The Wash Podcast: Validating Hand Hygiene Methods for Pathogen Removal

by Meritech, on Mar 20, 2020 12:07:27 PM

Welcome to The Wash, your trusted resource for the latest and greatest in public health and hygiene, where we will tackle topics like hand hygiene, best practices in footwear sanitization, creating an employee hygiene program, and more!

On today’s episode, we invite Meritech CTO Paul Barnhill to discuss the different ways to validate hand washing methods for pathogen removal, the human considerations to take into account when forming a testing methodology,  and reveal what every company can do to help prevent the spread of pathogens

You can listen to the podcast using the media player or read the podcast transcript below:

Podcast Transcript: Validating Hand Hygiene Methods for Pathogen Removal

Abigail: Thank you for joining us for another episode of "The Wash", your trusted resource for the latest and greatest in public health and hygiene. This podcast is brought to you by Meritech, the leader in automated hygiene technology. ,I'm your host, Abigail Owiesny, and joining me today is Paul Barnhill, chief technology officer and head engineer here at Meritech.

Paul, thanks for joining us today!

Paul: Thanks for having me !

Abigail: In our last episode of The Wash, Joe Johnson and Paul discussed proving the efficacy of hand hygiene methods, and how we prove the efficacy of Meritech's CleanTech Automated Handwashing systems in removing pathogens.

Today, we're going to discuss the different ways to validate hand washing methods for pathogen removal, the human considerations to take into account when forming a testing methodology,  and reveal what every company can do to help prevent the spread of pathogens. So let's get started!

Paul, what are the different ways to validate a hygiene process for pathogen removal?

Paul: There's actually numerous ways that you can actually validate , a hygiene process or a hand hygiene process. I mean, one of the most basic ones that people deploy is actually what is called, "policing the behavior".

Where we're actually monitoring how the staff are doing, making sure they're doing it for the proper lengths of time, touching all the aspects of the hand and so forth. But understand, that itself, has a little bit of flaw. You know, just like when you're speeding down the highway and you see the cop on the side of the road, you slow immediately. That's what happens when you police hand hygiene. People do exactly what you want them to do. But what you want them to do, is do the right job when you're not around and not watching. So that's the part you have to instill. So that has a little bit of its limitations.

There's other methods that you can do. , for example, one of them is a product called "Glow Germ". It's a really good tool for showing what it may  simulate , when you've put  product on the hands. "Glow Germ" is really a bioluminescence oil, and when you rub it onto your hands, you can see what it looks like under black light. You go then wash, and then you look at it post. But there's a challenge with it. The fact is, is that it is a visual aid. But,  there's no correlation between, it a pathogen for the simple fact, you can't kill it, you can only remove it.

Abigail: And there's the fact that it's oil based that has a factor as well?

Paul: Absolutely, so the big difference between an oil-based product and the pathogen is that, you know certain things you need for, an oil-based product to remove it obviously is friction helps, you need temperature, , and you need a little bit of pressure and a degreaser. These are the things that you really need to get oil-based products off. Pathogens don't behave the same way, at all.

Really the last thing is "hard science". "Hard science" is where we actually are using things like ATP to actually measure  a pre and a post hygiene event to see a reduction. And that's a really good method that plants can deploy in their facilities to get an immediate, behavioral reaction to see "What are we reducing?"

Abigail: And what exactly does "ATP" stand for?

Paul: Great question. Adenosine triphosphate is really what that means. It really is basically the cell of life, so every bacteria, every pathogen, so forth, have this. It's actually even in our skin cells as well, so it's really, a way to detect it from a scientific level, to sit there and look. And that way we can look at a pre number and then we can look at a post number to know that we want to get to, you know, either an 80% or greater removal or below a hundred and we recommend using the hygienist system because we've proven it works very, very well when in correlation with human skin where others may not work as well with human skin at detecting a reduction level.

Abigail: Okay. And what is the hygienist system?

Paul: The hygiene is a piece of equipment. You use their swabs to be able to measure, the hand hygiene before you wash the hands after wall sands so you can get a number to correlate to exactly "What is my reduction?" So you can actually start collecting real data behind it. Now in the labs, we do science a little bit differently than that, and so we go through those processes a little differently.

Abigail: So what are those different methodologies around hand hygiene validation?

Paul: There are several different methodologies that are deployed both within. A plant operation that you can use immediately , or others that you can deploy that we do within, laboratory settings and so forth.

