The hands have it: Food safety through handwashing

Handwashing is simple.

handwash_south_park(2)Science says otherwise.

Despite endless statements to just wash hands to be safe — in the kitchen, in food service, at the petting zoo —  little research has been done to quantify what actually works when it comes to handwashing.

U.S. government recommendations for 15-20 seconds of handwashing under vigorously flowing water after a potential contamination event may not be practical in a food service environment.

Dr. Donald Schaffner, a professor of food safety at Rutgers University, and colleagues, have attempted to add some science to the discussion.

“Many people seem to have strongly held opinions about handwashing, says Schaffner, “but the research base for those opinions is lacking. Our research begins to dispels some popular beliefs about handwashing.”

The researchers showed that even a minimal handwash (5 seconds, no soap) can remove about 90 per cent of bacteria on hands.

Further, the research showed that towel drying was much more effective than other methods because of the friction involved in physically removing bacteria from hands.

Schaffner says “Everyone has an opinion about handwashing, but our research is beginning to provide real data to help inform sensible policy.” 

 Contact: Dr. Donald Scaffner

schaffner@aesop.rutgers.edu

732-982-7475

Abstract

Quantifying the effect of hand wash duration, soap use, ground beef debris, and drying methods on the removal of Enterobacter aerogenes on hands

Journal of Food Protection®, Number 4, April 2015, pp. 636-858, pp. 685-690(6)

Jensen, Dane A.;Danyluk, Michelle D.; Harris, Linda J.;Schaffner, Donald W.

http://www.ingentaconnect.com/content/iafp/jfp/2015/00000078/00000004/art00007

Hand washing is recognized as a crucial step in preventing foodborne disease transmission by mitigating cross-contamination among hands, surfaces, and foods.

This research was undertaken to establish the importance of several keys factors (soap, soil, time, and drying method) in reducing microorganisms during hand washing. A nonpathogenic nalidixic acid–resistant Enterobacter aerogenes surrogate for Salmonella was used to assess the efficacy of using soap or no soap for 5 or 20 s on hands with or without ground beef debris and drying with paper towel or air. Each experiment consisted of 20 replicates, each from a different individual with ∼6 log CFU/ml E. aerogenes on their hands. A reduction of 1.0 ± 0.4 and 1.7 ± 0.8 log CFU of E. aerogenes was observed for a 5-s wash with no soap and a 20-s wash with soap, respectively. When there was no debris on the hands, there was no significant difference between washing with and without soap for 20 s (P > 0.05). Likewise, there was no significant difference in the reductions achieved when washing without soap, whether or not debris was on the hands (P > 0.05). A significantly greater reduction (P < 0.05) in E. aerogenes (0.5 log CFU greater reduction) was observed with soap when there was ground beef debris on the hands. The greatest difference (1.1 log CFU greater average reduction) in effectiveness occurred when ground beef debris was on the hands and a 20-s wash with water was compared with a 20-s wash with soap. Significantly greater (P < 0.05) reductions were observed with paper towel drying compared with air (0.5 log CFU greater reductions).

Used paper towels may contain high bacterial levels (>4.0 log CFU per towel) when hands are highly contaminated. Our results support future quantitative microbial risk assessments needed to effectively manage risks of foodborne illness in which food workers’ hands are a primary cause.

 Quantifying the effect of hand wash duration, soap use, ground beef debris, and drying methods on the removal of Enterobacter aerogenes on hands

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Journal of Food Protection®, Number 4, April 2015, pp. 636-858, pp. 685-690(6)

Jensen, Dane A.;Danyluk, Michelle D.; Harris, Linda J.;Schaffner, Donald W.

http://www.ingentaconnect.com/content/iafp/jfp/2015/00000078/00000004/art00007

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New research or PR: Why paper towels are the most hygienic way to dry your hands?

I have no problem with who funds research, as long as there is full disclosure and the methodology is available for critique in a peer-reviewed journal. That would be the public part.

handwash_south_park(2)The Daily Mail in the UK thinks readers are too dumb to ask for references, and begins with, “Paper towels are the most hygienic way to dry hands after going to the loo, a study has found.”

