title: Hand hygiene regimens for the reduction of risk in food service environments.
abstract: Pathogenic strains of Escherichia coli and human norovirus are the main etiologic agents of foodborne illness resulting from inadequate hand hygiene practices by food service workers. This study was conducted to evaluate the antibacterial and antiviral efficacy of various hand  hygiene product regimens under different soil conditions representative of those in food service settings and assess the impact of product formulation on this efficacy. On hands contaminated with chicken broth containing E. coli, representing a moderate soil load, a regimen combining  an antimicrobial hand washing product with a 70% ethanol advanced formula (EtOH AF) gel achieved a 5.22-log reduction, whereas a nonantimicrobial hand washing product alone achieved a 3.10log reduction. When hands were heavily soiled from handling ground beef containing E. coli, a wash-sanitize  regimen with a 0.5% chloroxylenol antimicrobial hand washing product and the 70% EtOH AF gel achieved a 4.60-log reduction, whereas a wash-sanitize regimen with a 62% EtOH foam achieved a 4.11-log reduction. Sanitizing with the 70% EtOH AF gel alone was more effective than hand washing with  a nonantimicrobial product for reducing murine norovirus (MNV), a surrogate for human norovirus, with 2.60- and 1.79-log reductions, respectively. When combined with hand washing, the 70% EtOH AF gel produced a 3.19-log reduction against MNV. A regimen using the SaniTwice protocol with the  70% EtOH AF gel produced a 4.04-log reduction against MNV. These data suggest that although the process of hand washing helped to remove pathogens from the hands, use of a wash-sanitize regimen was even more effective for reducing organisms. Use of a high-efficacy sanitizer as part of a wash-sanitize  regimen further increased the efficacy of the regimen. The use of a well-formulated alcohol-based hand rub as part of a wash-sanitize regimen should be considered as a means to reduce risk of infection transmission in food service facilities.
authors.affiliation: GOJO Industries, Inc., Akron, OH 44311, USA. edmondss@gojo.com
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Edmonds
authors.forename: Robert R
authors.initials: RR
authors.lastname: McCormack
authors.forename: Sifang Steve
authors.initials: SS
authors.lastname: Zhou
authors.forename: David R
authors.initials: DR
authors.lastname: Macinga
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Fricker
mesh_terms: D001419:Bacteria / Q000254:growth & development; D015169:Colony Count, Microbial; D004202:Disinfectants / Q000494:pharmacology; D000431:Ethanol / Q000494:pharmacology; D005506:Food Contamination / Q000517:prevention & control*; D005522:Food Services / Q000592:standards*; D005782:Gels; D006235:Hand Disinfection; D006801:Humans; D006920:Hygiene; D012915:Soaps / Q000494:pharmacology*; D000078329:Workforce
chemical_list: D004202:Disinfectants; D005782:Gels; D012915:Soaps; D000431:Ethanol