You know, obviously the ATP that we just discussed, that's a really good methodology that can be used by a lot of plant personnel to get immediate data back. And I described that one earlier. You then have another one that's called the finger plate method. It's really just an auger plate. You press the fingers into  and then you do a pre and post a little bit of erroneous data, because again, you're not looking specifically at general number and it's difficult to say, is this person high? This person low? Is that normal? Did I slough off to my skin cells? Understand that's where the resident pathogens lie.

So the next one, you may have a higher count, so there's difficulties with that one, of getting it repeatable and it could be off a factor of a hundred is our experience in finger plating. Then you have swabbing one of the challenges with people, they just swab everywhere. The challenges, if you don't have a consistent method when doing it, you don't get very consistent data. That's really what's important is you want to make sure that process you follow isn't creating unusable data because you don't have a consistent enough process. You're not doing it exactly the same way: Am I pressing the right way or hard enough? Am I covering the same area every time? Am I rubbing areas that aren't normally washed?

So you've got to make sure you're doing that right. And then people that look at total plate count. This is a really difficult one. When you're looking at total plate count, you're looking at both the resident and transient pathogens on the hand, and that can give you all kinds of variability because there's a lot of different variability is when it comes to total plate count. Again, dealing with both resident and transient pathogens.

Abigail: Okay, and just to clarify for our listeners, what is the difference between resident and transient pathogens?

Paul: A resident pathogen comes from me, it's really resides on me they're on our skin. They're on the various layers of our skin , they're there to help protect the skin, and so forth. So they live there as well as transient pathogens. Those are the passengers that you're picking up from other people. You may get it from shaking somebody's hands or a doorknob or a button or a stair railing or something like that where they have, may have come in contact with something that now is transient to you, not from you. So okay, that is what that means.

Now, there's a couple of other methodologies we've deployed in the lab. We will follow what is called the "Glove Juice" method, or what is called an ASTM standard E1174, which we typically do with bacterias, or we'll do E1838 which is a fingertip method that we do deploy for viruses.

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It depends on what we're challenging the hand with, when we do true specific human testing with a pathogen, what test methodology works best to make sure that we yield results the correct way. So we don't want to use a test method that doesn't work for the pathogen, that doesn't allow for the pathogen to survive and, and for us to collect data.

And we do pathogen-specific testing for a reason. Pathogen specific testing is important because we know what we're applying to the hand, we know what the baseline is, and then we'd go do a hygiene event and then we look at what that result is from there. And then we know what we're specifically looking at.

So, when we apply an E. coli, we know we're looking for E. coli, we're not looking at all this general population of the other 10,000 bugs that are living on my skin, and I'm looking for just this one specific one. So we can get really good, clear, concise data to an ASTM standard.

Abigail: Got it. And I know when you are in the lab, it's not just one time that you do to this hand hygiene event, you do it multiple times, right?

Paul: Oh, the amount of pathogen we're putting on a human is just absolutely amazing. Most people wouldn't even know. We're usually putting eight to the 10th power of a pathogen directly onto human skin. And we're measuring what that baseline is and we're showing somewhere between a three-log and a four-log reduction to this pathogen.

And we're doing this not only just once. We're actually doing it up to 10 times and we keep putting it on. And so every single time we're putting a pathogen on up to 10 times and we measure it. One, five and 10 is our methodology we've deployed before just so that we get a really good, consistent, confident number that we stand behind.

Abigail: Paul, what are those different human considerations to take into account when validating these different hand hygiene methods?

Paul: Yeah, there's just one thing about humans: there's nothing consistent. That's the most important piece that you can really think about when you're talking about doing true human skin testing applying pathogen directly to human skin. I mean, some of the basics are men are different than women. Okay. Our skins behave differently. You can look at the age. Age is a big variable, a younger person is going to have more ductile skin. It's going to be more vibrant, is going to be better at survival than somebody that may be elderly.

 When we choose people, we choose a very broad spectrum of individuals, that are both young and old, multiple different races, multiple different skin types. We want to make sure that we have really good, varied data so that we're looking at an average. We're looking at the workforce just like it is in food manufacturing, a varied workforce and cultures that we can make sure that we get good data when we're collecting it. But there's also other variables that are involved, you know, just your skin, your skin is a little bit pH acidic. And the reason why that is, is so that you can actually fight off the transit pathogens and those bad bugs. And so the advantages of that is that the skin behaves in a different way.

