Introduction Food Handler / Worker Two Way Transmission Effective Technique Meeting HACCP Requirements About Barry Michaels Back to papers

Barry Michaels
Senior Product Development Manager
Georgia-Pacific Corporation

Of all the reasons for improved personal hygiene, the most dreaded is a foodborne illness outbreak. When this occurs, the reputation and life of a company can sometimes hang in the balance. Management hopes that hygiene procedures were adequate to safeguard the integrity of their product and that the outbreak represents a few isolated cases of low severity.

Such scenarios don't always end happily, which is why it is so important to prioritize personal hygiene issues before a problem occurs. HACCP helps to prioritize process steps focusing on hazards that can be reduced or eliminated. In much of the food industry personal hygiene is a prerequisite program. This is true of most food processing environments. In a recent review by this author of 268 outbreaks of foodborne illness reported in international journals, attributed to the food worker, almost 40% were caused by foodworkers who were either working with clear symptoms of an infectious intestinal disease or were asymptomatic. The foods involved were almost all in the ready-to-eat category. In these situations an effective handwashing step would be considered a critical control point (CCP) aimed at preventing an outbreak of foodborne illness. If food handling step is deemed to be a CCP, then either hand contact could be avoided/eliminated or handwashing should be monitored, documented and verified (MDV). In addition to monitoring employee hand washing behavior through use of documentation forms filled out by managers, there are a number of newly introduced handwash monitoring systems that will do this automatically, providing documentation satisfying the MDV requirement.

Most infectious intestinal diseases are spread through contaminated hands via the fecal-oral transmission route. It has been estimated that between 25 and 40 percent of all foodborne illnesses are caused by poor personal hygiene. This includes outbreaks traced to food processing/service establishments as well as in the home environment. Specific outbreak-causing organisms have varying degrees of personal hygiene involvement as contributing causes. For example, camplybacter outbreaks implicate poor personal hygiene in 45 percent of those cases, while poor personal hygiene is found in 63 percent of salmonella outbreaks. Staphylococcus (71 percent), shigella (94 percent), and yersinia (100 percent) have even higher personal-hygiene-implicated contribution rates. Some microorganisms of concern such as Listeria seem less connected to personal hygiene issues.

While the proportion of foodborne illness attributed to food processing plants is very low, and a credit to that portion of the food industry, the personal hygiene component cannot be neglected. For food service the hygiene component is much greater significant. In the recently described study of outbreaks caused by the foodworker, almost all were connected to food service facilities ranging from restaurants, cafeterias and hotels to catering, the military, jails and prisons, commercial travel, camps and retail establishments.

Back to top

FOOD HANDLER/WORKER
With current large-scale production and distribution channels for food products, a single flawed practice in a processing plant or lapse of hygiene by a single individual can cause national or international product recall. With food service outbreaks, bare hand contact with food sometimes under quite exaggerated circumstances has been described as occurring. While even low levels of hand contact such as handling sliced pineapple, tomato or ice cubes were shown to be capable of initiating outbreaks, in other outbreaks extremely hazardous activities were documented as occurring. These consist of plunging hands into milk containers to change malfunctioning spigot, repeatedly tasting food with fingers, using bare hands to remove meat from bones or mixing salad by hand. Hand contact of this nature should not be tolerated. Alternatives to hand contact should be sought such as gloves, food handling utensils, bakery papers or tongs.

The U.S. Centers for Disease Control & Prevention has stated strongly that "handwashing is the single most important means of preventing the spread of infection." This holds true for processing plants, restaurants, households and hospitals. From farm to fork, or boat to throat, it is the one step that stands between outbreak and safety. It is also important to root out hazardous activities that require workers to plunge hands directly into food.

Back to top

TWO-WAY TRANSMISSION
Microorganisms pass both ways between handler and food. A worker's hands may even become colonized with organisms associated with the food where actual food handling takes place. This has been documented in the poultry industry. The fingers, fingertips and nail folds are known to harbor potential pathogens, such as staphylococci and various gram-negative bacilli, in the general populations. Allergies to foods, soap/sanitizer ingredients, metals or glove materials can also result in colonization of hands with pathogenic species. For this reason, skin health is of paramount importance.

Handwashing is not always effective in reducing bacteria counts is this region of the hand. It is not always performed in an effective and timely manner. Parts and areas of hands are known to be missed during the handwashing process. It is precisely these parts, fingers, fingertips, thumbs, etc., which touch contact surfaces. Drying hands with paper towels by developing the habit of unconsciously wrapping the towel around fingers can help remove microorganisms from this region.

Use of an effective soap, vigorous rubbing of hands during the washing process and thorough hand drying are key to good sanitary hygiene. The frictional aspects of hand drying can help remove microorganisms missed during handwashing on precisely parts of the hand that are missed. Hand drying is the last stage in the personal hygiene process and has been overlooked for its germ removal potential.

