Twenty people hold out their hands, palms down, fingers spread, awaiting inspection. Their hands are soaped, rinsed and dried. Yet many of them fidget nervously, afraid that close scrutiny will find their best efforts at the sinks to be lacking.
"We're going to see who did the best job," announces microbiologist Barry Michaels, examining one hand after another using an ultraviolet detecting instrument.
The hands belong to food-service industry executives participating in the "Handwashing Olympics," an event at the three-day Food Safety Summit conference held recently at the Washington Hilton Hotel. Competitors had rubbed their hands with Glo-Germ, a lotion used in hygiene training to mimic dangerous bacteria that are commonly transmitted by hand and cause food-borne illnesses. Then they scrubbed, using the latest technology, including super soaps and automated sinks. But wherever washing missed its mark, the Glo-Germ glistened green under ultraviolet light.
"Oh, yeah!" Michaels says, directing attention to luminous traces inside the thumbs of one appalled participant. "We've got some here."
Nearby, a chagrined Sharon Karlman studies her fingers. "I don't think I won. I missed the cuticles," says the director of quality assurance at Reinhard Food Service, a meat processing plant in LaCrosse, Wis. An "avid hand-washer," Nanette Thompson of the National Food Processing Association scrapes at the luminescence under her nails. "I thought it was enough to use soap and water," she laments. "But what I'm finding out is that even continual washing isn't enough."
Bad News-Good News
As public concern about bacterial contamination grows with each new major outbreak of food-borne illness, public health officials reiterate that improper hand-washing is the most common route for transmitting disease-causing bacteria -- in restaurants, food-industry plants and homes. But because educating about the whys and hows of hand-washing hasn't proven to be an adequate safeguard, science and new technology are now reinventing how you wash your hands.
"If you do it from beginning to end effectively, it can result in a 98-99.9 percent reduction in the germs you picked up," Michaels says of a thorough hand-washing.
One of the preeminent researchers in hand hygiene, Michaels has spent the past seven years deconstructing what appears to be the simple act of washing one's hands. He has identified areas of the hand that typically wash clean and areas that don't, such as fingernails, wrists and thumbs. He has charted approximately 150 critical junctures where the hand-washing process can go right or wrong in battling disease-transmitting germs.
More than you possibly want to know about washing your hands? Perhaps not under the circumstances: Each week in the United States, 1.5 million people get food poisoning; annually food-borne illness causes about 10,000 deaths. Poor hand hygiene is a usual suspect.
"You don't just do `x' and get `y' results," says Michaels, a product development manager for Georgia-Pacific Corp. who is sometimes referred to as the Guru of Handwashing. "I look at it as a mystery story."
But for all the subplots (from chapped skin that traps pathogens to people not adequately washing their dominant hand), what passes for a standard hand-washing is surprisingly effective. Research has found that lathering and washing rids hands of about 65 percent of the transient germs. Rinsing removes about 65 percent of what's left; hand drying eliminates another 90 percent of remaining germs.
"Even those people who just run their hands under cold water in the rest room aren't totally ineffective," says Michaels, explaining that harmful microorganisms found on the hands are "gut bacteria" better adapted to the digestive tract and not designed to adhere to skin. So they wash off easily.
But Americans are woefully insufficient in their hand-washing habits. Compliance studies find that only 40 to 60 percent of adults consistently wash their hands when appropriate. At home, it's only 43 percent; after using public restrooms, 60 to 78 percent; in schools, 51 to 55 percent. Food-service workers? Forty percent. Most mind-boggling: Only 32 percent of doctors wash when they should.
"People are the wild card. What they do in the bathroom when they wash their hands, you just don't know," says Dave Cole, quality services manager at Nancy's Specialty Foods, a Newark, Calif., manufacturer that makes quiche and other frozen foods. "So what we do is make it simple."
His company already installed two CleanTech 2000S HandWashers. It plans on adding two more of the automated, effortless, hand-washing systems. Workers extend their hands and arms up to the elbow in the system's two cylinders. A photo-optic sensor activates rotating jet sprays of an antimicrobial cleansing solution. In 12 seconds, the warm, massage-like, wash-and-rinse action removes 99 percent of harmful bacteria.
"There is no variation in the process of washing hands," says Christopher Maybach, design engineer at Meritech Inc., the Englewood, Colo., manufacturer of CleanTech systems, whose washes have laboratory tested as one step below a surgical scrub. "You don't end up relying on the employee to wash his hands properly."
Invented 12 years ago by a car-wash owner and a gynecologist, the $7,000 CleanTech 2000S is now washing some 60,000 hands a day in about 1,800 locations, including some McDonald's, Taco Bells and Pizza Huts. Meritech executives are betting on increasing those stats once its new CleanTech 400 model goes on the market at a third of the price.
Several trends are bringing the hand-washing issue to a head, says Maybach. "People eating out more aggravates the situation. The work force that restaurants have to employ now can be a challenge. And there's increased public interest in these outbreaks."
