Inspiring Handwashing Compliance

By Lisa Lupo

When a 2004 FDA study found that food establishments were often out of compliance with the Food Code requirements for proper and adequate handwashing, the agency developed the Employee Health and Personal Hygiene Handbook.

Even 13 years later, it includes some lesser known, or followed, handwashing requirements.

For example, do you know …

Although recent research has shown that there is statistically little difference between the cleanliness of hands washed in hot or cold water (QA, October 2017, https://bit.ly/2sHVSt2), the FDA Food Code specifies a minimum handwashing water temperature of 100°F. As the agency explains in the handbook, not only is this generally more comfortable than cold water, thus encouraging handwashing for the recommended duration, water temperature also can affect the solubility or emulsification of some soils. Warm water also is more effective than cold in removing fatty soils, and an adequate flow of warm water will cause soap to lather and aid in flushing soil quickly from the hands.

It is fairly common knowledge that workers should wash their hands before entering the processing area and after using the toilet; using tobacco, eating, or drinking; and switching between raw and RTE food handling. But do you also instruct employees to wash their hands after touching any bare human body part (other than just-washed hands and lower arms), coughing, sneezing, or blowing the nose, and before putting on single-use gloves and between glove changes?

…What managers are responsible for? Managers are responsible for ensuring that food employees wash their hands, as required. To enable this, they are to:

• Provide accessible, properly maintained, designated handwashing sinks with clean, running warm water; soap; and paper towels or other approved means for drying.
• Post signage that notifies food employees of the handwashing requirement.
• Monitor food employees to ensure proper handwashing and good hand hygiene protocol during the work shift.

… About other general rules of handwashing?

• Hand antiseptics (hand sanitizers) cannot be used in place of adequate handwashing in food establishments. They should be used only in addition to proper handwashing.
• You should avoid recontamination of hands and arms by using a clean barrier, such as a paper towel, when turning off hand sink faucets or touching the handle of a restroom door.

TIPS FOR COMPLIANCE. According to statistics from the World Health Organization, it is estimated that the consistent washing of hands with soap and water could reduce diarrheal disease-associated deaths by up to 50%. According to Handwashingforlife, “The chain of cleanliness risk factors is led by poor handwashing. It is the #1 cited element in outbreak investigations.” Thus, appropriate handwashing practices and the wearing of gloves can greatly reduce the risk of foodborne illness and other infections.

But it’s not always easy to ensure workers are washing their hands thoroughly or donning clean gloves when needed — even when handwashing and glove stations are set at every entrance. So, QA asked a number of industry authorities for tips on what they do or see done in the plant, not only to require, but to motivate, employees in their handwashing and glove-donning efforts.

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Following are their responses:

Back-up gloves. Teach the staff to put three to five gloves on each hand after washing hands. When the hand touches a non-food, non-food contact surface, different allergen or food product, cart, refuse container, etc. or the employee returns to the immediate work area, they are taught to peel off a glove. (A supervisor also should be trained to identify when one touches these non-food contact surfaces and alert staff to remove the glove). When a glove rips, tears, or is wearing thin, alert the staff to remove the glove. When one or both hands are without a glove; remove the other hand’s glove(s) and wash both hands. More experienced food handlers only need three gloves on each hand; novices or new hires should have five gloves on each hand. Four is generally a good number and not too bulky, though gloves should fit snug, not tight. (Bobby Love, Director, Global Food Safety, Technical and Regulatory Affairs, Phillips Foods)

Caught working safely. At MZB, we recognized the need to make handwashing, at the very least, more convenient, so we installed additional stations both in our break area and in strategic locations on the production floor. (We used portable stations on the floor to avoid the high cost of additional plumbing and contract work.) We also have a program that is several years old called “Caught working safely.” As part of the program to promote safe work habits, supervisors give employees a “caught working safely” card every time they’re observed working in a safe fashion or following one of our safety measures to a T. The employee can drop the card in a box, from which we draw a winner each month, who receives a prize. We’ve expanded this program now to include times a supervisor observes an employee washing his/her hands prior to entering production or while working. Naturally, we hold monthly safety and GMP trainings, at which we drill home the importance of good hygiene, GMPs, and workplace safety to the continued success of our operation. (Nigel J. Coelho Director of Manufacturing, Moonachie Opeartions, Massimo Zanetti Beverage)

You’re being watched. A German field study published in February 2018 was based on the idea that humans modify their behavior in a socially desirable way when being watched by others. Building on the assumption that hand hygiene behavior is socially desirable, and individuals would show stronger hand hygiene compliance when being watched, the researchers placed a placard in a women’s public restroom advising that handwashing protects against the spread of pathogens. The placard included a stylized image of human watching eyes. In another restroom, the placard with three stars in place of the eyes was used as a control condition. The analysis revealed a significantly higher percentage of hand hygiene compliance in the watching eyes restroom (83.3%) compared to the control restroom (71.9%). (https://bit.ly/2kOi7d9)

