title: Ability of Hand Hygiene Interventions Using Alcohol-Based Hand Sanitizers and Soap To Reduce Microbial Load on Farmworker Hands Soiled during Harvest.
abstract: Effective hand hygiene is essential to prevent the spread of pathogens on produce farms and reduce foodborne illness. The U.S. Food and Drug Administration Food Safety Modernization Act Proposed Rule for Produce Safety recommends the use of soap and running water for hand hygiene of produce handlers. The use of alcohol-based hand sanitizer (ABHS) may be an effective alternative hygiene intervention where access to water is limited. There are no published data on the efficacy of either soap or ABHS-based interventions to reduce microbial contamination in agricultural settings. The goal of this study was to assess the ability of two soap-based (traditional or pumice) and two ABHS-based (label-use or two-step) hygiene interventions to reduce microbes (coliforms, Escherichia coli, and Enterococcus spp.) and soil (absorbance of hand rinsate at 600 nm [A600]) on farmworker hands after harvesting produce, compared with the results for a no-hand-hygiene control. With no hand hygiene, farmworker hands were soiled (median A600, 0.48) and had high concentrations of coliforms (geometric mean, 3.4 log CFU per hand) and Enterococcus spp. (geometric mean, 5.3 log CFU per hand) after 1 to 2 h of harvesting tomatoes. Differences in microbial loads in comparison to the loads in the control group varied by indicator organism and hygiene intervention (0 to 2.3 log CFU per hand). All interventions yielded lower concentrations of Enterococcus spp. and E. coli (P < 0.05), but not of coliforms, than were found in the control group. The two-step ABHS intervention led to significantly lower concentrations of coliforms and Enterococcus spp. than the pumice soap and label-use ABHS interventions (P < 0.05) and was the only intervention to yield significantly fewer samples with E. coli than were found in the control group (P < 0.05). All interventions removed soil from hands (P < 0.05), soap-based interventions more so than ABHS-based interventions (P < 0.05). ABHS-based interventions were equally as effective as hand washing with soap at reducing indicator organisms on farmworker hands. Based on these results, ABHS is an efficacious hand hygiene solution for produce handlers, even on soiled hands.
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
authors.forename: Anna Fabiszewski
authors.initials: AF
authors.lastname: de Aceituno
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA. anna.aceituno@emory.edu.
authors.forename: Faith E
authors.initials: FE
authors.lastname: Bartz
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
authors.forename: Domonique Watson
authors.initials: DW
authors.lastname: Hodge
authors.affiliation: GOJO Industries, Inc., Akron, Ohio 44311, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Shumaker
authors.affiliation: GOJO Industries, Inc., Akron, Ohio 44311, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Grubb
authors.affiliation: GOJO Industries, Inc., Akron, Ohio 44311, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Arbogast
authors.affiliation: Departamento de Microbiología e Inmunología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás, Nuevo Leon 66451, México.
authors.forename: Jorgé
authors.initials: J
authors.lastname: Dávila-Aviña
authors.affiliation: Departamento de Microbiología e Inmunología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás, Nuevo Leon 66451, México.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Venegas
authors.affiliation: Departamento de Microbiología e Inmunología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás, Nuevo Leon 66451, México.
authors.forename: Norma
authors.initials: N
authors.lastname: Heredia
authors.affiliation: Departamento de Microbiología e Inmunología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás, Nuevo Leon 66451, México.
authors.forename: Santos
authors.initials: S
authors.lastname: García
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
authors.forename: Juan S
authors.initials: JS
authors.lastname: Leon
mesh_terms: D058491:Bacterial Load; D015169:Colony Count, Microbial; D004755:Enterobacteriaceae / Q000302:isolation & purification; D016983:Enterococcus / Q000302:isolation & purification; D004926:Escherichia coli / Q000302:isolation & purification; D000431:Ethanol; D000067565:Farmers; D005517:Foodborne Diseases / Q000517:prevention & control*; D006225:Hand / Q000382:microbiology*; D006235:Hand Disinfection / Q000379:methods; D064548:Hand Sanitizers; D006801:Humans; D012915:Soaps; D012987:Soil; D014481:United States; D014867:Water
chemical_list: D064548:Hand Sanitizers; D012915:Soaps; D012987:Soil; D014867:Water; D000431:Ethanol