Background
Do gloves help
when touching a contaminated surface and then, touching ready-to-eat food?
Is wearing
gloves or using utensils to handle food the correct answer to employees
not washing fecal pathogens from their fingertips?
Proper hand
and fingertip washing is the critical procedure to prevent cross-contamination.
Summary
Background
The United States' FDA Food
Code requires that there be no bare hand contact with ready-to-eat food.
This is broadly interpreted as the "glove rule." There is no scientific
reason for this requirement.
Correct fingertip washing
makes hands safe. The resident microorganisms in the skin of the
hands are non-pathogenic, except for Staphylococcus aureus.
When one touches food, one might get 10 to 20 S. aureus per gram,
maximum, into the food. Staphylococcus aureus, however, must
multiply to 100,000 or 1,000,000 per gram in order to produce enough toxin
to make people ill (Snyder, 1994b). Food must be grossly abused for
this to happen; in this case, the operator should not have a license.
The problem, then, is not
the skin's resident microorganisms. The problem is the transient
microorganisms on fingers from human fecal material on the fingertips (because
the toilet paper did not protect the hand) or contamination from touching
raw food, especially chicken.
Do gloves help when touching a contaminated surface
and then, touching ready-to-eat food?
The answer is, "No," because
employees cannot determine by sight if a food contact surface or food is
microbiologically contaminated or not. Potentially hazardous food
may or may not be contaminated. When employees touch the handles
on refrigerator doors, handles on display cases, buttons on scales, knife
handles, etc., it makes no difference if they wear gloves or not.
Cross-contamination occurs from one surface to another, but probably, at
a tolerable level. It is known that pathogens die on metal surfaces
over a period of a few hours. Hence, these surfaces are, to a degree,
self-disinfecting. This is not so with raw chicken, which can commonly
have infectious levels of Campylobacter jejuni on the surface.
The advantage to using bare
hands in the case of handling raw food is that employees can "feel" if
their hands are dirty—which they cannot do if wearing gloves—and will be
more likely to wash them more frequently.
If gloves are used, the
FDA code requires that employees first wash their hands for 20 seconds
before putting the gloves on and for another 20 seconds immediately after
removing the gloves, because the skin inside the gloves becomes hot and
moist, and the resident skin microorganisms multiply to high levels underneath
the gloves. Gloves only complicate the hand wash problem and make
the process more time consuming.
This is not to say that
gloves are not useful. They do protect the hands, and they are necessary
for many people who work with food, because they may have their hands in
very hot water or in alkaline or acid solutions. They may be allergic
to lemon juice or other food products. Hence, they need gloves to
prevent injury to the hands.
Why does the food code say,
"no bare hand contact," to include wearing gloves? I suggest that
this is because regulators do not know how to enforce their own laws regarding
hand washing. They do not know how to get employees to wash fecal
pathogens from their fingertips when coming from an "unknown" location,
presumed to be the toilet. As a result, regulatory officials have
chosen to require food handlers to wear gloves or use utensils when working
with ready-to-eat food.
Is wearing gloves or using utensils to handle food
the correct answer to employees not washing fecal pathogens from their
fingertips?
The answer, again, is "No."
The first concern is that new gloves are packaged in a container; so, if
an employee comes from the toilet without washing his/her hands, that employee
will contaminate the outside of the gloves with fecal pathogens in the
process of removing the gloves from the container and putting them on (Snyder,
1994a). These pathogens will then be transferred into the salad or
other ready-to-eat food that the employee handles next. It is impossible
to put gloves on unwashed hands without the contamination from the fingertips
getting on the outside of the gloves.
The next problem is that
the gloves used in foodservice are cheap and fragile, and the fingertips
break out so that the fingertips are exposed to the food. There is
a high failure rate in terms of the gloves blocking the transmission of
contaminants on fingertips into the food. The fingertips must be
clean before the gloves are put on. If they are properly cleaned,
they are safe.
Proper hand and fingertip washing is the critical
procedure to prevent cross-contamination.
Another problem with effective
control is that the government does not provide correct hand and fingertip
washing procedures. There are four components to successfully removing
soil: 1) friction, 2) water, which washes bacteria from the surface
and down the drain, 3) a chemical in the form of soap or detergent to loosen
the bacteria, and 4) temperature, because most chemicals work better at
warm temperatures than they do at cold temperatures.
