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Improving Hand Hygiene Compliance in Food Service

Alison Ziemianski
February 12, 2019



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Viruses, bacteria, and parasites are commonly transmitted to food by way of improperly washed hands. Approximately 97% of foodborne illness in the U.S. can be attributed to improper food handling practices(1). The CDC estimates that 48 million people get sick, 128,000 are hospitalized and 3,000 deaths per year can be attributed to foodborne diseases(2). Hand washing with soap removes germs from hands helping to prevent the spread of bacteria and infections. Germs from unwashed hands are easily transfer during the preparation of food and drinks. 



There are significant economic and public health issues related to foodborne diseases. The USDA’s Economic Research Service estimates the cost of foodborne illnesses in the U.S. to be a staggering $15.6 billion. According to a study by researchers at Johns Hopkins Bloomberg School of Public Health the cost of a single foodborne illness outbreak at restaurant could range between $6,330 to $2.6 million USD, depending on the severity of the outbreak, lawsuits, fines and legal fees, as well as the number of employees and guests impacted by the incident(3).  So why is hand washing so frequently overlooked in food service when the impacts are so staggeringly high?



From the deli counter at the supermarket to the kitchen of a restaurant there are approximately 14 million people working in the food service industry in the U.S(4). Improvement of food worker hand hygiene compliance requires more than just the basic food safety education provided in new hire training. Proper hand washing is essential in the prevention and spread of disease, yet it is estimated that up to 40% of food related outbreaks are related to poor personal hygiene such as poorly or improperly washed hands of food workers. A study by the Oregon State University, Department of Public Health on Food workers' perspectives on hand washing behaviors and barriers in the restaurant environment found that time constraints, inadequate facilities and supplies, lack of accountability, lack of involvement of managers and coworkers, and organizations that were not supportive of hand washing are some of the barriers affecting hand washing practice(5). The fast pace of the food service industry, high staff turnover, and language barriers also impact hand hygiene compliance. To drive long term behavior changes hand hygiene must become a part of the organizational culture of every food service establishment.




Effective hand hygiene at every stage of the food production process is critical in minimizing the occurrence of foodborne illnesses. A sustainable and effective program recognizes the importance of a strategic and multi-level approach including ongoing training, providing properly located hand washing stations with the appropriate products, ranging to monitoring of hand hygiene compliance, and providing food workers with feedback regarding performance. Monitoring programs range from direct observation which is time consuming and prone to observation, observer and selection bias; to self-reporting which is relatively inexpensive and provides an overview of overall hand hygiene activity but does not provide insight into timing of actions and by whom; to automated/electronic monitoring systems, while costly to implement may reduce observation bias and provide detailed information about hand hygiene behaviors.



A successful hand hygiene program involves continued focus on education, awareness and monitoring and involves both management and coworkers in the training. Additional factors to consider(6):



  • A hands-on training program that orients new employees to correct hand washing practice and more advanced education about foodborne illness.
  • Training on best practices for wearing gloves.
  • Easily accessible hand-washing facilities stocked with necessary supplies.
  • Signage in the common languages spoken in the facility that contain visual cues.
  • Incentives for elevated levels of compliance and reprimands for those who ignore hand hygiene policies.
  • Involvement of health departments and inspectors in providing managers and food workers with advice and consultation on improvement of hand washing practice.



Understanding the root cause of non-adherence to hand hygiene policy is key to developing the framework for procedures that are more easily adopted by all levels of staff and management. Promoting and influencing hand hygiene culture is ongoing and success requires continued support, training, monitoring and awareness activities.



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