SaniTwice: A Novel Approach to Hand Hygiene for Reducing Bacterial Contamination on Hands When Soap and Water Are Unavailable

Abstract

The risk of inadequate hand hygiene in food handling settings is exacerbated when water is limited or unavailable, thereby making washing with soap and water difficult. The SaniTwice method involves application of excess alcohol-based hand sanitizer (ABHS), hand "washing" for 15 s, and thorough cleaning with paper towels while hands are still wet, followed by a standard application of ABHS. This study investigated the effectiveness of the SaniTwice methodology as an alternative to hand washing for cleaning and removal of microorganisms. On hands moderately soiled with beef broth containing Escherichia coli (ATCC 11229), washing with a nonantimicrobial hand washing product achieved a 2.86 (±0.64)-log reduction in microbial contamination compared with the baseline, whereas the SaniTwice method with 62 % ethanol (EtOH) gel, 62 % EtOH foam, and 70 % EtOH advanced formula gel achieved reductions of 2.64 ± 0.89, 3.64 ± 0.57, and 4.61 ± 0.33 log units, respectively. When hands were heavily soiled from handling raw hamburger containing E. coli, washing with nonantimicrobial hand washing product and antimicrobial hand washing product achieved reductions of 2.65 ± 0.33 and 2.69 ± 0.32 log units, respectively, whereas SaniTwice with 62 % EtOH foam, 70 % EtOH gel, and 70 % EtOH advanced formula gel achieved reductions of 2.87 ± 0.42, 2.99 ± 0.51, and 3.92 ± 0.65 log units, respectively. These results clearly demonstrate that the in vivo antibacterial efficacy of the SaniTwice regimen with various ABHS is equivalent to or exceeds that of the standard hand washing approach as specified in the U.S. Food and Drug Administration Food Code. Implementation of the SaniTwice regimen in food handling settings with limited water availability should significantly reduce the risk of foodborne infections resulting from inadequate hand hygiene.

Efficacy of two hygiene methods to reduce soil and microbial contamination on farmworker hands during harvest

“…However, hand washing with soap is more effective in reducing the prevalence of contamination and specifically of Enterococcus spp (Burton et al, 2011). On the other hand, ABHS is significantly better than hand washing at reducing levels of Escherichia coli (Edmonds et al, 2010) and fecal streptococci (Pickering, Boehm, Mwanjali, & Davis, 2010). To our knowledge, data about the efficacy of soap and alcoholbased products to reduce Bacteroidales in hands is very limited or not available.…”

“…One hand hygiene intervention that may inactivate and remove microbes despite soiled hands is SaniTwice™, a two-step technique where an excess of ABHS is applied to hands and removed with paper towels, followed by a second, normal volume ABHS application (Edmonds et al, 2010). SaniTwice™ has been shown to reduce E. coli on hands soiled with beef broth and raw hamburgers (Edmonds et al, 2010).…”

“…SaniTwice™ has been shown to reduce E. coli on hands soiled with beef broth and raw hamburgers (Edmonds et al, 2010). Although use of ABHS is not currently an FDA-recommended hand hygiene intervention, it may be an effective alternative method when hand washing with soap and water is not feasible.…”

Assessment of anti-Salmonellaactivity of boot dip samples

“…Ideally boot dips should be used in conjunction with a boot change for entry into each individual house, since no disinfectant is likely to be effective within the few seconds that it takes to enter a poultry house (Allen & Newell, 2005;Edmonds et al, 2010). Dips should not be prepared or used in metallic containers and not be used if past their expiry date.…”

Hand contamination during routine care in medical wards: the role of hand hygiene compliance

“…The effectiveness of AHRs compared with water and soap has been investigated extensively in experimental studies (Edmonds et al, 2010;Hobson et al, 1998;Kampf et al, 1999). These studies have shown a clear reduction in the number of c.f.u.…”