For a food manufacturing operation to be successful and ensure that safe, hygienic food is produced, then all employees, visitors and contractors must maintain high standards of personal hygiene.  Legislation requires all food handlers to maintain a high degree of personal cleanliness.

Good Hand washing is one of the most important infection control measures to prevent the spread of seasonal and swine flu H1N1. Influenza occurs most often in winter and usually peaks between December and March in the northern hemisphere.
Holchem provide an extensive range of hand hygiene products to meet all requirements in food processing and food preparation facilities. A number of products within the range are suitable for helping control the spread of seasonal or swine flu through good hygiene practice. These include alcohol sanitising products (Luxsan, Foamsan) available in cartridge form and hand wipes (Hand & Surface Wipes) available in a tub of 150 wipes or a dispenser refill of 150 wipes.

Barriers to Hand Washing
The majority of people can appreciate to some extent the importance of correct hand washing but as a manager do you provide sufficient facilities, training, motivation, enforcement and monitoring to ensure this important part of hygiene management is carried out?
Some of the most common reasons for failing to wash hands correctly are:

• Insufficient management commitment and enforcement
• Failure to educate and motivate employees
• Inadequate facilities, soap or drying materials
• No effective system in place for hand washing
• Poor access to hand wash sinks
• Poor quality hand soap which can result in a weak lather or dry and cracked skin
• Water temperature too cold/hot making it unpleasant to wash hands
• Using a stiff nailbrush resulting in damaged skin or inflammation
• Not enough time allocated for hand washing
• Lack of notices/posters
• High staff turnover.

Another barrier to hand washing may be related to understaffing where too much pressure is placed on the existing workforce to concentrate on production tasks at the expense of personal hygiene.
Understaffing was partly attributable to the largest outbreak of Salmonella spp. ever reported. In this outbreak in Brazil there was a clear relationship between understaffing and the quality of health care provided, including hand hygiene.
Religious objection to alcohol sanitisers can also be an issue and clarification with regards to their use must be sought before implementation in situations where a multi faith workforce is employed.

Compliance
Good hand washing facilities, management commitment, training, coaching and signage all aid high levels of compliance.

Hand Washing
The objective of the food handler when washing their hands should be to reduce the number of transient pathogens to a safe level. Effective hand washing relies on friction and dilution to achieve this reduction.
A single wash procedure is required after following situations:

• After touching hair, nose, mouth or ears.
• After eating, smoking, coughing or blowing nose.
• After handling external packaging.
• After handling waste food or refuse.
• After cleaning, or handling dirty crockery, utensils, cloths or cleaning tools.
• After shaking hands.
• After handling money.
• After touching shoes, floor or other dirty surfaces.
• Before and after putting gloves on.
• Routinely throughout the day.

After the following activities, which are likely to result in a large number of pathogens on the hands, a double wash procedure is recommended:

• Using toilet paper when there is a risk of faecal contamination, especially on the fingertips (toilet paper is porous and can slip). It should also be remembered that several cultures do not use toilet paper.
• Cleaning up bodily fluids; for example, vomit from an ill person.
• Changing or putting on a dressing or touching an infected cut, wound or boil.
• After handling raw poultry, meat or vegetables.
• Touching floors & drains
• Touching dirty equipment, machinery etc.
• After a cleaning process.
• Entering a food room at the start of the day or after taking a break.

Thorough hand washing can significantly reduce the number of microorganisms.
Typically the number of transient bacteria on the skin can be reduced by a 3 log reduction by following a single hand washing and drying routine or anything up to a 5 log reduction by using a double wash technique.
A double wash procedure has been shown to be effective in reducing contamination to safe levels even when hands are heavily contaminated. It may also involve the use of a soft bristled nailbrush during the first wash. The physical action will assist in dislodging debris and bacteria from under and around the fingertips and nail.

Hand Contamination
Hands carry two types of bacteria, resident and transient.

Resident bacteria are a part of our natural flora and are not normally pathogenic. The washing and disinfecting of hands will remove most of these bacteria present on the skin surface, suppressing the bacterial levels for a given period of time. However, the numbers, however, will begin to increase shortly after the washing has been completed. It is virtually impossible to remove all resident bacteria from the skin and tests have shown that after repeated washing large numbers of bacteria can still be recovered from the fingers and thumbs.
Resident bacteria are permanent inhabitants of the skin of all people and are found on the superficial skin surface (epidermis). However, 10 to 20% of this total resident population are within the epidermal layer of the skin and in skin crevices where they are very difficult to remove or kill.
The types of resident microorganisms vary from person to person but in general they do not include types that cause food poisoning. The exception is Staphylococcus aureus, which is found on up to 40% of the population. Typically, infected cuts and boils are a significant source of Staphylococcus aureus.
Thorough hand washing can reduce the number of microorganisms but it is impossible to remove or kill all of them.

Transient bacteria are those that are found on the surface of the skin but do not normally reside there. They have been transferred onto the skin from another source either by direct contact or by aerosol. Transient microorganisms can cause infection on broken skin. These bacteria have been collected on the surface of the hands, usually on the palms, under fingernails and on the fingertips. Unless these bacteria can be removed effectively they are likely to be spread from hand to food contact surface; thereby presenting a cross contamination risk. The type of transient bacteria on the skin will be varied and dependant on what has been touched. Pathogens such as Escherichia coli O157, Salmonella spp, Shigella spp and, Clostridium perfringens can all be carried on the skin.
In addition high levels of transient microorganisms are found attached to hand, finger tips and fingernails surfaces after visiting the toilet and after handling raw food. These may include a significant number of pathogens.
Broken skin, cuts, boils and spots cannot effectively be cleaned by a hand washing routine and should therefore always be properly covered.

Hand Wash Procedures
A hand wash procedure involves the following stages:

• Wet hands thoroughly.
• Apply soap and produce lather.
• Rub hands and fingertips vigorously ensuring the fingertips, around the nails, between fingers, around the thumbs, the forearm and wrists are thoroughly massaged. This should take approximately 20 seconds. The hands should be thoroughly rinsed under free flowing warm water for about 10 seconds.
• The hands must be thoroughly dried.

The hand wash and drying procedure should take approx 45 seconds to complete, which doesn’t include the application of a hand sanitiser. This can be applied and rubbed into the hands whilst the person is making their way (where possible) to their point of work.

Gloves
Gloves may be used to protect the product from hand contamination, or to protect the hands from the product. However, the wearing of gloves will not prevent cross-contamination of product.  Gloves used in direct contact with high risk food must be of suitable design and material.  Gloves will require changing at regular intervals and/or washing, as do hands.  Typically gloves are changed at each break and after touching dirty surfaces.
Gloves may be seen as a method of stopping resident bacteria contaminating the food.  Studies showed that if individuals did not wash their hands correctly before putting on the gloves then microorganisms adhered to the internal and external surfaces of the glove.