Hand drying can also be flawed by contact with dispenser mechanisms, which can cause cross-contamination. The potential for this was illustrated by a study performed by Dr. M. Pierson for the Food Science Department of Virginia Polytechnic Institute. In this study, restroom and wash station contact surfaces from 12 food processing/service establishments were examined by sampling a variety of contact surfaces associated with personal hygiene. The highest counts of potential pathogens and indicator organisms were found on hand drying implements required for paper towel dispensing. Closely following these were faucet handles (where present) and sink countertops. The integrity of the entire personal hygiene process can be compromised by hand drying, which, due to lack of "hands-free" or touchless function, of necessity carries the risk of cross-contamination.

Having clear employee Sanitation Standard Operating Procedures (SSOP) directives outlining when, where and how employees should wash their hands if important. Training of employees and managers needs to be on an ongoing basis. Records of the training program may be important in protecting the company in the event of legal proceeding, but remember, records can become a two-edged sword.

Back to top

EFFECTIVE TECHNIQUE
The following is a description of the key elements for effective sanitary handwashing technique. It conforms to HACCP guidelines designed to reduce the risk of foodborne illness. It addresses the handwashing process, including hand drying and skin health. The information provided here is based on extensive literature review covering all available information on handwashing/drying microbiology and personal hygiene research sponsored by Georgia-Pacific Corp. and feedback/information from industry sources/customers.

The description and procedures described here should be considered current best practices. It identifies hazards that exist with each aspect of the handwashing and drying process and is written for those truly serious in improving the effectiveness of personal hygiene.

Back to top

EFFECTIVE SANITARY HANDWASHING TECHNIQUE MEETING HACCP REQUIREMENTS:

A. Handwashing station
Handwashing should be performed at a designated handwashing station consisting of:

1. Sink
   
2. Suitable sanitary warm water source. Water used for personal hygiene should be treated and/or filtered on a regular basis, and test data should be kept on file attesting to sanitary status.
   
3. "Hands-free" paper towel dispenser.
   
4. Handwashing station that is maintained in clean, organized state, with cleanup on a regular basis. Soap and towels need to be replenished before being emptied.
   
5. Soap that is non-irritating or sensitizing. I should contain a recognized active ingredient with fast broad-spectrum activity (have efficacy data on file)

B. Handwashing

1. Moisten hands with warm water.
   
2. Use 1-3 ml soap of a soap formulation known to be gentle to skin, having proven benefits.
   
3. Hand wash time that includes lathering with soap should be 15-20 seconds.
   
4. Use of antimicrobial soap is now being considered as optional, as similar efficacy can be achieved by bland soap. That said, the formula must include antibacterial preservative ingredients of sufficient strength to prevent product contamination, this in effect makes it a mild antimicrobial soap.
   
5. Friction should be used during the washing process (palm, top of hands, rubbing in between fingers vigorously). It has been observed that thumbs and tips of fingers are frequently missed during handwashing, as well as the fact that left hands are often washed better than right hands. The technique used should address these known handwashing deficiencies.
   
6. A good lather should be developed through vigorous rubbing during the soaping process. Hands should be washed up to the elbow or to include exposed skin beyond sleeve of protective work clothing, such as smock or uniform.
   
7. Use a fingernail brush or fingernail cleaning tool to clean under fingernails, only if necessary. Use fresh, preferably sterile, fingernail implements (see Section E, Fingernails).
   
8. The friction employed during the washing process aided by surfactants in the soap will loosen bacteria from hands, as well as flakes of skin, which may harbor bacteria.

C. Rinsing

1. Rinsing well in warm water at an adequate flow rate (3-4 liters/minute). During the rinse, hands and fingertips should be positioned down into sink with rinse progressing from elbow or forearm to fingertip. In this way, water is drained from fingertips into sink.
   
2. It is important to remove all soap residue from hands during rinsing, as irritation can develop due to prolonged exposure to soap components.

D. Hand Drying

1. Hands should be dried in a sanitary manner using methods resulting in frictional removal of remaining transient organisms. Single-use paper towels have been proven above all other methods to effectively remove both transient and normal flora along with loose skin cells. Friction provided during the drying process can be an effective final step for microbial removal.
   
2. Dry hand thoroughly, as wet hands can pick up and transfer more contamination than dry hands.
   
3. Dry hands in a way in which hands do not become re-contaminated. Touching of paper towel dispenser buttons, cranks or levers or use of hot air dryers can re-contaminate hands, resulting in cross-contamination.
   
4. Avoid contact with contaminated surfaces, such as sink or faucet handles, which can result in cross-contamination. If a faucet is used which required full grasp of the faucet handle, then leave the water running after rinsing hands. After drying hands, grasp the faucet handle with the used paper towel and turn the water off.

E. Fingernails

1. It should be realized that a significant portion of resident and transient hand flora exist in the area around nail folds.
   
