No wonder handwashing is considered a common courtesy. Even without soap, it can reduce the amount of bacteria on hands by 47 percent. With just plain old soap, it reduces the amount of bacteria by at least 82 percent.
Moreover, communities introduced to handwashing have seen a decrease in gastrointestinal illness (by 31 percent) and respiratory illness (by 21 percent). Clearly, washing our hands is important for our appearance and health. But it also has a wider impact: It is an essential part of safety in a food-handling situation, where even the slightest contamination from unwashed hands can lead to food poisoning.
At least, that’s the conclusion of the CDC, which analyzed cases of norovirus, a virus that causes vomiting and diarrhea, between 2009 and 2012. It found the vast majority–64 percent–of norovirus infections stem from restaurant contamination. Out of the 1,008 cases analyzed, 364 specifically cited food worker contamination as the cause, and 54 percent of those cases involved bare hand contact to ready-to-eat food.
Evan Henke, a professional service account representative for 3M Food Safety, says that although it is debated whether norovirus can survive in an animal host, it can certainly survive in a human host.
“The best way to avoid spreading norovirus through food is plain old, do not prepare food product when you’re sick with norovirus. So the problem that the food industry faces, then, is that people are very motivated to go to work, even when they’re sick. They may be…ill with vomiting and diarrhea, but they need to come to work in order to earn a paycheck,” he says.
The virus is also an issue in food service areas other than restaurants such as nursing homes, school cafeterias, and hotels, Henke says. Seventeen percent of foodborne norovirus cases come from “Catering or Banquet Facilities,” according to the CDC report. Though cruise ships compose only about 1 percent of cases, they attract plenty of bad press for an outbreak.
Michele Colbert, vice president of sales and marketing at Meritech Corp., warns that alcohol-based hand antiseptics do not work against the virus. The only effective strategy for killing the virus is using strong chemicals, like bleach, that would damage hands. Yet washing soap and warm water can remove the virus sufficiently well to prevent contamination.
So what’s a food worker to do? The CDC has issued specific guidelines for the best method of handwashing, in the following steps:
1. Wash hands with clean, running water, turn water off, and apply soap. Although many people believe that hot water is essential for a complete wash, the CDC does not require a specific temperature, and several studies have shown no difference in cleanliness with hot water.
2. Lather hands, including backs of hands, between fingers, and underneath the fingernails. Studies have revealed that the fingernails can harbor dirt and germs. Remember, as little as 18 norovirus specimens can lead to infection.
3. Scrub hands for 15 to 20 seconds, about the time to sing “Happy Birthday” twice.
4. Rinse hands thoroughly.
5. Dry hands.
Along with CDC guidelines, the FDA’s 2013 Food Code, issued as a guide to state and local health departments, outlines a handwashing strategy. It recommends use of a fingernail brush and highlights the benefits of vigorous scrubbing: “All aspects of proper handwashing are important in reducing microbial transients on the hands. However, friction and water have been found to play the most important role…The abrasive action obtained by vigorously rubbing the surfaces being cleaned…loosens the transient microorganisms on the hands.” Handwashing should take place at a well equipped, easily accessible station that is never used for food preparation or service (i.e., cleaning mops and rags).
Once the right actions are defined, the next question is how to get employees to follow the rules. As Colbert puts it, “I’ve done a lot of hidden studies at manual sinks to watch handwashing compliance. Unfortunately, it’s almost zero. It’s pretty bad.” Employees may forget to wash their hands, wash them at food preparation sinks, or skip some of the necessary steps to reduce contamination.
Colbert suggests the managers take charge, directing employees on the proper methods and enforcing the rules with regular reminders. In some restaurants, managers set an alarm that goes off every time employees needed to wash their hands.
The National Restaurant Association (NRA) also plays a role in ensuring restaurant compliance. In response to CDC’s report, the organization issued a statement defending the hygiene of its associates. “For the restaurant and food service industry, there is no greater priority than food safety and our customers’ and employees’ well-being,” says Scott DeFife, executive vice president for policy and government affairs at the NRA, in the press release.
To assist food managers with compliance, the NRA provides training on handwashing techniques through its ServSafe program, which has taught more than 5.6 million food service workers. In an email statement, Christin Fernandez, media relations manager for the NRA, says the program addresses the importance of handwashing, the proper technique, and the use of hand antiseptics.
One feature of the program is asking workers to wash their hands for what they think is 20 seconds, emphasizing the importance of washing for the full recommended duration. Glo Germ, a substance that simulates pathogens on hands under black light, is used to show the difference between washed and unwashed hands. Participants can use different handwashing techniques and see their effectiveness, points out Fernandez.
Whatever method is used for compliance, handwashing has the potential to reduce the prevalence of norovirus and a spectrum of other foodborne illnesses. Taking a little extra time in the restroom to wash hands fully could save food service establishments and their customers from sickness and regret.
Petenko is an editorial intern at Wiley.