Is Your Handwashing “Code” Compliant? New Science Says We Need a Reality Check!
We’ve all been taught the rules: wash your hands for at least 20 seconds, scrub vigorously with soap and water, especially after using the restroom or handling raw meat. But Is Your Handwashing “Code” Compliant? New Science Says We Need a Reality Check!
These guidelines are enshrined in the FDA Model Food Code, a document that dictates hand hygiene practices in countless restaurants and food service establishments across the country. But what if those rules, while well-intentioned, are simply not practical for real-world scenarios, and perhaps, not even the most effective?
That was the provocative question at the heart of a recent AFDO webinar on November 22, 2024, featuring renowned food safety experts Dr. Donald W. Schaffner of Rutgers University and Dr. James W. Arbogast, a leader in hand hygiene innovation. Their presentation, titled “New Handwashing Evidence: No Soap? No Water? No worry!”, unveiled groundbreaking research that challenges our long-held assumptions about hand hygiene efficacy.
The FDA Model Food Code: A Look at the “How” and “When”
The FDA Model Food Code lays out precise instructions for handwashing:
- How to Wash: At least 20 seconds total, with a vigorous scrub for 10-15 seconds.
- When to Wash: The list is extensive, covering everything from touching bare body parts, using the toilet, handling animals, coughing or sneezing, and touching soiled equipment, to preventing cross-contamination, switching between raw and ready-to-eat foods, and crucially, before gloving.
- Hand Antiseptics: Can be used, but only after hands have already been washed.
The Code even specifies water temperature, though as Dr. Schaffner pointed out, there’s been a persistent (and scientifically supported) effort to remove this requirement, as comfortable temperature is what truly matters, not a specific degree.
The Elephant in the Room: Why Aren’t People Washing Their Hands?
If the Food Code’s “when to wash” list were strictly followed, food handlers would be at the sink almost constantly. This leads to a glaring disconnect between prescribed practice and reality. As Dr. Schaffner bluntly put it, perhaps people aren’t “stupid” for not constantly washing their hands; perhaps the expectations are simply unrealistic.
The data supports this grim reality. Studies show “attempt rates” for proper handwashing ranging from 0 to 57%, with a median of only 25%. Even when attempts are made, “success rates” are dismal, ranging from 0 to 43%, with a median of a mere 13%. This means that even when people try to wash their hands according to the rules, they frequently fall short.
The Game Changer: ABHRs Outperform Soap and Water
This is where the new evidence presented by Drs. Schaffner and Arbogast truly shines. Their research, along with a comprehensive review of existing literature, strongly suggests that Alcohol-Based Hand Rubs (ABHRs), or hand sanitizers, often outperform traditional soap and water handwashing in reducing germs.
They presented data from studies comparing ABHRs and soaps, across various settings (healthcare and non-healthcare) and with both artificially introduced and naturally occurring contaminants. The consistent finding? ABHRs regularly appeared on the “left” of the rank order column, indicating superior germ reduction, while soaps were often relegated to the “right.” This holds true even with “soil load,” a common concern about ABHR efficacy on visibly dirty hands.
The New Study: Head-to-Head Comparison Reveals Surprising Results
A highlight of the webinar was the presentation of their new study, “Comparative Efficacy of Alcohol-Based Hand Rub vs. Hand Wash by an In Vivo Cross-Contamination Test Method” (Arbogast et al., IDWeek 2024 Annual Conference, Poster #324, October 17, 2024).
Using a rigorous test method (ASTM E2784) and carefully controlled variables, including hand wash water temperature and flow rate, the researchers compared:
- Hand Wash (20-second lather): Using a market-leading non-antibacterial foaming lotion hand soap.
- Hand Sanitizer (ABHR – 1 dose): Using a market-leading 85% ethanol vol/vol instant hand sanitizer.
- Sani-Once (ABHR 2x + paper towel): A double application of the ABHR followed by paper towel drying.
The results were compelling for Is Your Handwashing “Code” Compliant?
| Intervention (Test Article) | Mean Log Reduction (higher is better) | Mean Log Transfer to Melon (lower is better) |
| Hand Wash (20-second lather) | 3.00 A | 4.64 A |
| Hand Sanitizer (ABHR – 1 dose) | 4.06 B | 2.58 B |
| Sani-Once (ABHR 2x + paper towel) | 4.99 B | 1.88 B |
Means with different letters in the same column are significantly different (p≤0.05).
This data clearly shows that ABHRs delivered significantly higher germ reduction on hands and significantly reduced the transfer of bacteria to melon balls compared to a 20-second handwash. Even a single dose of ABHR was more effective than the prescribed handwashing method in the Food Code!
The Road Ahead: Real-World Application and a Risk-Based Approach
This groundbreaking research has profound implications for food safety and public health. The experts highlighted crucial areas for future research:
- Comparing other interventions: Including faster wash times (e.g., 5 seconds), water only, or contaminated gloved hands.
- Sampling real-world microbial burden: Investigating hands of food handlers and frequently touched surfaces in restaurants and healthcare.
- Testing in real foodservice settings: Measuring compliance baselines and the impact of targeted interventions (e.g., automated monitoring, behavioral science). A 2024 CDC study already found that restaurant workers engage in activities requiring handwashing about 9 times an hour but only wash 2-3 times an hour, citing time pressure, sink accessibility, and limited management emphasis as key barriers.
- Utilizing data in quantitative microbial risk assessments (QMRAs): Applying these findings to define future research and development priorities.
In Conclusion: It’s Time for a Hand Hygiene Evolution and making your Handwashing “Code” Compliant
The message is clear: The current FDA Model Food Code’s handwashing requirements, while seemingly robust, are often impractical and may not even represent the most effective way to reduce germs. The compelling new evidence presented by Drs. Schaffner and Arbogast strongly advocate for a reevaluation of our hand hygiene strategies, moving towards a more scientifically informed, risk-based approach that prioritizes efficacy and real-world compliance.
It’s time to embrace the science and ensure that our hand hygiene practices are truly protecting consumers, even if it means challenging long-held beliefs. The future of hand hygiene might just be “no soap, no water, no worry” – at least when it comes to effective germ reduction.