2. Fingernails should be kept trimmed and clean. Sharp edges should be eliminated. It is important to maintain trimmed fingernails to reduce chances of glove puncture.
   
3. Use fingernail brush or fingernail brush or fingernail cleaning tool only when necessary and choose a brush with specific ability to clean subungal region of soil. Bristles should not be too coarse, or skin damage can result.
   
4. Fingernail implements are easily subject to contamination and can result in the injection of potentially infectious material into skin and nail area. For this reason, fingernail brushes should be used judiciously and should be effectively sanitized between uses. If this cannot be achieved in the workplace, then as a minimum brushes can be assigned to employees for use at home, with a requirement for employment being clean trim nails.

F. Gloves

1. Use of gloves does not eliminate the need for sanitary handwashing and drying. Gloves can provide a false sense of security.
   
2. Gloves should be put on hands in such a way that they do not become contaminated by touching unclean surfaces, clothing or other parts of the body.
   
3. Gloves should be changed at regular intervals (at least once per hour); after touching contaminated surfaces or utensils; or if punctured.
   
4. Gloves should be changed after sneezing or coughing onto gloves or touching face, hair or unsanitized clothing.
   
5. Be mindful of possible glove allergies, hyperhydrosis and the possibility of food product, sanitizing chemical or process chemical entering the glove, causing adverse consequences.

G. Handwashing frequency
Extremely high handwashing frequency can have negative effects on skin health, due to physical disruption of skin barrier properties. When this occurs, skin cracking and sores can result, having overall adverse consequences on hygiene. Therefore, the acceptable frequency of handwashing needs to be established based on meeting the goals of reducing hand contamination events, insuring full sanitary compliance and safe food product (task appropriate).

That stated, hands should be washed:

1. Upon entry to work area.
2. As often as needed to remove soil and prevent product contamination.
3. After eating, drinking, smoking or handling money.
4. After using the toilet.
5. After sneezing or coughing onto hands or touching face, hair or unsanitized clothing.
   
6. After touching any dirty surface, soiled equipment or utensil.
   
7. Between glove changes.
   
8. When switching from raw food handling to cooked or ready-to-eat food preparation.

H. Skin damage, injury and skin health

1. Handwashing procedure should be designed to minimize skin damage. Avoid procedures, which result in skin abrasion, direct contact with strong solvents, scalding water or harsh chemicals. Rinse hands well to remove soap residue. Failure to do so can result in skin irritation with or without other contributing causes listed above.
2. Cuts, sores and rashes should be treated with antibiotic cream, covered with a bandage and a protective waterproof coating. Gloves should be worn to prevent contamination. Dressing should be changed if the bandage gets wet.
3. An antimicrobial-containing skin lotion could be considered as a means of maintaining skin health, barrier properties and minimizing drying and/or cracking. During winter months, due to cold, dry conditions, hands are most subject to drying or cracking. Hand lotion should be dispensed in a way to prevent possible lotion contamination.
4. Alcohol based instant hand sanitizers provide emollients and kill germs making them a good alternative to traditional hand lotions.
5. Treat skin rashes and cracking seriously and aggressively, because colonization by potential pathogens can occur. If necessary, change the employee to a job, which lowers handwashing frequency, exposure to offending chemicals or activities resulting in skin abrasion.

I. Instant Hand Sanitizer

1. Alcohol based instant hand sanitizer should be viewed as an adjunct to handwashing. Hands must be clean free of grease and grime for instant hand sanitizer to do its job.
2. Instant hand sanitizer can be used if there is no visible soil to reduce the risk of cross-contamination.
3. Be cognizant of possible sticky emollient residue that can possibly pick up and transfer microbial contamination.
   
   

Back to top

Barry S. Michaels
Senior Product Development Manager
Georgia-Pacific Corporation

Barry Michaels began his microbiology career, with the study of viral and cancer inhibitory substances, at Variety Children's Research Foundation, in Miami Florida, publishing in journals such as Nature and Cancer Research. He has worked for Georgia-Pacific, for the last 10 years, on issues and projects involving regulatory affairs, product development and product safety. He has recently performed an extensive review, of the microbiological aspects of personal hygiene, as pertinent to HACCP and the food industry.

Over 30 years experience in the field of infectious disease investigation, control and prevention. This includes work on a variety of viral and bacterial infectious disease microorganisms, under various test conditions and diverse venues. Initial interest was focused on the field of antiviral agents and viral induced tumor inhibitory substances interferon, etc. Work progressed to include related aspects in the marine sciences, exploring naturally occurring cytotoxic agents, marine viral agents and immunology. After a period spent as an independent consultant to governments, industry and non-profit scientific organizations, on diverse projects involving various aspects of microbiology, on diverse projects involving various aspects of microbiology, began work for Georgia-Pacific in the field of personal hygiene microbiology, product safety and product development. More recent work has included studies on the dynamics of surface cleaning/disinfection and enhancement of personal hygiene effectiveness.