Proper handwashing requires proper tools

The state government in New South Wales – that’s where Sydney is – has come out with a new push for handwashing as a cornerstone of food safety.

I agree. But proper handwashing requires proper tools – vigorous water-flow, soap and paper towels.

jon.stewart.handwashing.2002Almost no Australian restaurants have all three components, based on my anecdotal but extensive observation (and wet shorts because I don’t use blow-driers).

NSW Minister for Primary Industries, Katrina Hodgkinson visited the NSW Food Authority’s stand at the Sydney Royal Easter Show and said, “Handwashing is the most simple and yet the most effective means of reducing your risk of food poisoning.”

If it was simple, so many people wouldn’t get sick; proper handwashing requires access to proper tools.

80 crypto cases a year; handwashing is never enough: UK health chief warns over risk of infection from region’s petting farms

We have a paper coming out shortly about best practices at petting zoos and farm visits and state fairs and just hanging out with animals.

I’ll follow my own best practice and wait until it’s published to talk about it, but Dr Ken Lamden, the health chief of Cumbria and north Lancashire in handwashing.ekka.jpgthe UK is urging parents to be aware of potential infections that can be caught at farm attractions.

Over the past 20 years, an average of around 80 cases of cryptosporidium infection linked to visits to petting farms have been reported to Public Health England each year. This is out of a total of around two million visits to the 1,000 plus farm attractions in the UK, with peak visitor times during school and public holidays.

Dr Lamden, of PHE’s Cumbria and Lancashire Centre, said: “Visiting a farm is a very enjoyable experience for both children and adults alike but it’s important to remember that contact with farm animals carries a risk of infection because of the micro-organisms – or germs – they carry.

 “Anyone visiting a petting farm should be aware of the need to wash their hands thoroughly using soap and water after they have handled animals or been in their surroundings. Children are more at risk of serious illness and should be closely supervised to make sure that they wash their hands thoroughly.

“It is also very important not to rely on hand gels and wipes for protection because these are not suitable against the sort of germs found on farms.” 

Parents in Ohio say their kids not allowed to wash hands at school

First thing I do when a kid is checked into a new daycare or school is check out the handwashing facilities. Proper handwashing requires access to proper tools: vigorously running water, soap and paper towels.

Sorenne says at her kindergarten (prep here) she always washes her hands, uses soap, but because there is only blow driers she often dries her hands on her clothes (blow driers suck, the friction from wiping with paper towel provides an extra level of safety).

Too often, hypocrites preach about the importance of handwashing without checking to courtlynn.handwashensure the tools are available.

Two parents of students attending separate Toledo Public elementary schools in Ohio say their children are not being allowed to wash their hands after using the restroom, an allegation the school district denies.

Holly, who has two kids that attend East Broadway Elementary School, said she was surprised when her children told her that they couldn’t wash their hands while at school. “They told me they are only allowed to put hand sanitizer on twice a day after we use the bathroom,” said Holly.

The mother shared the information with her sister, Heather, who has a fourth grader enrolled at Burroughs Elementary.

Heather’s son told her that while at school he had witnessed another boy walk to the sink to wash his hands after using the restroom. The boy was stopped by a school staff member who called him over, squirted hand sanitizer in his hand, and walked away, according to Heather’s son.

When asked if they were sure of what their children were alleging, the women said that their kids have always been honest about what goes on at school.

Toledo Public Schools denies that students are prohibited from washing their hands. In an email to WNWO, TPS spokesperson Patty Mazur wrote, “Teachers take students to the bathroom as a class and then watch as students exit the restroom and wash their hands. If a student didn’t wash their hands properly, they are asked by their teacher to re-wash.”

Despite the response from TPS, Heather remains convinced that her son is not allowed to wash his hands while at school. “It needs to be addressed, ” she said. “This is disgusting. It makes me wonder if this is why my child has been sick so much this year.”
TPS said it holds hand-washing classes for elementary school students at the beginning of the year. Signs are posted in the restrooms reminding students to wash their hands after they use the bathroom.


‘Why do we have to wash our hands? We wear gloves’ bad inspection forces Wisconsin McDonald’s to close, give refunds

A McDonald’s at 3131 Mayfair Road in Wauwatosa was, according to the Journal Sentinel, closed briefly two weeks ago because of issues with handwashing, and the restaurant was forced to give customers refunds at the counter, public records from the city showed.

