Handwashing
December 2006

Letter to the editor
29.dec.06
Manhattan Mercury
p. A6
The Centers for Disease Control and Prevention estimates that up to 25 per cent of the 76 million annual cases of foodborne illness in  the U.S. could be eliminated with proper handwashing.
Based on the available evidence, proper handwashing consists of:
o wet hands with water;
o use soap;
o lather all over hands by scrubbing vigorously, creating friction,  
reaching all areas of the hands, wrists and between fingers, and counting to at least fifteen; o rinse hands; and, o dry hands,  
preferably with paper towel.
The all-in-one handwashing units at the Manhattan Town Center and K-State student union restrooms may be insufficient to control the  spread of dangerous microorganisms  (Look, Ma, no handles, Manhattan  
Mercury, Dec. 28/06). The washing time before the hand dryer is activated appears inadequate, as does the drying procedure itself.  
Any remaining moisture can support bacterial growth, or can limit people from washing their hands in the first place (who wants damp  
hands?). Anecdotal reports from campus reveal that some find the units inconvenient and that soap sometimes misses hands when being dispensed.
One research study found that average bacterial counts were reduced when towels (either cloth or paper) were used to dry hands, the most significant decrease being with paper towels; hot air dryers produced a highly significant increase in all bacteria on hands.
Another study concluded that dangerous bacteria could survive handwashing with soap and water if hands were not dried thoroughly  
with paper towels. The friction created when drying hands with paper towel removes additional microorganisms.
Proper handwashing begins with access to proper tools. That is why paper towels are a necessary addition to any public bathroom.
Sincerely,
Doug Powell
Associate Professor
KSU Food Safety Network
1729 Pierre St
785-317-0560
dpowell@ksu.edu

Soap opera
16.feb.06
Doug Powell, Commentary from the Food Safety Network
http://foodsafety.ksu.edu/en/article-details.php?a=3&c=32&sc=419&id=878
From norovirus to avian influenza to prevention of numerous other
yucky things, thorough handwashing is routinely touted as the best
defense.
So why don't more people wash their hands?
I used to steal toilet paper.
As an undergraduate 25 years ago, and once my girlfriend showed me
how to get at the theft-proof rolls in the university centre, the
supplies of toilet paper in our household became one less student
expense.
My hockey bag is still filled with those little soaps and shampoos
from hotel rooms around the globe.
I was the kind of student -- and apparently I'm not alone --
University of Guelph administrators in Canada were worried about when
they say that residence students should provide their own handwashing
soap.
About a year ago, the university switched to sanitizers instead of
soap and paper towels in the residence washrooms because soap
dispensers, paper towels and garbage cans went missing.
That was before a recent norovirus outbreak sickened over 150
students, primarily in one university residence.
The university has now placed soap and paper towels in all residences
to help control the outbreak, and a team will review whether the soap
and paper towels will remain a permanent fixture.
The mother of one of the sick Guelph students said, "Who in your own
house carries your own soap to the washroom?" while a student stated,
"We pay so much money in tuition . . . I just don't think it should
be considered a luxury for us to have the basic things to keep
ourselves sanitary."
 From norovirus to avian influenza to prevention of numerous other
yucky things, thorough handwashing is routinely touted as the best
defense. The Centers for Disease Control and Prevention estimates
that up to 25 per cent of the 76 million annual cases of foodborne
illness in the U.S. could be eliminated with proper handwashing.
That's a lot fewer sick people.
So why don't more people wash their hands?
While some practice a Howard Hughes-like paranoia, study after study
shows that many are lazy when it comes to handwashing. The
proclamations to practice proper handwashing, on restroom posters, in
daycare facilities, in media scare stories, will always fail to
register with those who are impervious to risk -- that bad things
happen to someone else, not me.
But as the Guelph example demonstrates, anything that can even
slightly encourage proper handwashing and hygiene in general needs to
be encouraged -- and that means ready availability of soap, warm
water and paper towels.
Once available, the facilities have to actually be used, whether in
the workplace, the home, the university residence, or, the farm.
For example, one farmer who packs fresh vegetables recognized the
need for handwashing holiness and invested $10,000 to upgrade
washroom facilities and provide gloves to employees, only to find an
employee, his gloves still on, urinating on the ground outside the
washroom.
Proper handwashing and hygiene, especially in the minimum-wage, high-
turnover reality of the farm-to-fork food system, needs to be
enforced and encouraged.
If it's easy to say that people should just wash their hands, it's
even easier to say that sick food employees should just stay home.
In April 2005, a sick employee -- who had worked at a family run
restaurant in Calgary for 25 years -- passed the E. coli O157:H7 she
was carrying from her tainted hands to the Marshmallow milkshake
flavoring she was preparing to 16 customers, including a 15-year-old
who was hospitalized for nearly a month. The restaurant owner said
the contamination did not come from unsafe practices, but from a sick
staff member, and asked, "If someone brings it in from outside, what
can you do?"
You can stress proper hygiene, and, as an added hurdle, tell the sick
employee to stay home.
Carrabba’s Italian Grill, a Lansing, Michigan restaurant that  
was the
source of a norovirus outbreak that sickened over 400 people in late
January and early February, 2006, is about to discover the economics
of hygiene -- in the form of lawsuits.
Already, reports are surfacing that sick employees showed up to work.
A food service employee in Lansing recently wrote that "What happened
at Carrabba's could occur at any of our local eateries. Not because
their kitchens are not clean, not because they don't follow all of
the safety standards, but because sick employees report to work. …
There is an internal peer pressure to report to work even when you
are ill, not to mention that a day without pay can be crucial for
some families."
The industry spokesthingies may say that sick employees should not
work, but the reality is, no work, no pay.
So, for the food industry, tell your sick employees to stay at home,
and perhaps even provide incentives, like allowing for a couple of
sick days. The cost of a few workers abusing the system pales in
comparison to the lawsuits and lost business.
For the University of Guelph residences, soap and paper towels should
remain a fixture. Whatever the students are stealing, it probably
pales in comparison to the salaries and overtime for those who had to
manage the outbreak.
And if all of this sounds inconvenient, ask one of the hundreds who
got sick.
Douglas Powell is scientific director of the Food Safety Network at
the University of Guelph.