It took The Mirror to note that the University of Westminster’s snappily-titled study ‘Comparison of different hand-drying methods: the potential for airborne microbe dispersal and contamination‘ was published in the March 2015 edition of The Journal of Hospital Infection.

The research was commissioned by paper towel manufacturers and claims that single-use towels are the most hygienic way to dry off.

It probably is.

The research also claims that bathroom air dryers may be blasting bacteria directly into the faces of children.

However, a major hand dryer manufacturer has disputed the claims, calling the research “flawed”.

The university’s study was undertaken by leading microbiologist Keith Redway of the University’s Department of Biomedical Sciences and looked at the potential for microbial contamination from hand drying and the potential risks for the spread of microbes in the air, particularly if hands are not washed properly.

jon.stewart.handwashing.2002The peer-reviewed research – which was commissioned by the European Tissue Symposium (ETS) – used four different hand drying methods and three different test models to compare differences between the drying methods and their capacity to spread microbes from the hands of users potentially to other people in public washrooms.

Paper towels, a textile roller towel, a warm air dryer and a jet air dryer were compared using three different test models: acid indicator using lemon juice, yeast, and bacterial transmission from hands when washed without soap.

The University of Westminster scientists found that the jet air dryer spread liquid from users’ hands further and over a greater distance – up to 1.5 m – than the other drying methods.

They also recorded the greatest spread of microbes into the air at both near and far distances for each of the tested models.

Levels recorded at close distance for a jet air dryer revealed an average of 59.5 colonies of yeast compared with an average of just 2.2 colonies for paper towels.

At a distance of 0.2 m the jet air dryer recorded 67 colonies of yeast compared with only 6.5 for paper towels. At a distance of 1.5 m the jet air dryer recorded 11.5 colonies of yeast compared to zero for paper towels.

The research also looked at the body height at which microbes were spread by air dryers.

It found the greatest dispersal was at 0.6 – 0.9 m from the floor, the face height of small children who might be standing near the dryer when a parent is drying his or her hands.

Leading researcher Keith Redway said: “These findings clearly indicate that single-use towels spread the fewest microbes of all hand-drying methods.

“Cross contamination in public washrooms is a legitimate public health concern. The extent to which jet air dryers disperse microbes into the washroom environment is likely to have implications for policy guidance to facilities managers operating in a wide range of environments from sports venues and airports through to schools and hospitals.”

But Dyson, a major hand dryer manufacturer, strongly disputes the study’s findings.

A spokesperson said: “The paper towel industry has consistently failed to invent new technology or respond to environmental concerns.

“Paper towels are costly to buy and replace, and are rarely recycled, meaning they are sent to landfill or incinerated. To argue their case, the paper towel industry is continuing to commission research with flawed methodology.

“A study conducted by Campden BRI’s (an independent membership-based organisation carrying out research and development for the food and drinks industry worldwide) hygiene specialists found that there are no practical differences between any of the hand drying techniques investigated (paper towels, conventional air dryers and the Dyson Airblade) with regard to microbial aerosol generation.

“The very low numbers of airborne microbes resulting from use of each of the hand dryers would make an insignificant contribution to the overall background microbial loading of the air.”

handwash_infosht-2-7-08 copy

But handwashing is never enough: Ireland says wash hands after farm visits

As the weather improves and visits to outdoor farms increase, the Health and Safety Executive for Northern Ireland (HSENI) is reminding parents and teachers of the importance of schoolchildren washing their hands after being in contact with animals.

handwash.UK.petting.zoo.09A visit to a farm and the chance to see and handle animals is an exciting time for young children.

However, it is vitally important to remember that farm animals can carry harmful bacteria such as E. coli, which can be transferred to children through contact with the animal or its faeces. If the child then goes on to eat, drink, or put their hands near their mouth, without washing their hands, there is a real risk of serious infection.

Urging everyone to follow simple hygiene steps to avoid spoiling anyone’s fun, Malcolm Downey who heads HSENI’s farm safety team said: “Anti-bacterial gels and wipes alone are not a substitute for properly washing your hands.”