The restaurant closed March 12 for several hours while a hand sink was being repaired. There were none working in the kitchen for washing hands or in the rest of the restaurant,handwash_south_park(2)except in the bathrooms. Restaurants in Wisconsin are required to have sinks designated solely for washing hands.

The inspection yielded several other violations, including dirty utensils, accumulations of food debris and grease, wiping rags in sanitizer buckets that didn’t have any sanitizer in them and a lack of basic knowledge about food safety.

According to the inspection report, one employee said, “Why do we have to wash our hands? We wear gloves.”

The inspector also instructed staff to throw out undated foods from the refrigerators.

Owner Deborah Allen said in a statement, “Nothing is more important to me than operating a safe and clean restaurant. We follow rigorous standards for food safety and quality, and we take great pride in the food and beverages we serve to our customers every day. We take these matters very seriously, and took immediate action to make the appropriate corrections.”

The inspection report is available at the Journal Sentinel’s restaurant inspection page,, which houses restaurant inspection data from the four-county Milwaukee area and is updated monthly. Wauwatosa is not included with other cities and towns in the four-county database because the city has said it is not able to release its database. Instead, the city provides inspection reports weekly.


No: Is hot water more effective for washing hands?


We’ve written about this before, but here is another take on the effectiveness of warm or hot water in handwashing.

Researchers surveyed 510 adults and asked them questions about their hand washing behaviours and perceptions.  People were asked how often they wash their hands, for handwashing.sep.12how long and how hot the water should be.

According to the published report, “70% of respondents said they believe that using hot water is more effective than warm, room temperature, or cold water, despite a lack of evidence to back that up.  The research showed a, “strong cognitive connection between water temperature and hygiene in both the United States and Western Europe.” 

So while many believe hot water is more effective for hand washing the study actually concluded, “the temperature of water used is not related to how well pathogens are eliminated during the process.”  Additionally, warmer water can irritate the skin and can affect its protective layer, which may cause it to be less resistant to bacteria.  Skin irritation has been reported as  one of the main reasons many healthcare workers forgo hand hygiene for example.

 Interestingly if you look at the official guidelines for hand washing from the CDC and WHO, both do not actually specify a water temperature.  They do recommend using soap and water and scrubbing using proper technique for at least 20-seconds, followed by drying hands thoroughly.

Despite this there is still lots of confusion as some public health organizations still recommend, “elevated water temperature.”  The FDA Food Code for example, which is a model used to enforce health standards in restaurants recommends the , “hand washing sink be equipped to provide water at a temperature of at least 100°F or 38°C.”

One subscriber to this blog recently commented, “I have come across a food safety consultant who insisted that the temperature should be 60°C (140°F).  Observations revealed that staff proceeded to use cold water saying hot water was too hot!  Microbiological swabbing of hands revealed an increase in Campylobacter, E.coli and Listeria counts on hands that were washed in basins when very hot water was demanded by the consultant, compared to hands exposed to water at 40 to 45 °C.”

Barry Michaels, a microbiologist and expert in infectious disease performed the only known comprehensive review of published recommendations or testing standards  on hand washing and rinsing water temperatures from 1938 to 2002.   He found that there was no consensus but instead temperatures ranged from ambient  to “as hot as you can stand” or “as hot as possible”.  Many recommendations in food and healthcare environments were not concerned with the water temperature at all, while an equal number only specified that water in the lukewarm to warm temperature regions be used.  Then there was a select group including ASTM test methods, American Society of Microbiology, the FDA Food Code  and  experts in food and healthcare who felt that hot jon.stewart.handwashing.2002water from 40 to 50 degrees °C (~100-120 degrees °F) should be used.  Reasoning was that hot water was needed to melt fats in food soils and increase antimicrobial effectiveness.  In testing on efficacy and skin health Barry Michaels and team found that hot water should not be used.

Michaels commented, “The damage at 60°C would probably be enough to stop workers from washing hands all together.  Results indicate that water temperature has only slight effect on transient or resident bacterial reduction during normal hand washing when bland soap is used.  We have also tested with four other soap products each having different active ingredients (PCMX, lodophor, Quat & Triclosan) and overall, the four soap products produced similar efficacy results”.

