The tweeting, texting, multitasking public increasingly expects food and beverage service in nontraditional locations — many of them without handsinks and running water. Whether we're talking about large, catered outdoor events on a campus or field applications like those the military faces in the deserts of the Middle East, hand hygiene technology has lagged well behind the pace of expanding mobile food service.
In the past, onsite operators in this situation have often sought to comply with health regulations that insist they have water available for handwashing by supplying a mostly inconvenient, ineffective trickle of water dispensed from coffee urns and the like.
Even that is not an option in many military situations, as was the case several years ago, when the new Iraqi police force was being trained at a temporary location where its foodservice tent had no running water. Its food safety advisors were led to test some alternate methods that would provide staff with an option that would be more effective than the use of standard alcohol hand sanitizers. And that in turn led The Handwashing for Life Institute to a no-water hand-cleansing and -sanitizing protocol dubbed SaniTwice®.
Mobile hand hygiene
In this case, awkward, expensive, portable handsinks were not an option, and the matter was urgent. Our early trials to add a friction factor to hand sanitizers evolved into a simple and timely solution using a pinch of chemistry and a dash of physics.
We tested a procedure in which a foodservice worker applied an excess of Food Code compliant alcohol hand sanitizer and vigorously scrubbed for 20 seconds, just as he would do with handwashing when water is available, so that its emulsifiers and emollients might have time (and temperature) to loosen soils. Then the hands, still wet, were wiped clean with a pattern-embossed paper towel (for increased friction) to pull away the soil. This was followed by a second application of hand sanitizer, this time used according to label instructions, allowing the hands to air dry.
In that case, there was neither time nor budget for laboratory confirmation. The solution made sense and the physical demonstrations were convincing: SaniTwice became a reality in the Iraqi desert.
From one desert to another
Two years later, Handwashing For Life® was approached by a major Las Vegas hotel that wanted to improve handwashing effectiveness at its catered events. We studied the possibility of adding larger water reservoirs and full plumbing hook-ups to portable bars, as well as installation of on-board water heaters.
The SaniTwice® Protocol STEP 1: Hands are vigorously “washed” 15-20 seconds with 3-5 ml of hand sanitizer. STEP 2: While wet, sanitizer is rubbed off with textured paper towel. STEP 3: Second application of 1.5 ml of hand sanitizer is used according to label directions.
As prototypes of these portable behemoths were tested on-site, it became apparent that their size and weight were taxing the stewards just to get the units to typical large-venue food and beverage service locations. Introducing running water and drains brought their own risks of cross-contamination, slips and falls, as well as the hazards of temporary electrical lines. All these options limited placement of the service bars.
The SaniTwice protocol was presented as a possible solution. It offered some clear advantages, but both the operator and the health department would not proceed based only on field research that had come from the military experience. They insisted on documented effectiveness data.
An independent laboratory was selected and a research project initiated. You can examine the results of this study and another that followed 16 months later at www.handwashingforlife.com/handsonsystem/sanitwice
At that point, the local health department was invited to participate in the discussions and shape additional field research. The SaniTwice protocol was tested with resoundingly positive results from food and beverage managers, bartenders and the health department inspectors.
The health inspectors themselves saw other applications for their clients, including outdoor events and in emergencies, such as temporary water outages at schools. Further, other operators are now looking at SaniTwice in other contexts, such as a way to improve glove changing in remote service areas and by dishroom workers in between the handling of soiled and clean dishes.
An interest in SaniTwice among regulatory groups has been enhanced by the arrival of two new wrinkles: the advent of reliable, touch-free dispensers and the development of a new breed of synergized alcohol hand sanitizers that retain their Model Food Code compliance while eliminating concerns regarding effectiveness on norovirus, the number one foodborne pathogen in foodservice.
The cruise industry and its health department, the CDC's Vessel Sanitation team, have completed studies that indicate norovirus is primarily introduced onto ships via ill passengers (one of the same problems that can plague special events.)
Such “front-door pathogens” need special attention as they are less likely to be controlled by traditional temperature control and other food safety interventions. Any norovirus penetration of a facility has a strong person-to-person element as well as high potential for surface cross-contaminations. And the current concerns over H1N1 flu, which also has very significant surface-to-surface contamination potential, may provide even more impetus to such strategies, as hand sanitizing remains one of the best forms of defense.
Is SaniTwice an option for onsite operators in situations similar to those described here? When running water is not available or is very inconvenient to use, this protocol can be an effective alternative as long as its implementation is approved by the local health department. It is yet another weapon to keep in your food safety arsenal.