Scientific Evidence Supports the Use of Alcohol-Based Hand Sanitizers as an Effective Alternative to Hand Washing in Retail Food and Food Service Settings When Heavy Soiling Is Not Present on Hands

Abstract

Suboptimal food worker health and hygiene has been a common contributing factor in foodborne disease outbreaks for many years. Despite clear FDA Model Food Code recommendations for hand washing and glove use, food worker compliance with handwashing recommendations has remained poor for more than 20 years. Food workers’ compliance with recommended handwashing is adversely impacted by a number of barriers, including complaints of time pressure, inadequate number and/or location of handwashing sinks and handwashing supplies, lack of food knowledge and training regarding handwashing, the belief that wearing gloves obviates the need for hand washing, insufficient management commitment, and adverse skin effects caused by frequent handwashing. While many of the issues related to poor handwashing practices in food service facilities are the same as those in healthcare settings, a new approach to healthcare hand hygiene was deemed necessary over 15 years ago due to persistently low compliance rates among healthcare personnel. Evidence-based hand hygiene guidelines for healthcare settings were published by both CDC in 2002 and by the World Health Organization in 2009. Despite similar low handwashing compliance rates among retail food establishment workers, no changes in the Food Code indications for handwashing have been made since 2001. In direct contrast to healthcare settings, where frequent use of alcohol-based hand sanitizers (ABHSs) in lieu of handwashing has improved hand hygiene compliance rates and reduced infections, the Food Code continues to permit the use of ABHSs only after hands have been washed with soap and water. This general interest manuscript provides clear evidence to support modifying the FDA Model Food Code to allow the use of ABHS as an acceptable alternative to handwashing in situations where heavy soiling is not present . Emphasis on the importance of handwashing when hands are heavily soiled and appropriate use of gloves are still indicated.

Comparative Assessment of the Efficacy of Commercial Hand Sanitizers Against Human Norovirus Evaluated by an in vivo Fingerpad Method

“…Hand hygiene is an important means by which to reduce transmission of hNoV, the leading cause of acute viral gastroenteritis and also foodborne disease ( Scallan et al, 2011 ; Hall et al, 2013 ). While proper hand washing with soap and water is considered the gold standard hand hygiene intervention, it has been shown that compliance with handwashing requirements in certain food handling settings, such as restaurants, is low ( Allwood et al, 2016 ; Boyce and Schaffner, 2020 ). Although hand sanitizers are not a substitute for handwashing by food handlers in the retail food sector, they may be used by food handlers after performing a handwash, which has been shown to significantly improve the overall efficacy of the hand hygiene treatment ( Edmonds et al, 2016 ).…”

“…For example, a recent study found that 60–80% of foodservice establishments were out-of-compliance for employee handwashing ( Verrill et al, 2021 ). Given the historical low compliance metrics with handwashing, and the fact that handwashing is the only permitted option for performing hand hygiene in retail food settings, there has been an interest in developing and evaluating alternative hand hygiene measures, including hand sanitizers ( Allwood et al, 2016 ; Boyce and Schaffner, 2020 ). Taken together, there is a clear need for fast, convenient, and effective hand hygiene treatments for hNoV control on human hands in food retail, processing, and harvesting environments.…”

Association between years with incidence of communicable diseases focused on COVID-19 and hand hygiene among adults in South Korea: a cross-sectional study

“…The dependent variable was the total score of handwashing calculated by a questionnaire including four common questions during the survey years. The questionnaire consisted of contents related to the investigation of previous studies [29][30][31][32]. The handwashing behavior questions were about handwashing "before eating", "after toilet use", "after going out", and "with sanitizer", and scores were assigned from four points.…”

Ethanol is indispensable for virucidal hand antisepsis: memorandum from the alcohol-based hand rub (ABHR) Task Force, WHO Collaborating Centre on Patient Safety, and the Commission for Hospital Hygiene and Infection Prevention (KRINKO), Robert Koch Institute, Berlin, Germany

“…Since norovirus is responsible for most (58%) cases of foodborne illness of known etiology [ 50 ], causing 125 million (95% UI 70–251 million) cases globally [ 51 ], there have been studies to compare hand washing vs ABHR. There is clear evidence to support modifying the FDA Model Food Code to allow the use of EBHR as an alternative to hand washing when heavy soiling is absent [ 52 ]. Indeed, medical staff consider hand washing to be inadequate for hand hygiene, especially for bacterial pathogens.…”