Category Archives: Hand Washing

Research – An outbreak of Hepatitis A virus infection in a secondary school in England with no undetected asymptomatic transmission among students

Cambridge Org


In June 2019 the Health Protection Team in Yorkshire and Humber, England, was notified of cases of hepatitis A virus (HAV) infection in staff at a secondary school. Investigation revealed that an earlier case worked as a food handler in the school kitchen. Indirect transmission through food from the canteen was considered the most likely route of transmission. Cases were described according to setting of exposure. Oral fluid was obtained from students for serological testing. Environmental investigations were undertaken at settings where food handling was considered a potential transmission risk. Thirty-three confirmed cases were linked to the outbreak. All of those tested (n = 31) shared the same sequence with a HAV IB genotype. The first three cases were a household cluster and included the index case for the school. A further 19 cases (16 students, 3 staff) were associated with the school and consistent with indirect exposure to the food handler. One late onset case could not be ruled out as a secondary case within the school and resulted in vaccination of the school population. Five cases were linked to a bakery where a case from the initial household cluster worked as a food server. No concerns about hygiene standards were noted at either the school or the bakery. Oral fluid samples taken at the time of vaccination from asymptomatic students (n = 219, 11–16 years-old) showed no evidence of recent or current infection. This outbreak included household and foodborne transmission but limited (and possibly zero) person-to-person transmission among secondary school students. Where adequate hygiene exists, secondary transmission within older students may not occur.

The Handwashing Handbook

Global Handwashing Org

The Handwashing Handbook is based on the experience of the Global Handwashing Partnership and presents best practices and new concepts to improve the uptake of handwashing. The Handwashing Handbook focuses on:

  • Making the Case for Handwashing
  • Designing and Implementing Handwashing Programs
  • Improving Handwashing in Specific Contexts
  • Addressing Handwashing at a Systems Level

The Handwashing Handbook is available in Arabic, Chinese, English, French, Portuguese, and Spanish.

Resource Attachments: (pdf) (pdf) (pdf) (pdf) (pdf) (pdf)

Australia – Donuts for weight loss? A norovirus outbreak associated with a bakery in the Australian Capital Territory

Gov Au

Three hundred and one people were surveyed, and 215 individuals (71.4%) reported vomiting and/or diarrhoea following consumption of a donut purchased from the business over a five-day period.
All ill respondents reported eating a donut. The medians of incubation period and illness duration were 34 hours (interquartile range, IQR: 29–42 hours) and 48 hours (IQR: 29–72 hours) respectively. Diarrhoea, vomiting and abdominal pain were the most commonly reported symptoms.
Eight out of 11 specimens collected from ill individuals were positive for norovirus. For the case-control study, data from 59 attendees were collected, with an attack rate of 46% (27/59). Eating any kind of filled donut was associated with a person becoming ill (odds ratio: 10.4; 95% confidence interval: 1.18–478.13).
No single flavour was identified as the likely source of infection.
Elevated levels of coliforms were present in two samples of donut filling obtained during the food safety inspection.
Donuts are a novel vehicle for norovirus infection. This implicated pathogen, plus evidence collected at the food premises suggestive of faecal contamination, indicates the source of this outbreak was likely an ill food handler. The findings of this outbreak highlight the importance of excluding food

Research – Virulence Potential and Antibiotic Susceptibility of S. aureus Strains Isolated from Food Handlers


Staphylococcus spp. are common members of the normal human flora. However, some Staphylococcus species are recognised as human pathogens due to the production of several virulence factors and enterotoxins that are particularly worrisome in food poisoning. Since many of Staphylococcal food poisoning outbreaks are typically associated with cross-contamination, the detection of S. aureus on food handlers was performed. Hand swabs from 167 food handlers were analysed for the presence of S. aureus. More than 11% of the samples were positive for S. aureus. All S. aureus strains were isolated and analysed for the presence of virulence and enterotoxin genes, namely, seasebsecsedsegseitsst-1 and pvl. The same strains were phenotypically characterised in terms of antibiotic susceptibility using the disc diffusion method and antimicrobial agents from 12 different classes. A low prevalence of antibiotic-resistant strains was found, with 55.6% of the strains being sensitive to all of the antimicrobial agents tested. However, a high prevalence of resistance to macrolides was found, with 44.4% of the strains showing resistance to erythromycin. At least one of the virulence or toxin genes was detected in 61.1% of the strains, and seg was the most prevalent toxin gene, being detected in 44.4% of the strains.

