Efficacy of simple hand-washing in reduction of microbial hand contamination of Iranian food handlers

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Abstract

Foods are likely to be faecally contaminated during preparation or dissemination by the Iranian Muslim food handler that their religion enjoins the mechanical cleaning of themselves after defecation. The current study was designed to determine the actual rate of hand contamination of Iranian food handlers with pathogenic flora of faeces or nose and to evaluate the efficacy of simple hand-washing instruction in reduction of hand contamination.

A before–after study was conducted on 150 randomly selected food handlers in an Iranian city, Shahrekord. At the first stage, the hands of 72.7% of food handlers were found to be contaminated. A comparison of the before-and-after data, revealed a significant decline in hand contamination of the food handler from 72.7% to 32% (P < 0.0001).

Our study showed that the poor hygienic practice by the food handler is such a serious problem facing the health sector that it merits a further consideration by Iranian authorities.

Introduction

It is generally accepted that the hands of food handlers are an important vehicle of food cross-contamination and that improved personal hygiene and scrupulous hand-washing would lead to the basic control of faeces-to-hand-to-mouth spread of potentially pathogenic transient microorganisms (Allwood et al., 2004, Daniels et al., 2002, Fry et al., 2005, Sneed et al., 2004).

The difficulties of achieving this in countries in which hygiene is poor or unfavorable and social habitual barrier exist, are almost overwhelming (Marshall & Dickson, 1998). In an Iranian kind of society as we live, there has been a speculation that foods are more likely to be faecally contaminated during preparation or dissemination by the food handler since their religion enjoins the mechanical cleaning of themselves after defecation rather than using toilet papers.

In the current Iranian surveillance and investigation of food safety, the focus of food shop inspection is on environmental health and the food handler’s personal hygiene inspection is limited to a systematic faecal examination of food-handlers with an interval time of six months to identify those infected with salmonellosis. In personal communication with the public health authorities in the region, they expressed dissatisfaction with the routine stool screening of food workers as they believed the approach is not sensitive enough and does not produce the evidence needed to design a practical plan of action in control of food contamination on spot.

Taking into consideration the fact that in hospital settings the introduction of hand-washing has been accompanied by reduction of infection rate (Steere & Mallison, 1975), we speculated that a simple surveillance that includes the food handler screening for hand contamination followed by a simple instruction of hand-washing might play a similar role in food safety. Moreover, we intended to provide the health sector authorities with solid evidence on the efficacy of an alternative simple approach in replace of current ineffective and complicated surveillance system. Therefore, the current study was designed to illustrate the dimension of hand contamination of food handlers and evaluate the effectiveness of a simple hand-washing instruction in reduction of hand contamination rate.

Section snippets

Materials and methods

An interventional perspective before–after study was designed and conducted on 150 randomly selected food handlers working in small retail food outlets such as fruit and vegetable shops, meat shops, grocery stores, traditional bakery shops and fast-food shops in an Iranian small city, Shahrekord (Table 1). Most food handlers worked face to face with the public. The study did not include those who were engaged in large scale food plants as there were no such establishments in Shahrekord city.

Results and discussion

Poor personal hygiene by food handlers frequently contributes to outbreaks of food borne illnesses caused by Staphylococcus aureus and gram negative bacilli such as Salmonella spp., Shigella spp., Campylobacter jejuni; enterotoxigenic E. coli as well as viral agents, i.e., hepatitis A, and Norovirus (Atreya, 2004, Hundy and Cameron, 2002, Lee and Middleton, 2003, Le Loir et al., 2003, Olsen et al., 2001, Sala et al., 2005, Wachtel et al., 2002).

Although thorough cooking of food just before

Conclusions

Our study showed that the poor hygienic practice is a serious problem facing the Iranian health sector. The results of our study confirm that hand-washing with plain soap and water is an effective, acceptable and tolerable approach in reduction of hand contamination. The results showed that the Iranian consumer has relatively much to be concerned with regarding the food they consume. The result has also emphasis on the fact that control is best focused on worker hygiene and avoidance of human

Acknowledgment

The authors thank Shahrekord University of Medical Sciences for supporting financially the current study.

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