Monitor compliance. Provide enough fully equipped handwashing stations to allow the employees to wash hands in a reasonable period of time; if they have to wait too long, they may be more inclined to skip handwashing. Encourage peer-to-peer monitoring and reporting of failure to follow handwashing procedures; conduct periodic compliance checks; station monitors near sinks with stop watches to see who washes hands correctly or who skips; and/or install CCTV camera to allow random unobserved observation of handwashing. (Elis M. Owens Director of Technical Services, Birko)

APPLAUD AND REWARD. In addition to implementing monthly or quarterly hand hygiene training, Best Sanitizers recommends motivational efforts include:

• Lead by example. When management employees properly wash and sanitize their hands, it shows there is a true commitment to hygiene.
• Recruit a hand hygiene champion(s) for each shift. Sometimes it is better if a peer mentions the need for better hand hygiene than if management does.
• Applaud and reward employees for a job well done. Supervisors and managers should praise employees when they see an employee practicing proper hand hygiene. They should also correct employees when they see improper practices. Implement a Hand Hygiene Star Employee of the Month program to encourage workers to wash and sanitize their hands.
• Choose products employees will want to use. Look for hand soaps and sanitizers formulated with emollients to keep hands soft and healthy, even with repeated use.
• Show and tell. Perform a training with a product that shows areas missed in handwashing, so employees gain insight and see where they are deficient.

MAKE IT ATTRACTIVE. Savvy Food Safety President Francine Shaw details five ways to encourage handwashing by employees:

1. Provide a high-quality, user-preferred soap. Everyone wants to wash their hands if the soap smells good. Install touch-free, reliable, easy-to-service soap and paper towel dispensers, to ensure that these are always readily available. It’s helpful to supply paper towels to thoroughly dry hands as team members don’t typically have time to stand around a hand dryer, nor are these as effective as paper towels.
2. Keep the handwashing stations clean. No one wants to wash hands at a filthy sink.
3. Provide easy-to-understand awareness materials. Use materials such as posters or stickers in the restrooms, on walls, mirrors, and doors. These materials can be fun and whimsical and still get the point across that regular handwashing is essential.
4. Reward employees for good behavior. One example of an effective reward program is: You’ve Been Spotted Cards. Two versions of cards adorned with a Dalmatian (for the “spotted” theme) were created. From a distance, they appeared indistinguishable, but up close, they were unique: The positive cards were flagged for incidents in which the employee was spotted using good hand hygiene practices. These cards included a coupon good for a nominal “prize” (e.g., a cup of coffee or soft drink). When employees receive multiple positive reinforcement cards, they could use them together for a larger prize (e.g., a free lunch).

The second card reads, “We are putting you on the spot for not using proper hand hygiene.” The reason the cards look nearly identical is to prevent embarrassment for the employees receiving the second card. It’s impossible to tell from a distance whether someone has received a positive or negative card, so the system provides important information in a non-confrontational manner. It gives positive reinforcement but also notifies individuals (without public embarrassment) if they need to improve their hygiene habits.

5. Make it fun. Use posters, conversation starters, reward systems, games, etc., to reinforce messages about handwashing and explain why it is so important. Your team is more likely to buy in and comply with the protocols if they understand why they are important than if you just spew statistics and say, “Do it because I said so.” Most people don’t realize that something as basic as not washing their hands can cause an extreme illness or death. Employees don’t purposely avoid washing their hands in the hopes of making someone ill. They might not understand the connection between proper (and regular) handwashing and keeping customers safe and healthy. Don’t just state the rules — explain why these protocols are in place.

And ... from the FDA

• Train. Create opportunities to remind food employees each week about the importance of hand hygiene. Emphasize handwashing at the beginning of a shift, after using the toilet, after handling raw meat, and between changes of gloves. This emphasis will help keep good hand hygiene at the forefront. Make food employees aware of media coverage on local and national foodborne outbreaks. This awareness reinforces the reporting of symptoms, illness, and good handwashing procedures.
• Prioritize. When management enforces handwashing compliance as a mandatory requirement, employees are more likely to comply.
• Motivate. Use incentive programs and other motivation to encourage food employees to take ownership and practice good personal hygiene habits. Positive reinforcement and rewards for compliance have been proven to have a positive impact on improving handwashing compliance.
• Buddy up. Use a “buddy” system so that fellow food employees can support each other.

Whether you institute a buddy-up system, a caught-working-safely incentive, or multi-glove program, the key is to ensure workers — and supervisors — understand the importance of handwashing, are regularly encouraged to do so, and know the repercussions of non-compliance. The more handwashing is brought to the forefront in any way, the more it will be top of mind for all.

The author is Editor of QA magazine. She can be reached at llupo@gie.net.