Abigail: So not only people's skin health and how the skin behaves, but also the different human behavior aspects can have an impact on validating those different hand hygiene methods, correct?

Paul: Absolutely, human behavior is the largest variable when it comes to to hand hygiene. Only 8% of people truly wash their hands correctly, manually. It's a large number and what they do at home tends to carry them through the workplace, and the workforce, and that's a big challenge. So we want to make sure that, especially in the workforce, that we really are thinking about how do we adjust that behavior to make sure that we're getting people to do hygiene the right way, the correct way, every time that you're able to get a consistent, repeatable result.

Abigail: All right, Paul. So I know we were talking about handwashing. What about hand drying?

Paul: Hand hygiene is a process. It has a beginning, a middle, and an end. Okay, the beginning is wetting my hands, in the middle of it is where I'm actually scrubbing and washing, and rinsing, and at the end of this is really what is called "drying". You're creating an event, and so you want to make sure that you do that the correct way, and there's a couple of different methods that you deploy. Obviously you have air dryers and then you have and/or paper towel products for drying.

And so really there's a couple challenges with either/or depending on what you choose, obviously with air dryers, especially within restrooms, you have what is called fecal shedding or particulates in the air. They can actually be spread by velocity, high velocity air dryers get these deposited back to a hand. and if you maybe don't wash your hand correctly, it can be redeposited back to the hand. If you're using some dryers that may have touch points. Those touch points if you didn't wash correctly, could then be a harborage point for other pathogens to grow, that then could be spread to the next users and so forth.

And then you have paper products. And so paper towel drying is really just a preferred method for ease and simplicity, and speed of getting done with your process of hand hygiene. Because keep in mind, hand hygiene is really not just about, applying soap and washing, it really is a process.  You have to make sure that you include that drying step, it really is that process you're going through.

Abigail: Got it. And I know there's both good and bad types of paper towel. What type of paper towel do you recommend?

Paul: It's funny, when people choose paper towel, they tend to choose one of the cheapest out there. And the reason why I don't recommend that, is really sometimes when you use the cheapest paper towel out there, you actually feel like you need to use more of that towel to thoroughly dry, because it doesn't absorb water well. It also tends to be a little bit rough on the skin. And we really want to make sure that you have really good, healthy skin for long periods of time.

So the more abration it is, it's more difficult to deal with. You can't separate the fact of having clean hands and healthy skin, so you need to protect that skin. Keep in mind, it's your lower body's largest organ.

I pick one of that's middle of the road, something that's soft, but very absorbent. When you use a better quality towel, you tend to actually use less, so you don't need more to thoroughly dry and it's also gentler on the skin.

The advantage of paper towel drying, especially in the food environments is vast. It's simple, you can move people very quickly through a process you're less likely to have a cross-contamination event. And if your staff have to wear gloves in your facility, you can then make sure that they thoroughly dry, giving you the opportunity to get that glove on the hand without failures of the glove.

Abigail: So what is something that every company can do, to prevent the spread of pathogens at their facility?

Paul: It really boils down to a couple of simple things. One of the first things is really creating a culture of hygiene, and let me put this very basically, the culture of hygiene is really to where you have an executive over here on the left, and you have a manufacturing worker over here on the right, and you have what is called a flat line of leadership where everybody is on that same flat line when it comes to hygiene. It doesn't matter if it's your executive, doesn't matter if it's your middle management, your team member leaders or your team members, they all understand that they are held to the same exact standard and have that same authority when it comes to the hygiene culture in their facility.

One of the beginning things that we do to help create that culture, is what is called the hygiene social contract. And it really upholds some very basic outlines, that everybody holds for that hygiene culture. And that's where it starts. It's really more mental than it is physical to make sure that you're creating that. And it really stems multiple ways throughout your corporation, to really start creating that good culture.

Abigail: And another aspect of creating a hygiene culture that you've talked about previously is a food safety committee.

Paul: Absolutely. I think that's an excellent thing that ties into this really well. There's a woman I've spoken about in the past, I think she really does a better job at explaining it than I do, her name is Joyce Watford. She is absolutely an expert at "How do you create a food safety committee?"