USA – Luigi’s restaurant in Roanoke Virginia linked to Hepatitis A ill food service worker

Food Poison Journal

Just months ago the Roanoke City and Alleghany Health Districts (RCAHD) announced that RCAHD had identified a total of 50 confirmed primary cases and 2 secondary cases.  There have been at least 31 hospitalizations and unfortunately 4 deaths.

Now the risk of another outbreak is striking the same community.

New details have emerged as part of an ongoing investigation conducted by the Virginia Department of Health. The report involves an employee of Luigi’s restaurant in Roanoke who was recently diagnosed with hepatitis A. New information, obtained today, revealed that the employee may have had limited involvement in handling food prior to the food being cooked before consumption. Cooking food kills the virus that causes hepatitis A, therefore this situation does not meet the criteria of an exposure.

Given the high level of sensitivity of hepatitis A in our community, and out of an abundance of caution, the Roanoke City Health Department is offering hepatitis A vaccine to anyone who ate at Luigi’s between the dates of April 26 – May 17. Hepatitis A vaccinations will be available at the Roanoke City Health Department, 2nd Floor, 1502 Williamson Rd., Roanoke, VA 24012 this week at the following times:

  • Thursday, May 19, 3-6 p.m.
  • Friday, May 20, 8:30 – 11:30 a.m. and 1-4 p.m.

USA – 11 Hepatitis A cases linked to Gino’s Ristorante & Pizzeria

Food Poison Journal

The Montgomery County Office of Public Health (OPH) announced today the temporary closure of Gino’s Ristorante & Pizzeria in West Norriton in relation to a Hepatitis A Virus (HAV) outbreak in the county. The restaurant will be closed until further notice while the investigation continues.

At this time, 11 total cases are under investigation, with 9 confirmed cases of Hepatitis A and 2 potential cases of Hepatitis A. Of the 9 confirmed cases, 7 people were hospitalized. To date, one death is confirmed and one additional death is under investigation.

USA – Wendy’s patrons may have been exposed to hepatitis A; still time for treatment for some

Food Safety News

The Arkansas Department of Health  is warning of possible hepatitis A exposures after an employee of Wendy’s at 721 North Arkansas, in Russellville tested positive for the virus.

Anyone who ate at the restaurant between Dec. 12, 2021, and Jan. 3, 2022, should seek care immediately if they have never been vaccinated against hepatitis A or are unsure of their vaccine status.

There are no specific treatments once a person contracts the liver virus. However, it can be prevented through vaccination. It can also be prevented from developing in people who have been exposed if a medicine called immune globulin is administered within two weeks of exposure. This medicine contains antibodies from other people who are immune to hepatitis A.

Polish Handwashing Poster – Chilled Food Association

Click to access CFA-Polish-Poster-rev-14-7-071.pdf

Global Handwashing Day

Global Handwashing Day

October 15 is Global Handwashing Day, a global advocacy day dedicated to increasing awareness and understanding about the importance of handwashing with soap as an effective and affordable way to prevent diseases and save lives.


This unprecedented time provides a unique impetus to institutionalize hand hygiene as a fundamental component of health and safety. The learnings from the past year have emphasized the need for collective action to address the historic neglect of hand hygiene investments, policies, and programs once and for all. As we enter a new normal, beyond COVID-19, our future is at hand.  This year’s theme, “Our Future is at Hand – Let’s Move Forward Together,” calls for coordinated action as we actively work toward universal hand hygiene.

No matter your role, you can celebrate Global Handwashing Day!

Click to access GHD-2021-Fact-Sheet.pdf

Research – Handwashing Observations in Fast-Food and Full-Service Restaurants: Results from the 2014 FDA Retail Food Risk Factors Study

Journal of Food Protection

Properly executed handwashing by food employees can greatly minimize the risk of transmitting foodborne pathogens to food and food contact surfaces in restaurants. However, food employee handwashing is often not done correctly nor does it occur as often as it should. The purpose of this study was to assess the relative impact of 1) the convenience and accessibility of handwashing facilities; 2) the maintenance of handwashing supplies, 3) multi-unit status, 4) having a Certified Food Protection Manager, and 5) having a Food Safety Management System on compliance with proper handwashing. Results showed marked differences in handwashing behaviors between fast-food and full-service restaurants. Forty-five percent of fast-food restaurants and 57% of full-service restaurants were found to be out of compliance for washing hands correctly. Fifty-seven percent of fast-food establishments and 78% of full-service establishments were out-of-compliance for employee hands being washed when required. Logistic regression results point toward the benefits of accessibility and maintenance of the handwashing sink and food establishments having a Food Safety Management System to increase the likelihood of employees washing hands when they are supposed to and washing them correctly when they do.