Sorry Malcolm, it’s not that simple.

Our paper on human-animal interactions published in Zoonoses and Public Health, includes a 2-page checklist for parents, and the teachers who book these events.

Gonzalo Erdozain, Kate KuKanich, Chapman and I have all seen microbiologically terrible practices at petting zoos or in homes, and read about them from around the world, so we thought, maybe we should try and provide some guidance.

The uniting factor is we all have kids, and in my case, grandkids, and keep adding more.

claudia.e.coli.petting.zoo.may.14In Brisbane, they have the Ekka, something like the Texas State Fair. The petting zoo was absolute madness, and after living in Brisbane and hanging out with micro-types I got the message, don’t go to the Ekka, you’ll get sick. We didn’t go in 2013: 49 people, primarily kids, got sick from E. coli O157 (and in typical Queensland style, the outbreak has never been written up, there has been no follow-up, nothing; guess it would be bad for agriculture).

North Carolina has had repeated and terrible outbreaks.

As a father of five daughters, I’ve had many requests over 20 years to go on a school trip to see the animals. As a food safety type, I’ve been routinely concerned about best practices. The other parents may dislike microbiology, but I’m concerned with the health and safety of the children involved.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Best practices for planning events encouraging human-animal interations

Zoonoses and Public Health 62:90-99

Erdozain , K. KuKanich , B. Chapman and D. Powell, 2015

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess
 Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. ‘It is estimated that 14% of all disease in the USA caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

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Jersey restaurants’ 4-strike rule: Hamilton considers stiff fines, closure for failed health inspections

In an attempt to make sure restaurant workers are washing their hands and keeping the kitchen clean, Hamilton officials are preparing to bring the hammer down on restaurant owners who frequently violate health codes.

jon.stewart.handwashing.2002The township council on Tuesday is scheduled to introduce an ordinance that would stiffen penalties for restaurants with a history of failing health inspections, imposing fines as much as three times the current amount and imposing mandatory closures.

Under the current model, restaurants that receive a “conditionally satisfactory” rating, which denotes health issues that need to be addressed, are charged a $250 reinspection fee after each of their second, third and fourth consecutive violations.

After four consecutive violations, the restaurant is shut down until the violations are resolved. Kenji Fusion and China Grill were both shut down for brief periods earlier this year after failing three consecutive inspections.

Township health officer Jeff Plunkett said that some businesses do not take the $250 fee seriously: One owner simply tried to hand a health inspector $250 in cash from his wallet.

“We’ve come to the conclusion that people just pay it,” Plunkett said in February.

The new ordinance would impose steps in the reinspection fees: $250 on the second consecutive offense, $500 on the third and and $750 on the fourth. After four consecutive offenses, the township will shut down the restaurant for a minimum of two days — even if the violations are resolved quickly.

“You keep trying to educate the ownership that they have a responsibility to every customer who walks through their door. It cannot be taken lightly.”

Food safety doesn’t happen in an office

About 15 years ago, I was a goofy grad student without a lot of ambition.

I had an interest in infectious diseases, genetics and how people talked about risk. Not necessarily in that order.

I found Doug and he set me up with a project working with a bunch of greenhouse tomato and cucumber producers.

His advice was watch everything, ask questions and write it down or you will forget it.

Being on farms and in processing plants I learned about the real challenges that folks encounter when they try to manage risks and ended up finding a passion for food safety. I saw food safety in action daily.11024653_10205679691698903_6143155856293942610_n

Over the past few weeks I’ve spent a bunch of time out of my office doing food safety stuff in the real world like working with chefs on HACCP plans, visiting storage facilities, providing risk communication messages for an outbreak.

But the most food safety fun I’ve had recently was talking to a friend’s Brownie troop about micobiology and handwashing. Grad students Natalie Seymour, Nicole Arnold and Katie Overbey did the heavy lifting, showed the girls what science is and were excellent scientist role models. I just showed up.

But I guess my handwashing prowess blew a mind or two (above, exactly as shown).

