Scientific Evidence Supports the Use of Alcohol Based Hand Sanitizers as an Effective Alternative to Handwashing in Retail Food and Foodservice Settings When Heavy Soiling is Not Present on Hands.

Suboptimal food worker health and hygiene has been a common contributing factor in foodborne disease outbreaks for many years. Despite clear FDA Model Food Code recommendations for hand washing and glove use, food worker compliance with handwashing recommendations has remained poor for more than 20 years. Food workers' compliance with recommended handwashing is adversely impacted by a number of barriers, including complaints of time pressure, inadequate number and/or location of handwashing sinks and handwashing supplies, lack of food knowledge and training regarding handwashing, the belief that wearing gloves obviates the need for hand washing, insufficient management commitment, and adverse skin effects caused by frequent handwashing. While many of the issues related to poor handwashing practices in food service facilities are the same as those in healthcare settings, a new approach to healthcare hand hygiene was deemed necessary over 15 years ago due to persistently low compliance rates among healthcare personnel. Evidence-based hand hygiene guidelines for healthcare settings were published by both CDC in 2002 and by the World Health Organization in 2009. Despite similar low handwashing compliance rates among retail food establishment workers, no changes in the Food Code indications for handwashing have been made since 2001. In direct contrast to healthcare settings, where frequent use of alcohol-based hand sanitizers (ABHSs) in lieu of handwashing has improved hand hygiene compliance rates and reduced infections, the Food Code continues to permit the use of ABHSs only after hands have been washed with soap and water. This general interest manuscript provides clear evidence to support modifying the FDA Model Food Code to  allow the use of ABHS as an acceptable alternative to handwashing in situations where heavy soiling is not present . Emphasis on the importance of handwashing when hands are heavily soiled and appropriate use of gloves are still indicated.