A risk-based menu of best practice hand hygiene protocols

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The ServeReady Regimen Selector gives operators a comparative risk-based look at a range of hand hygiene interventions to better align with the operation's customer base, menu, staff (span of control), facility and management's tolerance for risk. Supporting research is outlined below.

On the vertical axis is the log reduction scale and each bar represents the effectiveness of a specific intervention. A log 1 represents 90% removal or kill while log 5 is 99.999%.

This hand hygiene menu facilitates an integrated look across the entire operation to match the risk with the right intervention.

The first four hand hygiene protocols are designed for locations with ready access to running water and a properly equipped hand hygiene station. It is important to note that a Core Handwash is the foundation for all four. Bar (1) is purely a germ/soil elimination process. It removes germs. In bar (2) a kill step is added by applying alcohol hand sanitizer. It kills transient pathogens that survived the wash cycle. It's effectiveness is greatly increased when gross soils are first removed.

Bar (3) brings in the heavy-duty friction factor of a nail/hand brush, loosening organisms/soils, particularly around the nail beds. Some refer to the nailbrush as the doubler  as it can often double the effectiveness of a Core Handwash. Friction is a friend of serious handwashers. This is first seen within the Core Handwash where paper towels add an important friction factor not available with air dryers, even with the latest airblade technology.

The Core Handwash is a good wash, not one of 5-6 seconds (a common "standard" behavior) and not one achieved with a trickle of water often found at temporary foodservice sites.

The last three protocols are engineered for locations where an adequate water supply is not readily available. The SaniTwice variables are based on adding friction via a paper towel wiping/drying step between two sanitizer applications. A single-use nailbrush or a recyclable model is recommended for maximum hygiene when adding the brush to the SaniTwice procedure.

An added level of protection is available for all seven regimens by donning single-use gloves as the final step.

1. Removal of bacteria from fingertips and the residual amount remaining on the hand washing nailbrush.
2. Comparison of the antimicrobial efficacy of povidone-iodine, povidone-iodine-ethanol and chlorhexidine gluconate-ethanol surgical scrubs
3. Effect of a 1 min hand wash on the bactericidal efficacy of consecutive surgical hand disinfection with standard alcohols and on skin hydration
4. Use limitations of alcoholic instant hand sanitizer as part of a food service hand hygiene program.
5. Effect of hand wash agents on controlling the transmission of pathogenic bacteria from hands to food.
6. Management of risk of microbial cross-contamination from uncooked frozen hamburgers by alcohol-based hand sanitizer.
7. A comparison of hand washing techniques to remove Escherichia coli and caliciviruses under natural or artificial fingernails.
8. Risk assessment of hand washing efficacy using literature and experimental data.
9. A "SAFE HANDS" HAND WASH PROGRAM FOR RETAIL FOOD OPERATIONS
10. Guideline for Hand Hygiene in Health-Care Settings
11. Hand washing for life
12. The Effect of Antibacterial Formula Hand Cleaners on the Elimination of Microbes on Hands
13. Hand Hygiene and Hand Sanitizers
14. Retail Food Protection: Employee Health and Personal Hygiene Handbook
15. Improved inactivation of nonenveloped enteric viruses and their surrogates by a novel alcohol-based hand sanitizer.
16. Hand washing frequencies and procedures used in retail food services.
17. An investigation of the factors that affect surgical hand disinfection with polyvidone iodine
18. Microbiological effects of hand washing at a beef carcass-breaking facility.
19. Observation of everyday hand-washing behavior of Japanese, and effects of antibacterial soap.
20. Evaluation of hand-washing agents efficacy for food handlers.
21. Study for effectiveness of washing hand with various soaps and disinfectants.
22. Hand washing for retail food operations - a review.
23. Residual moisture determines the level of touch-contact-associated bacterial transfer following hand washing.
24. A field study evaluating the effectiveness of different hand soaps and sanitizers.
25. Comparative in vivo efficiencies of hand-washing agents against hepatitis A virus (HM-175) and poliovirus type 1 (Sabin).
26. Evaluation of efficiency of antiseptics for washing the hands.
27. In vivo protocol for testing efficacy of hand-washing agents against viruses and bacteria: experiments with rotavirus and Escherichia coli.
28. Efficacy of germicidal hand wash agents in use in a meat processing plant.
29. Efficacy of germicidal hand wash agents against transient bacteria inoculated onto hands.
30. Efficacy of germicidal hand wash agents in hygienic hand disinfection.