 

The Brits have a way with language: townies wash their hands

Germs. You can’t get away from the blighters. If it’s not the teeming populations of camplylobacter that infest the cavities of supermarketchicken, it’s the E coli, salmonella and worse that disport themselves on our towels and dishcloths.

courtlynn.handwashAgainst these regiments of invisible enemies we deploy a vast arsenal of weapons-grade cleaning products. But while we’re spraying our surfaces with bleach and washing our dishes in Eucalyptus detergent, a shaming 60-odd per cent of us neglect to wash our hands after we’ve visited the loo, according to a Rentokil survey.

While confirming my conviction that you’re better off eating dinner at home, where at least the bugs are mostly familiar, this news has made me reflect on my own handwashing habits which are, I realise, completely perverse.

At home in London, I carry on like Lady Macbeth, washing my hands dozens of times a day. But at weekends, in the stableyard, I find myself cheerfully eating a sandwich from an unwashed hand that moments ago was feeding a horse a mint.

I’ve no idea whether it is my scrupulous townie cleanliness or my robust rural exposure to pathogens that means I’m almost never ill. But either way I view with misgiving Rentokil’s proposed solution to the handwashing recidivists. Stewart Power, its marketing director, predicts that one day every washroom will have a monitoring system “to give us a nudge to wash our hands”.

It’s bad enough being nagged by an electronic voice about an unexplained item in the bagging area. Just imagine the irritation of being slut-shamed by a disembodied nanny in the loo door.

Food Safety Talk 73: I Wish They’d Wash Their Hands More

Food Safety Talk, a bi-weekly podcast for food safety nerds, by food safety nerds. The podcast is hosted by Ben Chapman and barfblog contributor Don Schaffner, Extension Specialist in Food Science and Professor at Rutgers University. Every two weeks or so, Ben and Don get together virtually and talk for about an hour.  They talk about what’s on their minds or in the news regarding food safety, and popular culture. They strive to be relevant, funny and informative — sometimes they succeed. You can download the audio recordings right from the website, or subscribe using iTunes.Handwashing-Words-In-Shape-Of-Hand

This show starts with Don and Ben talking about the number-six item on their list of things to discuss for the episode:  Yosemite and how beautiful it is; Ben rates it at three thermometers, a rating system they invented.  Ben’s favorite thermometer is the Comark PDT300, even though someone sent him a ThermoWorks Thermapen which is Don’s favorite. Ben’s hockey team has been using thermometers when the grill sausages, this is what Ben’s contribution to the grill-outs.  Ben gets chirped for being the guy who brings the thermometer to the hockey grill. Ben is now supplying thermometers to other hockey guys.

Don talks about his lunch date with a podcast celebrity from the 5by5 network. Don tells the whole story about flying business class from Brazil to Texas then while in Texas, buying comic books and having lunch with Dan Benjamin.  Dan asked Don lots of food safety questions; they didn’t talk much about 5by5.  After this, Don attended the NoroCORE Food Virology meeting with Ben (the guys talked in real life, not just over Skype).

The conversation then turns to food safety culture and what that really means as it is in the literature.  Ben talks about a conversation he had about food safety culture with a person trying to develop a presentation on food safety culture for farmers. Don shares an email from Doug about food safety concerns at [insert big company name] that shared a Dropbox video of text and images displaying poor food safety. The guys then talk about the difficulties of creating a food safety culture when no one thinks it’s important. Ben talks about the many things that must be in place before a food safety culture can begin to be established.

Then conversation then transitions to how to talk about food safety risks. Ben suggests talking about risks frankly. The guys then discuss the uncertainties around risks and how to discuss them.  Discussing how quantitative risk assessments are performed and applied, and the issue of uncertainty messages, also come up in conversation.  Salmonella Hypetheticum then comes up in the conversation.

Don then brings up a book that he has been reviewing about food waste.  The same food waste topic has been featured on a television show that Don’s real life friend Randy Worobo was a guest on.  The issue of food waste and risk is discussed, with a focus on lower income persons and how to manage the need to save money against food safety risk decisions.  The use of fruits and vegetables that are past their optimum date to make infused vodka brings back memories of pruno-associated C. botulinum outbreaks.  Ben appreciates Don for working the math around food safety questions and the time and effort it takes to accurately answer without just ‘no don’t do that thing’.

