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INTERVENTIONS
TO PREVENT OR MINIMIZE RISKS ASSOCIATED WITH BARE-HAND CONTACT WITH
READY-TO-EAT FOODS
Excerpted from a summary of current
information from scientific literature or provided to FDA that evaluates
the factors related to contamination of foods by food workers and the
effectiveness of interventions to prevent or minimize contamination of
ready-to-eat food by food workers. This excerpt covers the use of gloves
as barriers to prevent bare-hand contact with ready-to-eat foods.
Concludes that the use of gloves does not
replace hand-washing due to potential contamination of glove surfaces,
leaks, and the creation of a favorable environment for bacterial
growth. Information provided in this review includes all
applicable submissions that were received in response to Federal Register
Notice, Vol. 64, No. 63, Friday, April 2, 1999
BioScience Laboratories. Gloves and Hand
Washing (April 1996) Studies
performed strongly suggest that the increased safety margin thought to be
derived from food workers' wearing gloves to prevent transmission of
disease from the hands are grossly overestimated. Found glove changing
spreads contaminants if proper hand-washing is not performed, and that
gloves provide an advantageous environment (moisture, nutrients and
warmth) for bacterial growth. Likewise, overall quality of food
grade gloves having "pre-existing" punctures resulted in
significant bacterial counts on the outside of the glove. It was
determined that hand-washing is a critical part of glove use.
Black,
R. E., Dykes, A.C., Anderson, K.E., Wells, J.G., Sinclair, S.P., Gary, G.W.,
Hatch, M.H., Gangarosa, E.J. 1981.
Hand washing to prevent diarrhea in day-care
centers. Am. J. Epidemiol. 113: 445-451.
Study
demonstrated that hand washing will prevent diarrhea in day-care centers.
The incidence of diarrhea in two hand-washing day care centers was half
that of two control centers for the entire 35-week study period.
Casewell,
M., and Philips, I. 1977. Hands as route of transmission of
Klebsiella species. Brit. Med. J. 2: 1315-1317.
Seventeen
percent of the staff of an intensive care ward were found to have Klebsiella
spp. contaminating their hands, and these strains could be related to the
serotypes infecting or colonizing patients in the ward on the same day.
Some simple ward procedures were identified that resulted in contamination
of nurses' hands with 100 to 1000 Klebsiella per hand. The Klebsiella
survived on artificially inoculated hands for up to 150 minutes. Hand
washing with chlorhexidine hand cleanser reliable gave 98 to 100%
reduction in hand counts, and the introduction of routine hand washing was
associated with a significant and sustained reduction in the number of
patients colonized or infected with Klebsiella spp. Staff clothing
was occasionally contaminated, but ward air and dust rarely contained
klebsiellae.
Emery,
H. C. 1990. Changing poor hand washing habits - A continuing challenge
for Sanitarians. Dairy Food Environ. Sanitation 10(1): 8-9.
Review
article. "Studies indicate that personnel in both the health care and
food service industries have poor hand washing habits. (60% of food
service personnel in one study were reported to not wash their hands after
using the toilet.) Need for training and education of food service
personnel.
Garner,
J. S., and Favero, M.S. 1985. Guidelines for hand washing and hospital
environmental control. Springfield, VA., NTIS. United States
Department of Commerce.
Government
publication for hospital infection control. Discusses Hand washing;
Cleaning and disinfecting; Infective Waste; Housekeeping; and Laundry.
Hand
washing with plain soaps or detergents (in bar, granule, leaflet, or
liquid from) suspends millions of microorganisms and allows them to be
rinsed off; this process is often referred to as mechanical removal of
microorganisms. This process removes transient microorganisms. Hand
washing with antimicrobial-containing products kills or inhibits the
growth of microorganisms; this process is often referred to as the
chemical removal of microorganisms (both transient and some resident
microorganisms).
Hand
washing with plain soap for 15 seconds or less appears to be sufficient
for most routine activities. For invasive procedures within hospitals or
health care settings antimicrobial products may be used.
When
gloves are used, hand washing is recommended because gloves may become
perforated during use and because bacterial can multiply rapidly on gloved
hands.
Horwood,
M. P., and Minch, V.A. 1951. The numbers and types of bacteria found on
the hands of food handlers. Food Res. 16: 133-136.
The
study dealt with the collection and bacteriological examination of hand
washed samples derived from the hands of food handlers selected at random
from 22 eating establishments in the Boston and Cambridge, MA. area.
The
large numbers of bacteria isolated from the hands of food handlers in this
investigation and the frequency with which E. coli, hemolytic
streptococci and staphylococci and aerobic spore formers were isolated
indicates the magnitude of the problem of hand hygiene among food handlers
and the need for a greatly accentuated campaign of health education for
this large and important group of workers.
Their
hands are frequently soiled with the discharges from nose and mouth and in
other ways. Frequently, food handlers bring the hands in contact with food
when the use of an implement is indicated. This investigation discloses
the bacterial conditions of the hands of food handlers as found. No
attempt was made to discover how they got there. The data justify the
conclusion that the hands of food handlers should be kept clean and that
they should avoid contact with food whenever possible. Management must
assume the responsibility for daily education and supervision.
Khan,
M. U. 1982. Interruption of shigellosis by hand washing. Trans.
Royal Soc. Trop. Med. & Hygiene. 76(2): 164-168.
Shigella
is associated with poor hygiene. The effectiveness of the simple
intervention of hand washing with soap and water was investigated, in
preventing the spread of the disease.
The
study population was comprised of confirmed cases of shigellosis. These
and matched controls were followed up for 10 days. Several pieces of soap
and earthenware pitchers for storing water were provided to the study
families and they were advised to wash their hands with soap and water
after defecation and before meals. Compliance was monitored daily by
observing the sized of the soap and residual water. Rectal swabs of
contact of both of the groups were obtained daily for culture.
The
secondary infection rate was 10.1% in the study group and 32.4% in the
control group. The secondary case (symptomatic) rate was 2.2% in the study
group and 14.2% in the control group. These results suggest that hand
washing has a positive interrupting effect, even in insanitary
environments.
Oldenburg,
D. 1996. Wash up! Dirty hands can have tragic, deadly consequences.
Washington Post. Washington D.C.
Article
effectively describes the importance of hand washing in every day life,
for medical personnel and for personnel in the food service industry.
Seligmann,
R., and Rosenbluth, S. 1975. Comparison of bacterial flora on hands of
personnel engaged in non-food and food industries: A study of transient
and resident bacteria. J. Milk Food Technol. 38.(11): 673-677.
Prevalence
and level of coagulase negative and coagulase positive staphylococci,
fecal coliforms and enterococci on the hands of employees in non-food
industries were compared with findings from five occupational groups,
varying in their degree of food contact. A correlation was noted between
the flora on the hands and that of the food contacted. Further evidence
for transmission of bacteria from food to the hands emerged from
comparison of the results before and during work in meat industries. The
prevalence and level of coagulase positive staphylococci were present at
the same rate before and during work. The conclusion was drawn that this
organism and to a limited extent, the other test bacteria had changed
their status and had become permanent residents on the skin. The complex
etiological relationship in food production was described as a permanent
interaction between three factors: food, environment, and food handler.
Bacteria were considered ubiquitous and the food handler, a small link in
the multiphase process of food preparation. Strict implementation of
hygienic measures in all stages of food preparation was urged to prevent
bacteria from becoming a health hazard.
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