Alcohol-based hand sanitizers are popular due to their ease of use and perceived germ-killing abilities. They have become even more prevalent due to the continuing COVID-19 pandemic, but can they also improve hand hygiene among food handlers?

Research conducted over the years has shown that 56-80% of foodborne illness originates from restaurants. Poor personal hygiene and poor hand washing practices have been cited as the most common contributing factors for foodborne outbreaks.

Anirudh Naig, a food safety state specialist with Iowa State University Extension and Outreach, called attention to a December 2020 article in the Journal of Food Protection titled “Scientific Evidence Supports the Use of Alcohol-Based Hand Sanitizers as an Effective Alternative to Hand washing in Retail Food and Food Service Settings When Heavy Soiling Is Not Present on Hands.” The authors note that hand washing compliance is low in foodservice settings, so allowing the use of alcohol-based hand sanitizers might help improve hand hygiene among foodservice workers, thus lowering the possibility of contaminating food with microorganisms. The article asserted that in healthcare settings, alcohol-based hand sanitizers have been allowed in place of hand washing and have resulted in increased compliance with hand hygiene practices and hand washing among healthcare workers.

Naig said the authors recommended that the U.S. Food and Drug Administration modify the FDA Food Code to allow the use of alcohol-based hand sanitizer when hands are not heavily soiled. According to the FDA website, the Food Code “assists food control jurisdictions at all levels of government by providing them with a scientifically sound technical and legal basis for regulating the retail and foodservice segment of the industry (restaurants and grocery stores and institutions such as nursing homes). Local, state, tribal and federal regulators use the FDA Food Code as a model to develop or update their own food safety rules and to be consistent with national food regulatory policy.”

“While using alcohol-based sanitizers in place of hand washing might seem like a great way to improve hand hygiene among foodservice workers, the FDA Food Code does not allow the use of just alcohol-based hand sanitizers for hand hygiene, because proper hand washing has been shown to decrease the possibility of transmitting microorganisms,” Naig stressed.

“In foodservice settings, workers typically perform multiple tasks at the same time or are involved in situations where the work process might result in hands getting ‘heavily soiled’ and ‘lightly soiled.’ A foodservice worker might get confused on when to wash hands or if their hands are heavily soiled or lightly soiled, which might negatively impact the frequency of hand washing,” Naig said.

Microorganisms cannot be seen with the naked eye, and most foods served in foodservice settings provide ideal conditions for microbial growth, so to err on the safe side, wash hands with soap and water as recommended in the FDA Food Code, Naig said. The Centers for Disease Control and Prevention recommend proper hand washing as the first step in reducing microorganisms on hands, followed by the optional use of hand sanitizers. Soap and water help to dislodge germs that adhere to the skin surface and reduce the number of microorganisms on hands.

Naig said it still is recommended that food handlers continue to use the following steps for hand washing:

• Wet hands under water.

• Apply soap and scrub hands for 10-15 seconds.

• Rinse hands under running water.

• Dry hands using a paper towel or hand dryer.

These steps are illustrated in Wash Your Hands, a poster available for free download from the ISU Extension Store.

Food handlers may choose to apply hand sanitizer after washing hands, but this is not a requirement according to the FDA Food Code. If hand sanitizer is used, air dry hands after applying sanitizer to prevent the possibility of chemical contamination of food from the hand sanitizer. Using alcohol-based hand sanitizers may provide food handlers with a false sense of security. It might result in them not washing hands when they are supposed to wash hands (e.g., after handling garbage or before handling ready-to-eat produce).

“To conclude, hand sanitizers are a helpful tool for preventing the spread of microorganisms, but their efficacy in preventing the spread of foodborne microorganisms from contaminated hands continues to be studied. Until then, keep those hands clean by using soap and water!” Naig said.