Ben then brings up the issue of thawing a turkey on the counter the risks associated with that action.  Doug Powell has a paper in the Canadian Journal of Dietetics Practice Research about the calculations around thawing a turkey at room temperature.  Actually, it is ok to thaw a turkey at room temperature if you are within certain parameters.  This topic follows along with the possible Food Safety Talk tag line:  and it’s messy.

Next, Ben wants to talk about communication, but Don talks about the decision to eat fresh produce in Brazil, and other’s decision not to eat the fresh produce while visiting.  While at meetings Ben seems to focus on following the news and typing up Barfblog posts (some people are ok with that and will resist complaining; Ben does type rather loudly).  When Ben gets really into what he is writing, he lets out really loud sighs others have noticed, but Ben hasn’t noticed his inappropriate sighing.

Transitioning back to communication, Ben brings up a hepatitis A outbreak reported in Cumberland County Maine, but without a retail location identified. The State of Maine is taking some flack (could we call this chirping, see above) for their handling of this incident; the State of Maine tried to explain that this is because of a lack of personnel with specific expertise.  Maine has been in the news for other public health issues… a nurse breached a quarantine for Ebola by going for a bike ride.  Don suggests the public health system in Maine may be broken, Ben suggests this may be due to their having just eleven health inspectors for the whole state.

In the After Dark session, Ben reveals the most popular Food Safety Talk episode.  The guys aren’t sure which episode they just completed, 74?, 75?, whatever it takes.  Speaking of documentaries, Don recommends Jodorowsky’s Dune a documentary about a movie that was never made.

Lots of support for restaurant that had food handler with hepatitis A

n a truly Canadian move, more than 70 owners, management and staff from Sudbury bars and restaurants ate and drank at a Sudbury, Ontario (that’s in Canada) Casey’s in a show of solidarity. In early February over a thousand patrons might have been exposed to hepatitis A after a food handler was diagnosed with the virus. According to The Sudbury Star, even the local health unit, the folks who ran the hep A shot clinics, hosted a retirement party for over 40 folks at the restaurant.default-1

Last week, Peddler’s Pub invited fellow establishments to join them in a show of support for the Kingsway bar and grill, which suffered a publicity setback last month when an employee was diagnosed with hepatitis A and patrons were urged to get vaccines through the Sudbury and District Health Unit.

“It’s one of those unfortunate things that can happen to any restaurant,” said Peddler’s marketing manager Cliff Skelliter. “Casey’s is such an important part of our community. A lot of people have jobs there and the owners are amazing, just absolute sweethearts.”

Dave Temmerman, co-owner of Hard Rock, brought a contingent of 14 people affiliated with his Elm Street pub.

“In times like this it’s nice to know who your friends are and stick together,” said Temmerman.

The public should have no fear of dining at Casey’s, he said, as standards of hygiene at this restaurant are as strict as any he’s encountered.

“I’ve worked in a lot of places, and it’s one of the cleanest I’ve worked in,” he said. “What happened to them is just a bad deal. People in the industry know it can happen to anybody, and it’s not because their place is dirty.”

Casey’s owner Marty Wills said the endorsement of counterparts means a lot.

“It’s wonderful what all the other restaurants have done,” he said. “They’ve been getting together and showing a little love, a little support for us, because they understand we didn’t do anything wrong.”

The hepatitis A that was detected in a Casey’s employee “was never created here,” said Wills. “She just happened to work here.”

Having a clean restaurant (whatever that means) doesn’t really matter; in this situation, risk is influenced by the food handler’s handwashing behavior. US FDA risk factor studies have shown that handwashing compliance in food service isn’t great. Requiring your staff to have hep A vaccinations would avoid stuff like this.

Jersey officials plan database of restaurant health inspection reports, higher fines for violations

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Spurred on by the outbreak of Hepatitis A linked to a food server at Rosa’s Restaurant and Catering, Hamilton Township in New Jersey is taking steps to ensure that every consumer knows just how safe — or unsafe — food establishments are, with an online database of food inspection reports scheduled to go live within the next few months.

jon.stewart.handwashing.2002“Accountability is everything,” township health officer Jeff Plunkett said on Friday. He said a new ordinance is also being drafted to increase fines for health code violations.