Noel Segal believes making hand-washing easier is half the battle; making the hand-washer accountable is the other half. "With measurement, we can get proof," says the president of Compliance Control Center, the Forrestville, Md., maker of the HyGenius Hand Washing Control and Monitoring System. "Without proof, it is like any other behavioral habit. People tend to focus on it intermittently or maybe not at all."
But industry focus sharpened last February, says Segal, when the U.S. Food and Drug Administration defined hand-washing in its Food Code as a critical control point in the Hazard Analysis Critical Control Point Program (HACCP). "That told people in the food business that we need to measure critical control points -- time, temperature, storage, movement of foods, hand-washing, anywhere in the process where food safety might break down," says Segal, whose firm sponsored the Handwashing Olympics and lent the event its automated no-touch, HyGenius sink.
Featuring built-in controls for timed washes, water flow and water temperature, the sink is designed for optimal hand-washes -- plus computerized monitoring that so far has recorded more than 5.5 million hand-washes at companies such as Marriott and McDonald's.
"There are a lot of nifty gadgets and any number of companies assessing how they might encourage hand-washing," says Segal. "When you can literally prevent 30 percent of the aggregate illnesses and deaths by just proper hygiene, there really is very little excuse not to."
In the Public Interest
Jeanne Koepke stands at the Kimberly-Clark exhibition booth at the Food Safety Summit demonstrating the company's SaniTouch HACCP Towel Dispenser. Not as sexy as automatic sinks and Jacuzzi-like hand washers, it is a sleek, seamless improvement over past dispensers and designed to eliminate hand contact and not harbor germs.
"You're not touching any levers. You're pulling one towel down at a time to dry your hands. You don't have to worry about who touched what prior to you," says Koepke, a national accounts manager for Kimberly-Clark's Away From Home Division.
Like many major manufacturers targeting the medical, food-preparation and food-service industries, Kimberly-Clark has entered the anti-germ market with a vengeance, promoting new products such as its no-touch, sensor-operated soap dispensers and its rinse-free, Kimcare Antimicrobial Skin Cleanser.
"We're seeing an increase of these go into public restrooms," says Koepke, adding that antibacterial soaps, gels and lotions have become big sellers at supermarkets.
Germ-killing consumer products are estimated to have nearly tripled in the past five years. So new products are vying for industry attention and eventual supermarket sales with the promise of improved germ-killing capabilities while treating the skin gently. "We compete against alcoholic antibacterial gels in the food-service industry," says Chris Petrakis, a vice president with Medical Care Concepts Inc., maker of alcohol-free SafetyDerm. Not only does SafetyDerm kill germs on contact, it keeps on killing germs for four hours while moisturizing the skin, he says. "And we're going into the consumer arena shortly."
As the public embraces cutting-edge, germ-killing products, Steven Blaushild is arguing for a kinder, gentler hygiene for household use. "There really have not been that many improvements in hand-washing since the bar of soap was invented," says Blaushild, president of Advanced Health Products, in Beachwood, Ohio, which manufactures $8 tubs of natural, back-to-basics, soap made of vegetable and animal oils, and $8 bottles of mildly antiseptic facial dips, sold direct and by health stores.
"We know that most of the germs are really under the fingernails and they enter the body as we touch our eyes, nose and to a lesser extent the mouth," says Blaushild, "so what were about is washing away the germs from where they are, and from where they enter the body."
Without using harsh chemicals that can harm the skin, these products emulsify germs, says Blaushild. "They're designed to wash away the germs and keep them from getting too healthy, but not kill them all."
The upshot: If you use the Advanced Hygiene soap several times a day and the facial dip every morning, not only will you be cleaner, with time you'll notice health benefits such as fewer colds, flu and allergies, says Blaushild. "You can't be afraid of germs. There are more germs in your intestines than there are people who have ever lived. But how we wash is as good as you can wash."
More Harm Than Good
In fact, some scientists fear that widespread use of antibacterial products could produce more dangers than benefits. In killing 98 percent or more of transient, harmful bacteria, antibacterial hand-washes also eliminate more than a third of good, resident bacteria that are vital to the healthy skin ecology. Overuse of household antibacterial products may enable dangerous microorganisms to adapt and eventually become resistant -- just as some have to antibiotics in medicine.
"If the product makes claims like, `removes 99.9 percent' or whatever, who cares? You are facing millions and millions of bacteria every time you move," warns Stuart Levy, a professor of medicine and molecular biology and microbiology at Tufts University School of Medicine and director of the Center for Adaptation Genetics and Drug Resistance. "You can't sterilize your home. You can't sterilize yourself. But by trying, you potentially are going to cause more havoc."
In a pivotal study two years ago, Levy found that the antibacterial agent Triclosan, which is widely used in soaps, lotions and other products, sets off a genetic mutation in bacteria that could change them into tougher strains of germs. Calling the antibacterial products just another form of antibiotic, he says "every time you muck up the environment with antibiotics, you obtain something worse."
While Levy says household antibacterial hand-washes are useful when caring for a patient home from the hospital, or an immune-deficient family member, he believes they are not substitutes for a good, old-fashioned hand-washing.
"Washing the hands with soap and water is sufficient in the everyday household," says Levy. "The important point is that we don't wash our hands."