Crab House, Orlando Florida, 2001 Hepatitis A outbreak, 29 people struck ill and 1 dead; BilMar Meats, 1998 Listeria outbreak, 21 people died - 100 people sick; Iwan's Deli 1998 E. Coli outbreak 5200 people sick; and who can forget Jack in the Box, 1993 E. Coli outbreak 4 children dead, 600 sick - The list goes on and on.

Nightly the TV blares with news of another foodborne illness outbreak or a recall on meat. From Hepatitis A, Salmonella, Shingella, Campylobacter, Norwalk virus, Mad Cow, Foot and Mouth, and E.coli, the list gets longer and longer. The end results are devastating, sometimes even deadly.

Every year one of every four Americans are struck with some type of foodborne illness, that is 6.4 million to 76 million* cases a year with an annual mortality rate of 5-9000 and 325,000* hospitalizations. The majority of these cases go unreported, people thinking they just caught a "bug".

The onset of a foodborne illness is anywhere from 4 hours to 7 weeks with a duration of 1 day to 24 weeks. Some of the causes of a foodborne illness outbreak, are undercooked food or cross contamination. However poor or lack of personal hygiene is the top contributing factor to a foodborne illness. In other words, THEY DIDN'T WASH THEIR HANDS!

• Workers use the restroom, don't wash their hands.
• Workers run their fingers through their hair, don't wash their hands.
• Workers rub face, nose and mouth don't wash their hands.
• Workers scratch ears, don't wash their hands.
• Workers rub their eyes, don't wash their hands.
• Workers constantly touch open sores on their face, don't wash their hands.
• Worker feels that wiping hands on dirty apron is sufficient for cleaning hands.
• Workers clean raw chicken and then make salad but don't wash their hands.
• Workers have open sores and infections on hands, handle food, don't wash hands.
• Workers prepare food and take dirty money, and don't wash their hands.

Although we know the consequences of foodborne illnesses, it takes someone getting sick or even dying to get our attention. What can we do to prevent future foodborne illness outbreaks?

On April 6, 2001 at the National Press Club in Washington D.C. the Handwashing Leadership Forum held a Handwashing for Life Seminar. Together Jim Man, the President of In focus Leaning Systems and the founder of The Handwashing Leadership Forum, and Dion Lerman, CFSP, Vice President of Infocus and serves as Education and Training Director for the Forum, have combined their knowledge to carry the message of understanding and managing the risks associated with infrequent hand washing and poor gloving practices in the industry.

*statistics from CDC Atlanta, Georgia

Members of the Handwashing Leadership Forum include:
Advance Tabco, manufacturer of stainless steel foodservice equipment including handsinks;
Cini Little, kitchen design consultants;
NSF International, a standards-setting organization;
Gojo, manufacturers of soap and sanitizers;
Tucel, manufacturers of fused-bristle fingernail brushes;
Georgia Pacific, manufacture paper towels;
FoodHandler, foodservice glove producers;
Rubbermaid, manufacture trash disposal products;
Glo Germ, a handwashing demonstration and effective product;
Hygenius, developers of handwashing monitoring technology.

In a combined effort with their members the Handwashing Leadership Forum has created an educational program that not only educates but also motivates the industry on proper handwashing techniques.

There are two steps that need to be followed to Motivate the foodservice worker:

1. Handsinks. "Promoting more handsinks in an establishment to be in the workflow so that when people want to wash hands it is convenient" says Jim Mann, Executive Director of the Handwashing Leadership Forum. Foodservice workers are under great pressures especially when there is a "rush" of customers. To walk 25 feet when you are busy is equivalent to walking a mile. More handsinks in a kitchen will make it convenient and accessible for the foodservice worker.
   • Handsinks should be located so that they are in open view of the manager or supervisor of the foodservice operation.
   • Handsinks should be installed in each food prep area of the foodservice facility.
   • Handsinks should be located at the front line.
   • Handsinks should be located within 8' of the restroom facility that is designated for the sole use of the kitchen and foodservice employees.
   • Handsinks should have a 3' clear wall dimension, free of all other equipment and readily accessible. This location should be designated as the "Handsink Area."
2. Motivation. Help the foodservice worker to understand the importance of washing their hands frequently and effectively. Explain how it benefits their own health, and the health of their families, as well as the health of their customers, and the business. Help the regulators, field inspectors and health inspectors. "The Health Inspectors are out there everyday and need tools to captivate their audience. We can make the kitchen convenient for handwashing but with out motivation nothing will work. The Handwashing Leadership Forum is working to motivate the industry" says Jim Mann of the Forum. "The Forum is out there educating the field inspectors with seminars and providing them with educational materials to assist in training the foodservice workers."

The law surrounding foodborne illness and handwashing is an important resource in helping establish the risks and solution. Foodborne illness lawsuits are on the rise, and settlements continue to increase.

Breaking the law is clearly a risk however the bigger risk is the injury or loss of life sustained by the customer. Virtually all foodservice workers who prepare and/or serve food do so within the parameters of the law. The regulatory Plan Review process assures the basics of facility compliance. Unfortunately, many operators stop there.

Strict Liability is a critical legal principle that if you cause harm you are liable. It is often applied in foodborne disease outbreaks. Modern epidemiological tools such as genetic fingerprinting of organisms makes possible positive identification of the source of an outbreak. Once the source is identified, the operator is liable.

Constructive Knowledge is another legal principle often invoked. An operator is responsible not just for what he or she actually knows, but what they should have known. For instance, if an employee spent a vacation in an area where hepatitis is an epidemic, the operator can be liable under constructive knowledge if the employee causes an outbreak of Hepatitis A.***

In conclusion, the key to food safety and to avoid a lawsuit is proper handwashing. To achieve successful handwashing we must make it convenient for the foodservice worker by providing more handsinks in the foodservice establishment while at the same time motivating and educating the foodservice worker of the consequences not only to themselves but to their co-workers, family and the general public.

***Dennis Stearns, Partner, MarlerClark