“Although there were slight increases in Log10 reductions (ascribed to antimicrobial speed of chemical reaction), skin moisture content decreased while Visiometer skin dryness score and transepidermal water loss (TEWL) increased at higher temperatures. Results were not statistically significant for any parameter, but all trends were unmistakable.”

“In summation, water temperature should be comfortable to allow or encourage frequent hand washing with mild, but effective soaps (designed for soils to be encountered).  Vigorous hand washing is the preferred method.  In terms of ideal temperature, I would say from ~70 to 105 °F or ~20 to 40.5 °C.  This is comfortable without the risk of skin damage,” concluded Michaels.

Reference for the research cited is: Michaels, B.; Gangar, V.; Schultz, A.; Arenas, M.; Curiale, M.; Ayers, T.; Paulson, D.  Water Temperature as a Factor in Handwashing Efficacy.  Food Service Technology 2002; 2:139-149.

Hot water is ‘unnecessary and wasteful’ for handwashing – study

We’ve said for a decade hot water is not a factor in reducing microbial loads during handwashing. Friend of the blog Don Schaffner at Rutgers agrees.

And now, so do researchers at Tennessee’s Vanderbilt University.

We admit, warm water is often a preference, but scientifically, it does not handwash.south.parklower microbial loads.

And we all want to be evidence-based.

As reported in the European Cleaning Journal, using hot water for hand washing is unnecessary while potentially being harmful for the environment, but nearly 70 per cent of Americans believe hot water to be more effective than cold or warm water – despite having no evidence to back this up.

According to research assistant professor Amanda Carrico: “It is certainly true that heat kills bacteria, but if you were to use hot water to kill them it would have to be way too hot for you to tolerate.”

She explains that pathogens can be killed by water at temperatures of 99.98°C – but hot water for hand washing is generally between 40°C to 55°C, and even at these temperatures the sustained heat required to kill some pathogens would scald the skin.

Carrico’s team found water as cold as 4.4°C to be just as effective at reducing bacteria as hot water if the hands were scrubbed, rinsed and dried properly. And they noted that hot water could even have an adverse effect on hygiene. “Warmer water can irritate the skin and affect the protective layer on the outside, which can cause it to be less resistant to bacteria,” said Carrico.

And she adds that no water temperature is specified in official guidelines from the Centre for Disease Control and Prevention nor the World Health Organization, which simply recommend using soap and water and scrubbing vigorously for at least 20 seconds followed by a thorough dry.

Now, about that 20 seconds …

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Australia has a food safety problem; eateries in Capital ignoring hygiene standards

Maybe it’s payback to the federal politicians in Australia who are utterly clueless about basic food safety and steps to improve public accountability, but Canberra food businesses are flouting food safety laws such as installing a wash basin and cleaning the kitchen, according to the territory’s chief health officer.

The number of improvement notices issued to restaurants, cafes and food stalls in the second half of last year  was more than double  the canberranumber for the same period in 2012.

While some of the 163 notices  were for minor infringements, chief health officer Dr Paul Kelly said “we’re still finding significant problems” with general hygiene standards in some premises.

Among the problems were business owners failing to install a basin for hand washing in food-preparation areas.

Others did not maintain clean kitchens or had been caught out

not storing food at correct temperatures.

“It’s pretty standard infrastructure that you’d think would just be second nature,” Dr Kelly said.

“We’re trying … to work with industry to get them to fix their act by themselves.”

“I think we’ve got a way to go still.’’ he said.

‘‘People who don’t have somewhere to wash their hands in a food-preparation area, with running water and soap – that sort of thing is still there,” he said.

FDA not sure antimicrobial soaps do anything

Every day, consumers use antibacterial soaps and body washes at home, work, school and in other public settings. Especially because so many consumers use them, the U.S. Food and Drug Administration believes that there should be clearly demonstrated benefits to balance any potential risks.

There currently is no evidence that over-the-counter (OTC) antibacterial soap products are any more effective at preventing illness than antimicrobial.soapwashing with plain soap and water, says Colleen Rogers, Ph.D., a lead microbiologist at FDA.

