, create a risk-based system to manage them and finally a success-based budget to implement. Each site, equiped with proper standards, measurement, documentation and feedback systems, can sustain safe levels of hand hygiene.

Documented handwashing is the primary intervention for norovirus. Norovirus-specific* alcohol hand sanitizers also have an important role, particularly in keeping customers’ hands clean, minimizing norovirus entry into service areas and employee-shared restrooms.

*note: Not all alcohol based hand sanitizers have proven efficacy against Norovirus. See recent research here: Drs. Christine Moe (Emory) and Lee-Ann Jaykus (North Carolina State).

The Dirty Dozen

HACCP teaches us the value in ranking risks. Assessing surface risks starts with a visual inspection of the surfaces and a visual surveillance of staff hand hygiene practices (hands are surfaces too).

We suggest isolating the multitude of risky surfaces to 12, the dozen most likely to be touched and transfer pathogens to ready-to-eat food either directly or indirectly. Cleaning methods must be put under the microscope (now without the microscope) and without the delays of laboratory tests. A rapid detection method called ATP bioluminescence can now give the operator cleanliness data in seconds.

ATP bioluminescence is a rapid measurement technology that can provide real-time information to help reduce the risk of cross-contamination from hands and other surfaces which have not been cleaned to a sufficient standard. Chefs can start their shift knowing relevant surfaces are TouchReady

The ATP molecule, adenosine triphosphate, is the fuel that drives light production in fireflies. The molecule is essential for life and is found in all living cells, including bacteria and the organic matter associated with norovirus (fecal matter and vomitus). In addition, it is highly stable on environmental surfaces.

Surface cleanliness is simply measured by swabbing the surface and inserting the swab into a hand-held luminometer (pictured below.) RLUs, relative light units, are registered and displayed in 25 seconds (based on 3M Clean-Trace luminometer and swabs.) If the result is higher than a pre-determined threshold then re-cleaning and re-testing can be conducted immediately to ensure minimum hygiene levels are maintained.

We can define the TouchReady Surface, train methods to achieve it, and monitor as part of routine QA and auditing systems:

Are your …

  1. Safe level controls working?
  2. Cleaning protocols effective?
  3. Cleaning frequencies right?
  4. Staff training tools effective and efficient?

Cleaner surfaces. Cleaner hands. Safer food.

Setting standards, monitoring and reporting cleanliness factors are critical for one very simple reason: What gets measured gets done!

The best starting point to take advantage of an ATP program is at the kitchen design phase when specifying equipment and cleaning processes. Adding the ATP advantage to an existing facility depends on the size of the operation, menu, and labor force risks. The owner/manager’s tolerance for the potentially business-closing risk is another important criteria to weigh in determining if enhanced surface surveillance meets ROI priorities.

For clean-as-you-go operations, ATP bioluminescence proves to be an outstanding on-the-job training tool. When the worker can connect their behavior with the readings of say a cutting board, you achieve an instant platform for changing behavior. They see it as a rewarding moment to know just what it takes and when the task is completed successfully.

Data trending software is supplied with the 3M Clean-Trace system to provide rapid graphic comparisons to standards and past readings. Trends can be identified and cleaning protocols adjusted to achieve consistency and a base for continuous improvement in hygiene standards.

Customer Surfaces & Hand Hygiene Intervention

Restrooms have already been pointed out as a prime source for norovirus and serve as an example of shared space - shared by the public and the staff. In casual dining and other foodservice environments, the general service area is also shared. From what we have learned from the cruise industry, there can be more norovirus coming through the front door than through the back, the staff entrance.

Handwashing is a must for anyone entering through the employee/delivery entrance. At the front door, operators should consider having food code compliant alcohol hand sanitizer available for entering customers. These barriers can reduce the penetration of norovirus into the kitchen, particularly if a noro-effective product is selected.

Designing low risk operations includes a lot more that specifying easy-to-clean, rounded surfaces. The growing understanding of virus must now be translated by consultants who are in a position to guide operators well beyond stainless steel through the decisions leading to effective and efficient hand and surface cleanliness systems.

Based on an article originally written for Foodservice Equipment and Supply and published in March, 2008.

Best Practice Products

norovirus testing After the target surface is swabbed, a simple insertion into this luminometer provides a reading in 25 seconds.

The immediacy of the feedback helps establish surface cleanliness standards and the training of staff to consistently achieve the safe level.

travelerThis traveler, Carolyn Mann, was the first early morning customer to dine at this Milwaukee airport foodservice outlet en route to a Handwashing Training Workshop in Las Vegas. The odds of cross-contamination at this table were very high. With a reading of over 1,000 RLUs, it was a good bet that the tabletop was not cleaned before the shift started. (Swab and luminometer can be seen on the table.)

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

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

Teaching Videos

Teaching Videos

Globally recognized for their ease of use in any language. Available in DVD and MP4 file download.