Hand Washing Basics for the Food Industry

The global COVID-19 pandemic taught us all about the need for regular and effective hand hygiene (1). Some of the lessons learnt during that time are important for us to remember now as we move forward, particularly in relation to combating the on-going food safety challenges.

The challenge

Handwashing is a basic, yet critical personal hygiene practice for preventing contamination and disease within food handling establishments. According to the CDC, about 89% of foodborne illness outbreaks occur due to inadequate handwashing by food workers (2). Many key foodborne pathogens can be controlled through proper hygiene, including noroviruses, Salmonella, Campylobacter, E. coli, Listeria and Vibrio cholerae. A recent three-year USDA observational study showed that participants handling raw poultry did not even attempt to wash their hands or did not wash their hands sufficiently about 95% of the time before and during meal preparation, thereby increasing the chances of direct contamination of prepared foods by contaminated hands (3).
Even when food handlers do wash their hands, it may not be enough. A 2004 FDA study involving food workers at full service restaurants showed that, on average, 3 out of 4 handwashes failed to meet the required quality compliance standards (4). Monitoring of hand hygiene (5) after handwashing revealed a pattern of commonly missed areas:

Illustration by iStock Photo*, edited by Remco

As illustrated above, the greatest concentration of microbes (including pathogens), and dirt exist under the fingernails, which is unsurprisingly the most difficult area to properly clean. Other areas of concern are around the webbing of hands, skin ridges, palm lines, knuckles, and wrists.

How nailbrushes can help

Cleaning of the areas highlighted above, and of the hands in general, could be improved by using a nailbrush (6). The bristles of a nailbrush can help clean underneath fingernails and can assist in cleaning other areas of the hands. The use of a nailbrush specifically features in the US Food Code sub-paragraph 3-301.11(E)(6), which states, in part, that,

‘Food employees (not serving a highly susceptible population) may contact exposed, ready-to-eat food with their bare hands, if there are provisions and documentation showing that two or more of the stated control measures have been adopted’.

This list of acceptable control measures includes,

• double handwashing,
• the use of nail brushes,
• hand antiseptic use post-handwashing,
• and more.

Additionally, Annex 3 of the Code, section 2.301.12 on the cleaning procedures of hands and arms, specifies, in part, that,

“Proper use of single-use fingernail brushes, or designated individual fingernail brushes for each employee, during handwashing procedure can achieve up to a 5-log reduction in microorganisms on the hands.”

Hand hygiene compliance

In brief, hand hygiene is a critical requirement in FDA, FSIS, EU, CODEX-based and public health regulated food handling operations, and an integral component of global food safety standards (e.g., GFSI-benchmarked programs like SQF, BRCGS, and FSSC22000). A handwashing violation in a food facility could lead to a serious regulatory non-compliance or trigger an auto-fail for certification audits. Effective handwashing practices are therefore a matter of high priority.

The following requirements are key to improving handwashing practices:

(1) Availability of staff facilities and resources – Handwashing must be done only at a properly equipped station that has dedicated handwashing facilities conveniently accessible to employees. These stations should be fitted with sinks supplied with potable water at a suitable temperature and pressure, appropriate hand cleansers, nailbrushes, and a proper method of hand drying. The absence of any of these requirements will result in poor hand hygiene. It is also essential to note that wearing clean gloves to handle exposed food is never a substitute for proper handwashing.

(2) Enhanced awareness – Handwashing education (on the why), training (on the technique), and refresher training (at least annually, or if any requirements have significantly changed) need to be mandatory, especially for food workers and contractors dealing with exposed food in the establishment. A handwashing poster (illustrated example below) at visible locations can also be a helpful communication aid:

Illustration by iStock Photo*

(3) Understanding the importance of hand hygiene in food safety systems – Employees need to learn about hand hygiene, cross-contamination prevention, and its role in food safety. It is equally as important to understand that dirty hands may contaminate surfaces, equipment, utensils, and exposed food products, and that unhygienic or insanitary conditions may re-contaminate clean and hygienic hands.

(4) Focusing on food safety culture – Fostering a hand hygiene culture is an important part of a site’s food safety and quality plan. According to a study conducted by EHS-Net, about 9 handwashes are recommended per hour for foodservice workers who carry out various activities after which handwashing is necessary. However, it was observed that workers in restaurants only washed their hands about 2-3 times an hour (7), which clearly shows a wide gap in handwashing compliance. Therefore, management leadership and commitment toward providing the necessary resources, competencies, and tools help encourage more frequent and consistent handwashing compliance from employees.

In summary

The use of a nailbrush is just one of the effective resources for a hand hygiene program. Here are some short takeaways that should help if you decide nailbrushes are right for your facility:

1. Assess food safety hazards and their associated risks and consider whether the use of a nailbrush can be one of the controls.
2. Use high-quality, durable, hygienically designed nail brushes. These should be cleaned and sanitized before and after use. Replace badly damaged or worn-out nailbrushes.
3. Treat each brush as a personal employee item—they should be maintained and stored properly. Nailbrushes cannot be shared between users.

Since most foodborne illness outbreaks happen because of inadequate handwashing from food employees, helping employees learn better hand hygiene compliance raises the bar for food safety and sanitation in a facility.

Selected References:

(1) Prevent the spread of COVID-19 by washing your hands often | National Academies
(2) Food Worker Handwashing and Food Preparation - EHS-Net Study Findings and Recommendations (cdc.gov)
(3) Handwashing for Food Safety (usda.gov)
(4) Report on the Occurrence of Foodborne Illness Risk Factors in Selected Institutional Foodservice, Restaurant, and Retail Food Store Facility Types - 2004 (fda.gov)
(5) Webster, S., & Benson, L. (2007). Hand hygiene guidelines. Manchester, England: NHS Manchester Infection Control.
(6) Amend Food Code 3-301.11 - Double Handwashing and Nail Brush Usage | Council I | 2023 Biennial Meeting | Conference for Food Protection | Conference for Food Protection
(7) Food Worker Handwashing in Restaurants | EHS-Net | EHS | CDC

*Note: The images provided have been sourced from istockphoto.com. The closest author references we can give credit to are as follows:

- Webster, S., & Benson, L. (2007). Hand hygiene guidelines. Manchester, England: NHS Manchester Infection Control.

- Smith, D. (2009). Guideline no. 62. Hand hygiene: guidelines for best practice. Campden BRI, Station Road, Chipping Campden, Gloucestershire, GL55 6LD, UK