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The year 2020 will be remembered as the year handwashing became a practice to embrace. Personal hygiene has long been a pillar of food safety; the coronavirus pandemic not only created massive global awareness campaigns for handwashing, but it also provided food safety practitioners a platform for driving hygienic practices as the simple yet undisputed foundation of public health.
These are the elements of handwashing that have been stressed in the most populated and the most rural places around the world. If the successes in 2020 were listed, I would argue the increase in handwashing and hygiene awareness activities carried out across the world would top the list. Never before has such a large campaign for handwashing been conducted. From flyers to signs on doors to articles, slogans, memes, videos, social media, and TV, the message was everywhere. These messages targeted every single person on the planet: Wear a mask, keep your distance, wash your hands. These are essentially the same elements of food safety that are enshrined in separation and cleaning, two of the overarching principles that keep food and consumers safe.
Over 200 diseases are caused by the consumption of food and water contaminated with bacteria, viruses, parasites, and toxic chemicals. Most methods of preventing these diseases involve large risk assessments and implementing a variety of preventive controls, almost all of which are specific and sometimes expensive. It would be impossible to target every single disease to perfect the effectiveness of these methods, yet this is certainly the goal of a holistic food safety system based on prevention. In contrast, handwashing is one of the most direct ways of providing basic infection control to prevent the transmission of foodborne pathogens from person to person, person to food, and from surfaces to people or food. Thus, the cultivation of hygienic conditions, both of the person and the home/facility/environment, coupled with proper handwashing, is really the single best approach for improving public health.
Personal hygiene does not stop at the wrists. It includes the state of hygiene of the whole person. Workers entering facilities arrive each day covered in countless invisible bacteria, viruses, mold, pet dander, fibers, and other materials. As part of basic Good Manufacturing Practices, handwashing and gowning are generally practiced as a means of controlling risks in a food environment. During the pandemic, it has become apparent how these preventive measures also apply to personal health and wellness.
As we take a sweeping view of the past year’s illness-related data, stark differences in cases of respiratory and acute illnesses (including foodborne illness), access to hygiene products, and societal elements tell an interesting story. Numerous studies have reported a variety of observations ranging from significant increases in hand hygiene performance to short-term improvements; improvements in water, sanitation, and hygiene facilities; and the adoption of novel approaches. In a study of hand hygiene in hospital personnel, hand hygiene performance initially improved to 60 percent after the declaration of the pandemic and improved again immediately after school closures but regressed toward normal soon after.1 In this study of nine hospitals, including over 35 million hand hygiene opportunities, hospital hand hygiene performance hovered in the range of 54 percent. Normal hand hygiene in the hospital facilities was already in need of improvement, and although pandemic measures were implemented, it is unclear what interventions will be needed for new habits to improve these metrics. The data in this study do not show much promise.
In Odisha, India, where access to water was not considered an issue, 86 percent of adults reported improved hand hygiene practices and the potential for new habit formation in response to government messaging with lockdown measures.2 Going from India to Europe, a study of 2,323 youth in Poland concluded that, in a population-based sample of Polish adolescents, individuals from regions of low coronavirus disease (COVID) morbidity presented more beneficial hand hygiene habits than those from regions of high COVID morbidity.3 Furthermore, a comparative handwashing survey of youth (12–15 years of age) in 80 middle- and low-income countries4 (many of which actively participate in the international trade of food ingredients and finished products) highlighted a correlation between the reported improvements in hand hygiene practices and lower levels of food insecurity. The study also exposed the need to obtain more granular data about specific handwashing practices that could be helpful in designing and investing in better interventions.
The use of sanitizers and disinfectants in lieu of proper handwashing has led to misuse and incidents of poisoning, with 87 percent of participants in one study inappropriately mixing disinfectant preparations.5 The focus on handwashing itself thus becomes important as the primary means for infection control and reduces the potential for unexpected and unfortunate side effects from misuse by the overzealous and inappropriate use of disinfectants.
“Over 200 diseases are caused by the consumption of food and water contaminated with bacteria, viruses, parasites, and toxic chemicals.”
As 2021 settled in, reports of the impacts of COVID precautionary measures on foodborne illnesses and other communicable diseases from different regions of the world arrived, providing valuable data. The Australian government6 reported 50 percent fewer notifications of communicable illness in the first 6 months of 2020 than in the same period in 2019 and 20 percent fewer notifications than the 5-year average (2015–2019). Cases of salmonellosis were significantly lower than in the same period, corresponding with additional precautionary measures and an emphasis on proper and frequent handwashing. Further reports and published data from numerous parts of the world mirror a similar story of a reduction in reported cases of foodborne illnesses like listeriosis, salmonellosis, and norovirus infection. While there are several factors that could contribute to this, an increase in home cooking, less frequent consumption of food without proper handwashing, and a reduction in reporting of illness or admission to points of care are important considerations. The additional drastic reduction in cases of influenza in the 2019–2020 and early 2020–2021 periods also suggests that perhaps higher compliance with recommended hygiene measures may have contributed to fewer cases of illness.