The HITM double hand washing
process requires the use of a nail brush for friction on the first wash
to aid in removing bacteria from fingertips that are soiled with high levels
of fecal pathogens. HITM recommends the Anchor 2000 Surgeon's Scrub
Brush. It is used when an employee enters the kitchen from using
the toilet, coming from home, with the possibility of feces and vomit on
the hands, etc. The process is as follows.
1. Turn on the
water (75 to 110ºF).
2. Put 3 to
4 ml of plain liquid soap on the nail brush (soap put on fingertips is
likely to slide off).
3. Underneath
the flowing water in the sink, for about 10 to 12 seconds, lightly brush
the fingertips with the tips of the brush bristles while the water flows
over the brush and fingertips. The bacteria come off and go down
the drain. This gives a 1,000-to-1 reduction of bacteria on fingertips.
4. Put the brush
down. Put soap on the hands, and lather the hands underneath the
flowing water for about 5 seconds to get a 100-to-1 reduction. Rinse
the soap from the hands.
5. Paper towel
dry for another 10-to-1 reduction.
The government method of
hand washing is to put soap on the hands and lather for 20 seconds.
This does not remove the bacteria. Lathering merely moves the bacteria
around the back and front of the hands, between the fingers, etc., and
the hands become completely contaminated with fecal bacteria from the fingertips.
The last step to the food code's 20-second wash is to rinse. This
is not correct. One must rinse throughout the procedure. Flowing
water, along with friction, is absolutely key to removing fecal pathogens
from hands and fingertips.
Once in the kitchen, there
is no need for the nail brush part of the HITM double wash. Food
pathogens do not occur in as large a number as fecal pathogens, and a single,
5-second hand wash, as in the second wash in the double hand wash, is sufficient
to reduce these food pathogens to a safe level. It is unreasonable
to expect that employees will spend 20 seconds at the hand sink every time
they touch a piece of raw food before touching ready-to-eat food or changing
gloves. It is more realistic to expect employees to spend 5 seconds
lathering and rinsing their hands under flowing water.
Summary
The resident skin bacteria
are not a food safety issue. The only organism of concern is S.
aureus, and it must grow to 1,000,000 per gram to cause illness.
However, this is extremely unlikely. While using utensils can prevent
cross-contamination, using gloves to prevent cross-contamination from raw
food to ready-to-eat food is not a solution. First of all, gloves
can become contaminated, but employees are less likely to realize this
if they cannot feel the soil. Without the gloves, they are more likely
to wash their hands to prevent cross-contamination, because they can feel
the soil on the hands as a warning that it is time to wash the hands.
Covering up unwashed, fecal-pathogen-contaminated
fingertips with gloves as a substitution for washing hands to prevent cross-contamination
merely sidesteps the issue of the lack of regulatory enforcement of hand
washing. Furthermore, gloves are not perfectly constructed.
They have holes and can leak, and the fingers can break off, which means,
pathogens on the hands, if present, will leak through and contaminate the
food.
The only solution to preventing
fecal-oral contamination is fingertip washing using the double hand wash
with a nail brush, when entering the kitchen, to reduce pathogens on fingertips
to a safe level. The friction on the fingertips from the nail brush,
combined with flowing water, dramatically improves the reduction of bacteria
on fingertips, compared to a simple lathering of the hands for 20 seconds,
as required by the food code.
When the government puts
forth a properly designed hand washing program—a double wash with a nail
brush when an employee comes into the kitchen, presumably from the toilet,
and a single wash and rinse once the employee is in the kitchen—there will
be a 1,000,000-to-1 reduction of bacteria on fingertips with the double
wash and a 1,000-to-1 reduction with the single wash, and there will be
no need for gloves.
Gloves are simply an indicator
that the regulatory system has failed in its responsibility to provide
and enforce a correct hand washing program. Gloves are not a way
to prevent foodborne illness.
References:
Snyder, O.P. 1994a. Cross-contamination of
gloves when being put on. 1999 rev. Hospitality Institute of
Technology and Management. St. Paul, MN.
Snyder, O.P. 1994b. Technology of HACCP-based,
Chilled Food Production Systems. 1998 ed. Hospitality Institute
of Technology and Management. St. Paul, MN.