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Food handlers’ hygiene practices and behaviours are some of the most important factors in preventing foodborne diseases and cross-contamination, in fact, the Centers for Disease Control and Prevention estimates 80 percent of all infections are transmitted by hands. It should, therefore, be in the interests of everyone working in the food industry to make sure that hand hygiene compliance rates are high. But what does this mean in practice?
Good hand hygiene practice and handwashing compliance is highly variable and in some cases can be as low as 10%. In one study of trained staff which included observations of over 31,000 food handling activities, hand hygiene malpractices occurred more frequently than any other kind.
Establishing a hand hygiene culture, an organisation-wide belief that compliance with hand hygiene requirements is essential, is the responsibility of everyone working in a food business – from senior management to the individual food handler. An effective hand hygiene culture means that high rates of hand hygiene compliance cannot be seen as one-off achievements. A positive hand hygiene culture should be considered a core business value. This culture will need to be collective, stable, learned and consistent in order to be successful.
Positive hand hygiene culture requires a significant management effort. Those in senior leadership roles play a key part in motivating employees, setting the strategy, values, priorities, expectations and culture for hand hygiene and changing an inappropriate culture. They should provide food hand hygiene documentation which highlights the goals, standards and clear expectations that food handlers need to meet.
Once expectations have been formalised, the requirements need to be communicated effectively to employees, for example, through training sessions or a formal food safety and hand hygiene communications policy. However, communicating effectively about hand hygiene is often difficult and even tailoring communication to different groups will only achieve limited success. Establishing a hand hygiene culture, therefore, requires a multi-faceted approach that’s responsive and proactive.
Training in hand hygiene should be provided for everyone in a food business. To make sure it is effective as possible, training is best performed on site at the point of practise using an appropriate format. Organisations may also find that their effort to change behaviours will improve by introducing additional hand hygiene campaigns alongside training.
If managers promote a positive hand hygiene culture where good hand hygiene is the norm, and where people feel safe to discuss issues openly, particularly when they see other co-workers being non-compliant, then they will feel motivated and committed to maintaining and enforcing hand hygiene for the long term.
Hand hygiene assessment and monitoring will help organisations to determine if their hand hygiene culture is positive, and includes things like:
A number of methods exist to assess and monitor hand hygiene compliance, including recorded observations, electronic monitoring via sensors, and microbiological testing.
Behaviour is often influenced by the perception of consequences. Unfortunately, in the food industry, undue emphasis is often placed on punishment (for non-compliance) rather than rewards for compliance. Performance can be improved by providing recognition, praise and financial incentives for good compliance. Equally any sanctions or reprimands should be preceded by an investigation into why individuals are not complying. Any organisational barriers identified can then be removed, and alternative strategies developed.
Finally, organisations should be aware that good hand hygiene is a journey, not a destination. Introducing a continuous cycle of improvement – for example based on the Plan, Do, Check and Act (PDCA) methodology - is a particularly good idea if managers want to make sure their improvement is both well planned and responsive to change.
Hand hygiene is crucial in safe food handling and compliance is essential. But, considerable ongoing effort is required to make this happen, positive hand hygiene culture will not happen by accident and requires a substantial amount of management effort. Developing a positive hand hygiene culture should be implemented as part of a series of steps of continuous improvement, which will result in safer food for all.