Handwashing
December 2008

BARFBLOG: Dude, wash your hands – researchers required
30.dec.08
barfblog
Doug Powell
Barfblog Post
Handwashing compliance has been identified as a significant factor in reducing foodborne, hospital-acquired and other infectious disease. People say they wash their hands, but often don’t. Our goal is to develop evidence-based, culturally-sensitive messages using a variety of media to compel individuals to practice good handwashing in numerous settings, and to accurately evaluate the effectiveness of different approaches.
That’s a bunch of projects – and we’re looking for a bunch of people with diverse skills. Whatever your background, from microbiology to psychology, as long as you have excellent communication skills and can work both independently and collaboratively, we’re interested in chatting with you. Undergraduate or graduate students, if you’re interested – passionate – about compelling individuals to wash their hands and enhance public health, please contact Dr. Kate Stenske at kstenske@vet.ksu.edu, or Dr. Doug Powell at dpowell@ksu.edu.
Don’t eat poop – wash your hands.

UK: Call for cameras to check NHS hand washing
26.dec.08
Edinburgh Evening News
http://news.scotsman.com/health/Call-for-cameras-to-check.4821525.jp
Calls have been made for spy cameras to check on NHS hand washing.
Labour public health spokesman Dr Richard Simpson questioned the reliability of official monitoring of hand hygiene designed to combat hospital superbugs. And he called for covert camera surveillance to ensure all staff were washing their hands appropriately. Figures released under the Freedom of Information Act have shown that NHS Lothian audited only eight per cent of wards – 21 wards out of 260 – with most surveillance periods lasting only an hour. This compares, however, to more than 50 per cent of wards in NHS Forth Valley being surveyed, where 22 of its 42 wards were audited.
But concerns have been raised about staff being aware of audits, which it has been claimed leads to temporary changes in practice.
Earlier this week, Health Secretary Nicola Sturgeon ordered NHS boards to adopt a zero-tolerance approach to hand hygiene.

UK: Axe docs for not washing hands
22.dec.08
The Sun
Rhodri Phillips
http://www.thesun.co.uk/sol/homepage/news/article2061190.ece
Medics who fail to wash their hands could be sacked under new rules to stop superbugs in the NHS, it was revealed yesterday.
The “zero-tolerance” regime will apply to all staff in Scottish hospitals from next month.
But it is unclear when — or even if — the rest of the UK will follow the lead.
Ministers previously set a 90 per cent target for handwashing, to be met by February next year. But that has already been achieved and now health boards are being told to target the remaining ten per cent of staff who fail to keep their hands clean.
An aide to Health Secretary Nicola Sturgeon said it was “unacceptable” for medical staff to flout hygiene rules.
He said: “Hand hygiene is an important part of our drive to tackle healthcare associated infection. We are now adopting a zero-tolerance approach to non compliance.”

Handwashing: Hand hygiene saves lives
12.dec.08
Centers for Disease Control and Prevention
http://www.cdc.gov/features/handhygiene/
Hand hygiene is a simple thing and it's the best way to prevent infection and illness.
Clean hands prevent infections. Keeping hands clean prevents illness at home, at school, and at work. Hand hygiene practices are key prevention measures in healthcare settings, in daycare facilities, in schools and public institutions, and for the safety of our food.
In healthcare settings, hand hygiene can prevent potentially fatal infections from spreading from patient to patient and from patient to healthcare worker and vice-versa.
To that end, CDC has developed new resources for patients and healthcare providers.
Hand Hygiene Saves Lives: Patient Admission Video
CDC partnered with the Association for Professionals in Infection Control and Epidemiology and Safe Care Campaign to develop and launch a new hand hygiene video for patients and visitors in hospitals. The video teaches two key points to patients to help prevent infections: the importance of practicing hand hygiene while in the hospital and the appropriateness of asking or reminding their healthcare providers to practice hand hygiene.
Modeled after the video that airline passengers are required to view prior to take-off on a flight, this new video is intended to be shown to patients upon admission to the hospital. The goal is to inform patients at the beginning of their hospital stay about what they can do to help prevent infections throughout the duration of their stay.
The 5-minute video begins with a brief introduction on healthcare-associated infections. It is then narrated by a nurse character named Gayle who stresses the importance of hand hygiene for both patients and healthcare providers. There are two patient room scenes in which patients and visitors model the behavior of asking one another as well as their healthcare providers to perform hand hygiene – with positive results.
Patients and visitors should take an active role and become involved in their healthcare by practicing and encouraging others to practice hand hygiene during their hospital stay.
To download the video and accompanying brochures and posters in English and Spanish, please visit Hand Hygiene in Healthcare Settings.
Hand Hygiene Interactive Training Course
This new online training course reviews the key concepts of hand hygiene and other Standard Precautions to prevent healthcare-associated infections. It is intended for healthcare providers and includes a self-paced navigation program that allows users to learn through both text and image-based pages. The course also includes several interactive activities and questions, which reemphasize the learning objectives throughout. A unique close-captioned 60-second video demonstrates the appropriate technique for handwashing mid-way through the course. At the conclusion of the course there are creative posters and screen savers available for download.
The training course is available at Hand Hygiene in Healthcare Settings.