In a very basic way of putting it, it's really getting everybody involved from multiple aspects of the company. It's not just your QA/QC person and your plant manager involved, you really do want somebody from executive leadership to make sure you have the right direction that the company's going, but also have that ability to be able to secure finances when you need it as you want to grow and change. You want middle management involved. You want those team member leaders and team members on there, but just beyond them, there's other aspects of the company. Sales can be involved. Marketing can be involved so that everybody understands that this is an incredible step that you're taking in your organization. You're making it part of your culture of creating both food safety and a quality hygiene product.

Abigail: Got it, and I know we talked about leveraging the employee hygiene contract as part of the onboarding process previously, and another part of that was having a team member mentor. Can you describe to our listeners what that is?

Paul: One of the things that's unique about food manufacturing in the United States is we're getting a very diverse work culture. I spoke a while back about, how one plant I was in had 32 different spoken dialects in a plant. That's very challenging for owners and operators to make sure that we're really following all the hygiene standards and appliances that we need to do per the regulations we create, but it's also difficult to create that culture. So you have this diverse culture that we have to work with. So we need to be able to train and teach them. One of the ways to do that, during that onboarding process is actually assign them a team member mentor. What that team member mentor does, not only teaches them and helps with their daily part of their job as they learn it, but also helps them during those hygiene and those safety times.

It's somebody they can speak with, somebody that will work with them, and it's not just a day or two, not a week or so, I prefer at least a month that they work with them to make sure that they're working with them to understand  the hygiene and food safety requirements.

The other advantage of having a team member mentor working with this team member is that they're on the same level in the company. They're not looking as if it's a superior or a boss or a leader telling them what to do. It's really somebody that's equal to them. They're more likely to receive that information and grow with it and follow that lead. That is really important. That helps you create that hygiene culture that stems throughout the whole organization.

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Abigail: So hygiene culture really helps to prevent the spread of pathogens just by having that unified mindset, but you also kind of need the facility to be laid out in a way that helps promote that as well. So can you talk to me a little bit about hygiene zones?

Paul: Hygienic zoning is not new, but a lot of people are looking at it in a different way. Meritech is one of those companies that looks at it a different way. We want to make sure that when you're coming into an area, you're following a set of processes that guide you through the process that doesn't allow for circumvention, that makes sure you're following the correct order of operations  and then looking at those risk factors of hygienic zoning.

So yes, when the employees are first coming in. They have a known set of procedures they have to go through that guides them through the process without circumventing, let's say the hand sink or the automated hand washer that they go through, that they're putting their PPE on in the correct order and they have a drying area and then they go off to their work area.

Avoiding things that are maybe additional handrails or something where you could have cross-contamination areas. But additionally, within plants, you need to think about, hygenic zoning isn't just that place you enter. It really needs to be everywhere you could enter, there may be a back area that come from maintenance or from packaging or something to that effect. Even a QA office coming out, may need a hygiene zone, it may be small, but it's a hygiene zone. Or in that plant, do you go from a raw area to a ready-to-eat area that not only needs a hygiene zone, but needs an intervention step, something that prevents you from moving from one area to another. Same thing a lot of plants don't think about is: "Am I dealing with an allergen?" So I could have a trifecta of different things, where I have a raw, I have a RTE, and I may have an allergen in there.

So one of the things I've talked about for a while now is the three P's: the People Place, and the Products that you're dealing with. So that really addresses it from a hygiene aspect. But I'm really adding a fourth "P" to this, and that's called "Practice". We can put the right people, the right place in the right products in line, but we also have to do that practice, making sure that process we go through works for everybody, addresses what that person does in the plant, and it works for a hygiene aspect every single time.

Abigail: That's amazing. All right, Paul, so thank you so much for joining me today to discuss this topic and I look forward to our next discussion.

Paul: I enjoyed it very much. Thank you.

This podcast is brought to you by Meritech, the leader in automated employee hygiene. Meritech offers a complete line of fully-automated hygiene equipment that provides the only clinically-validated, technology-based approach to human hygiene in the world. Meritech’s line of CleanTech® Automated Handwashing Stations perform a fully-automated 12-second hand wash, sanitize and rinse cycle, removing over 99.9% of dangerous pathogens while using 75% less water than manual handwashing. Meritech delivers employee hygiene, contamination control, and infection prevention programs within a wide variety of markets, including food production, food service, cleanroom, healthcare, medical, theme parks, and cruise lines. For more information call 303-790-4670.

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