Moreover, antibacterial soap products contain chemical ingredients, such as triclosan and triclocarban, which may carry unnecessary risks given that their benefits are unproven.

“New data suggest that the risks associated with long-term, daily use of antibacterial soaps may outweigh the benefits,” Rogers says. There are indications that certain ingredients in these soaps may contribute to bacterial resistance to antibiotics, and may have unanticipated hormonal effects that are of concern to FDA.

In light of these data, the agency issued a proposed rule on Dec. 13, 2013 that would require manufacturers to provide more substantial data to demonstrate the safety and effectiveness of antibacterial soaps. The proposed rule covers only those consumer antibacterial soaps and body washes that are used with water. It does not apply to hand sanitizers, hand wipes or antibacterial soaps that are used in health care settings such as hospitals.

No soap at school, kids sick

Go evidence or go home.

Children are, according to The New Zealand Herald, becoming sick at one of the country’s most modern new schools, parents say, because for three years the board banned soap and hand towels, fearing that they harmed the environment.

The school, which has Greenstar accreditation for environmentally friendly design, has a healthy attendance rate of 93.4 per cent, the board says, handwash_south_park(2)with no unusual illnesses.

But some parents say their children are suffering due to the school founders’ green philosophy and have complained to the board about their children’s repeated bouts of illness.

Stonefields has stocked only hand sanitiser in bathrooms since it opened in February 2011.

After an approach from the Herald on Sunday this month, board chairman Israel Vaeliki said the school would install hand driers and soap dispensers.

One mum, who asked not to be named, said she, her husband and their child had suffered gastro-intestinal illnesses this year. “The hand sanitiser’s not effective.”

The woman had raised the issue with the school but had been assured handwashing, with soap, was available in the children’s learning hubs.

Another parent said her daughter and classmates had suffered several bouts of gastroenteritis, due to the lack of soap and hand driers. Instead, the children would wipe their wet and dirty hands on their clothes. But a third Stonefields parent, Camille Harvey, believed sanitiser was more effective as children tended to do a poor job with soap and water.

The original sanitiser solution was decided by the establishment board in consultation with the Ministry of Education before the school opened, Vaeliki said. “Having no paper towels was in line with the school’s environmental sustainability philosophy. Recently, the school has received one complaint about the solution but otherwise there have been no issues for three years.”

A ministry spokesman said schools were required to provide a cleaning agent and warm water so the potential spread of germs was kept to a minimum.

As hospitals in the U.S. began to realize several years ago, sanitizer does not replace proper handwashing with soap and drying with paper towel.

Water temperature does not matter, but a vigorous water flow does, as does the vigor of drying with paper. Hand driers don’t cut it.

A google search would have revealed handwashing basics for the environmental educationalists.

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7-year-old sickened by E. coli at Minnesota petting zoo returns to school

Days after visiting a petting zoo at a pumpkin patch before Halloween, Emma Heidish was in the hospital. Almost a month later, her family is grateful she will spend Thanksgiving at home.

Heidish was one of 3 people who got sick after visiting Dehn’s Pumpkins in Dayton, Minn., but while the others were able to recover at home, her case was severe.

Like many 7-year-olds, Heidish loves animals, but after what she’s endured, her opinions about her favorite farm animals have goat.petting.zoo_changed.

“They are the ones that made me sick!” she explained.

Within days of visiting the pumpkin patch in mid-October, stomach cramps and diarrhea landed Heidish in the intensive care unit.

For a month, the little girl fought through a form of kidney failure that required her to undergo surgery and near-constant dialysis because her digestive system basically shut down.

The family is also bracing for the bill. Even though they have health insurance, they’re not sure what a month-long stay in the ICU will cost them. Friends have organized two fundraisers to offset the coasts and have established a fund for the family.

For more information on the benefit’s and more ways that you can help visit:

As for Dehn’s farm, the owners still aren’t sure what they’ll do with the livestock next year because E. coli can simply be in an animal’s fur or the pen they’re kept in, but the Heidish family says they just want to stress the importance of hand washing.

Handwashing is never enough when it comes to human-animal interactions. My colleagues and I have a paper on best practices that will hopefully be published soon.