KANSAS: K-State study looks at why restaurant workers don't wash hands and follow other food safety practices
11.dec.08
Kansas State University
Jane Marshall
http://www.k-state.edu/media/newsreleases/dec08/foodsafe121108.html
MANHATTAN -- Why do restaurant workers -- who handle an estimated 70 billion meals and snacks in the U.S. every year -- sometimes not follow common food safety practices such as washing their hands properly or keeping work surfaces sanitary?
According to a recent Kansas State University study, restaurant workers blame time constraints, inconvenience, inadequate training and inadequate resources for failure to follow food safety practices.
K-State researchers conducted focus groups with restaurant employees to identify perceived barriers to hand-washing, cleaning work surfaces and using food thermometers. Foodborne illnesses are most commonly caused by poor personal hygiene, cross contamination and improper time/temperature controls.
Barriers, they found, were not only a lack of food safety knowledge but also often a lack of understanding why employees should comply with food safety guidelines. Previous research indicated that training increases knowledge regarding food safety issues, but that knowledge does not always translate into improved behaviors.
"We have used the results of this study to develop and implement an intervention program to address the barriers that training appears," said Amber D. Howells, an instructor of dietetics, registered dietitian and the study's first author.
The restaurant industry employs 13.1 million people, and 59 percent of reported foodborne illness outbreaks were associated with restaurants in 2005. Howells said outbreaks usually are directly related to food-handler error.
Because of the study, K-State researchers recommend that restaurant managers:
* Provide regular food safety training to their foodservice employees;
* Educate employees about the consequences of improper food handling to improve attitudes toward food safety;
* Place signs about consequences of improper food handling in food production areas;
* Encourage food safety compliance with verbal reminders and praise;
* Be good role models;
* Incorporate food safety practices into employees' daily routines to eliminate the perceptions that they do not have time to perform them.
Other researchers with the K-State's department of hospitality management and dietetics involved with the study included Betsy B. Barrett, associate professor and a registered dietitian; Kevin R. Roberts, assistant professor; and Carol W. Shanklin, professor, interim dean of the Graduate School and a registered dietitian. Also involved were Valerie K. York, an evaluator in K-State's office of educational innovation and evaluation, and Laura A. Brannon, associate professor of psychology.
For the study, two series of focus groups were conducted. Focus groups were to identify obvious barriers to following safe food preparation practices. The 34 participants in Group A, all restaurant employees involved in food preparation, received no special food safety training. The 125 participants in the second series of focus groups, Group B, were divided into 20 focus groups and received four hours of formal training from certified ServSafe instructors.
The research found that employees did not comply with food safety guidelines because of a variety of perceived barriers.
In Group A, additional barriers identified lack of space and other tasks competing with cleaning work surfaces; inconvenient location of sinks and having dry skin limiting hand-washing; and lack of working thermometers and thermometers in inconvenient locations.
Group B agreed with Group A, but added other barriers: lack of incentive to clean work surfaces and manager not monitoring the work and manager not monitoring the use of thermometers.
Research results were published in the August 2008 issue of the Journal of the American Dietetic Association. The study was funded by a grant from the U.S. Department of Agriculture to Shanklin. The $482,763 grant also is funding other food safety research.