The new database will allow customers to simply search for the name of a restaurant to view its health inspection reports, Mayor Kelly Yaede said Friday.

“This is an initiative we’ve been working on for a year,” Yaede said, attributing the concept to one proposed by San Francisco Mayor Ed Lee at the 2014 U.S. Conference of Mayors.

“The number one goal of our health office is to maintain the public safety of our residents,” Yaede said. “This tool makes these restaurant inspection reports more readily available to individuals when they’re making a choice of whether they’re going to patronize a restaurant.”

It isn’t clear whether a restaurant’s entire history or recent history of inspection reports will be available, Yaede said.

“As much information as we have that’s accessible will be released to the public,” Yaede said.

The software will hopefully provide an incentive for restaurants to maintain clean bills of health: It could provide a sales boost for the cleanliest establishments and motivation for less cleanly restaurants to fix problems, Yaede said.

“It would be a positive tool for a majority of restaurants in Hamilton to help them promote their business,” Yaede said.

“And if you don’t have a good report? There’s more of a bite in it for enforcement,” Plunkett said.

Hep A is fecal-oral: Rosa’s Restaurant cited with handwashing violations shortly before Hepatitis A outbreak

Any time there is an outbreak of Hepatitis A, it’s not just a lack of vaccination, not just about identifying those at risk and giving them a shot, it’s about poop.

hepatitis.ASpecifically, that person making your salad went #2 and failed to properly wash their hands.

The Trentonian reports that the month before a Rosa’s Restaurant employee was diagnosed with Hepatitis A — sending residents scrambling for vaccinations — the eatery was cited for numerous handwashing violations.

According to an Oct. 8 food inspection report obtained by The Trentonian through a public records request, the restaurant was listed as out of compliance for employees conducting handwashing in a timely manner, workers performing proper handwashing and the business providing paper towel for handwashing facilities.

Also marked as a violation, an employee was observed making sandwiches and handling rolls with his bare hands, while another worker was shredding and handling lettuce with his bare hands, the report states.

“Due to the number of critical violations, the person in charge is not demonstrating proper knowledge of food safety principles pertaining to this operation,” Hamilton Township food inspector Kelly A. Thomas wrote in her report, which gave the restaurant a conditionally satisfactory evaluation. “No proof of food handling certification was available on-site at time of inspection.”

In response to the October report and some of the continued handwashing violations throughout the years, restaurant owner Rosa Spera said in an email on Friday that her establishment has four handwashing sinks.

“On past inspections some of the signs reminding workers to wash their hands have been missing,” Spera stated. “Unfortunately, sometimes people remove the

After the first case of Hepatitis A was reported in late November, officials disclosed three other Hamilton area residents contracted the virus that had eaten at Rosa’s during the time period the worker was affected.

MrHankyHowever, township officials previously stated that it does not know with any certainty that any of the three cases had any link to or is a direct result of the original incident.

Spera said in the email it’s “unfortunate” that one of her workers got sick in November.

“When he did, he reported immediately to a doctor, not to work,” Spera stated. “When I learned of it, I took immediate action to take every precaution. With the guidance of the Hamilton Health Department, we threw away all open food and had the township observe our deep cleaning of all food areas.”

Jeff Plunkett, the township’s health officer, said in an interview on Tuesday, that the restaurant was closed for approximately seven to eight hours on Dec. 1.

“They had to remove the entire staff, bring an entire staff new that hadn’t worked there during that period of communicability when the gentleman was sick,” Plunkett said. “The entire place was clean and sanitized and witnessed by an inspector who was there the entire time.”

But even as the health inspector stressed the importance of wearing gloves on Dec. 1, Thomas stated in her report that she observed an employee slicing and handling bread with his bare hands. Two days later, Thomas stated she observed employees doing prep work scramble to put on gloves as she walked through the doors, while another employee put on gloves without washing his hands first, inspection documents read.