While negatively impacting many restaurants, entertainment venues, and foodservice outlets, the urgent need to clamp down the spread of the virus led to the rapid growth and sale of shelf-stable, refrigerated, and frozen foods that, incidentally, also corresponded to relatively fewer cases of foodborne illness and recalls. There are numerous reasons why this trend may have occurred. It is also possible that protecting the personal hygiene of employees is linked to the reduction of food recalls and cases of foodborne illness, leading to fewer cases of foodborne illness transmitted through foodservice and retail outlets. Working while sick, and fewer incidences of lax handwashing that would otherwise occur, may also have changed the number of reported cases of foodborne illness. Could we consider the possibility that providing stricter guidelines and more supplies to protect workers might also improve the bottom line?
The case for keeping personal hygiene a high priority is strong, but how we move forward in the months and years to come will certainly impact global food safety and public health.
Although Ignaz Semmelweis (1818–1865), the Hungarian physician, is widely credited with introducing the practice of antiseptic procedures to medicine, it is important to recognize hygienic rituals ingrained in religious practices that, for centuries prior, have been customary in much of the non-Western world. “Wudu” or “ablution” in Islam is the ritual practice of washing the head, face, mouth, hands, and then the feet to cleanse oneself in preparation for prayer, a ritual performed five times a day. Hindu values of purity and cleansing are also long-standing principles that, while imperfectly distributed, have some value in this context. Buddhists ritually practice bathing and cleansing prior to eating, and the washing of feet and removal of footwear is a common practice in much of Asia. These rituals provide a foundation upon which requirements for handwashing practices, daily showers, and home and workplace hygiene can be built. The recognition of inside versus outside, otherwise found in most cultures, is not well observed in cultures where the boundary between humans and the outdoors is less defined by rituals, such as the leaving of footwear at the door or the washing of hands and feet upon entry into a domicile. These rituals can translate into “zone” thinking that in essence enforces hygienic practices specific to each zone. Creating such zones between the microbiomes of human-friendly organisms and those of the wild world is an important benefit afforded by something as simple as clothing hygiene, foot hygiene, and the act of handwashing.
Establishing barriers and hurdles to airborne and tactile transmission is the antidote to infectious diseases. For this strategy to work as laid out above, personal hygiene and awareness are indeed the critical preventive measures. But while health officials widely recommend washing with soap for 20 seconds, the glaring truth is that there are still challenges to achieving this in many parts of the world.
Access to water for basic sanitation is a challenge for a quarter of the world’s population. The rapid spread of COVID infections and growing waves of illness and deaths as the pandemic took hold of every aspect of life put a spotlight on the need for innovation—and collaboration—to quickly address the rapid rates of infection.
Using COVID to couple respiratory virus control with foodborne illness prevention through a common preventive control method, handwashing, can enhance the message in all contexts including within food production and foodservice.
The World Health Organization suggests the best return on investment in the sanitation game is to invest in public health messaging. Essentially, this means enabling communities, businesses, and the public to be aware of the benefits of better hygiene and the consequences of its absence. Here, agriculture and food stakeholders have a unique opportunity to be the vehicles for grassroots-level education, driving better compliance in handwashing and enabling positive hygienic behaviors. The additional benefit of using strategic partnering to drive a message of hygiene while keeping employees safer is a return on investment that enhances the bottom line and consumer perception of brands and makes an actual contribution to the betterment of our ecosystem.
Healthcare and food industry employees are ideal candidates to teach, show, and advocate for good hygiene in their communities. They are trained in and have the means to teach both how good hygiene can improve public health and how to practice good hygiene. Keeping the COVID message current and strong also helps communities adapt that message toward improving food safety and preventing the spread of other infectious diseases.
User access to data is not just trendy; it also drives changes in behavior. Take a look at a smartphone and the apps you might use daily. Nutrition, exercise, motion tracking, handwashing, and health monitoring apps are all methods to provide transparent and immediate feedback that can improve many kinds of practices but especially handwashing.
All these measures and more can help reinforce positive behavior at home and at work, leveraging the signal of cleanliness to drive improvements in human behavior that might just make a dent in outcomes far beyond food safety.
Skolmowska, D., et al. 2020. “Hand Hygiene Behaviors in a Representative Sample of Polish Adolescents in Regions Stratified by COVID-19 Morbidity and by Confounding Variables (PLACE-19 Study): Is There Any Association?” Pathogens 9: 1011.
Smith, L., et al. 2020. “Hand-Washing Practices among Adolescents Aged 12–15 Years from 80 Countries.” Int J Env Res Pub Health 18(1): 138.
Angela Anandappa, Ph.D., is the founding executive director of the nonprofit Alliance for Advanced Sanitation, an organization focused on improving food safety.