BARFBLOG: Food handlers don't have time
11.dec.08
barfblog
Ben Chapman
http://barfblog.foodsafety.ksu.edu/2008/12/articles/culture-of-food-safety/food-handlers-dont-have-time/
Researchers at Kansas State published the results of a study of the barriers to food safety practices of food handlers. Conducting focus groups with 159 food handlers, split into 2 groups, the researchers report that food handlers not only have a lack of food safety knowledge but also often a lack of understanding why employees should comply with food safety guidelines (http://www.k-state.edu/media/newsreleases/dec08/foodsafe121108.html).Yep. Totally. So what do we do about it?
The recommendations the researchers provide are:
-Provide regular food safety training to their foodservice employees;
(sure, except training for knowledge change on it’s own doesn’t do much, as they state in their press release)
-Educate employees about the consequences of improper food handling to improve attitudes toward food safety; (we prefer to use “compel” instead of educate, education is too limiting).
-Place signs about consequences of improper food handling in food production areas; (kind of like our food safety infosheets? http://foodsafetyinfosheets.blogspot.com/)
And three food safety culture ideas -- (at barfblog we’ve been talking about food safety culture for a while, http://barfblog.foodsafety.ksu.edu/articles/culture-of-food-safety/, as have Frank Yiannas and Chris Griffith):
-Encourage food safety compliance with verbal reminders and praise;
-Be good role models;
-Incorporate food safety practices into employees' daily routines to eliminate the perceptions that they do not have time to perform them.
Hey this is great -- but what’s missing is the how. Just telling managers to make more time for food handlers isn’t very realistic. Food safety communications types, us included, need to get out and start testing food safety culture and measure behavior. And share the results so everyone can build on it.
I presented some similar findings of food handler barriers at IAFP 2007 and some qualitative data on food safety practices at food service (highlighting time pressures especially) at IAFP 2008. I don’t think the solution to time pressures is telling the industry to slow down, or more "education". I think we need to engineer processes and equipment (like self sanitizing knives), look to new tools (like using sanitizer during busy times, instead of handwashing) -- and test them. If they work, and they don’t slow the kitchen down, it’s an easy sell.
Our research in food safety culture needs to move to show me, don't tell me (http://barfblog.foodsafety.ksu.edu/2008/05/articles/food-safety-communication/
show-me-dont-tell-me/)

TEXAS: Wear scrubs? Then don't skimp on hand-scrubbing
02.dec.08
Houston Chronicle
Liz Austin Peterson
http://www.chron.com/disp/story.mpl/front/6144095.html
The Harris County Hospital District is stepping up efforts to get doctors to wash their hands frequently, enlisting patients to encourage good hygiene habits and implementing stiffer penalties for physicians who scrimp on scrubbing.
Laminated handouts that now come with every patient's first meal at Lyndon B. Johnson or Ben Taub general hospitals urge them to "gently remind their health care providers to wash their hands and wear gloves." Doctors caught treating patients without properly washing their hands face counseling by administrators and written reprimands in their employment files.
Hospital administrators across the country have focused for years on improving hand-washing rates in an effort to reduce hospital-acquired infections, which kill about 90,000 people every year, according to the U.S. Centers for Disease Control and Prevention.
Some post flyers reminding employees to wash their hands, while others have monitored supplies of soap and sanitizer to determine whether workers are washing up as they should.
The CDC and the Association for Professionals in Infection Control and Epidemiology released a DVD that hospitals can show to new patients that repeatedly emphasizes how important it is for everyone in the facility to wash their hands.
The stakes are even higher now that Medicare has stopped paying hospitals for the added cost of treating hospitalized patients who develop certain infections, such as catheter-related urinary tract infections.

UK: Hospital-style handwashes help to cut pupil illness
01.dec.08
Wales Online
http://www.walesonline.co.uk/news/wales-news/2008/12/01/hospital-style-handwashes-help-to-cut-pupil-illness-91466-22376620/
Hospital-style antiseptic hand-gel dispensers are helping to keep children in the classroom and out of the doctors’ waiting room .
A pioneering campaign at a Cardiff school is stopping the spread of germs and reducing sickness absence.
Peter Lea Primary is believed to be the first school in Wales to introduce the antiseptic hand-wash dispensers in the school corridors and the canteen.
And in just a few weeks of the dispensers being in use, early indications show that pupil sickness is down.
The hand-gel works in the same way as that used in hospitals to reduce the spread of superbugs such as MRSA.
The initiative is being led by pupils through the School Council and supported by staff as part of its Healthy Schools campaign.
The School Council – which is made up of representatives from each class – is now hoping to prove the case for the introduction of the hand-gel in all schools by monitoring the sickness absence this academic year and comparing it with last year.
The action at Peter Lea has been welcomed by Wales’ chief medical officer Dr Tony Jewell, who recently visited Ysgol Gymraeg Evan James Primary School in Pontypridd to encourage pupils to wash their hands to help beat the Norovirus, also known as the winter vomiting bug.