Research, Rumors & Realities Programs extending lab data into restaurant research August 15, 2007 National Restaurant Association Viruses Impacting the Restaurant and Foodservice Industry Jim Mann

Viral Issues Business / Restaurant risk Hand sanitizer efficacy against the hard to kill viruses Risk reduction without running water Restaurant level approaches & compliance

Assessing Your Risk

It is a Growing Risk

People Served

Break this chain! … manage as if you have an ill employee on every shift. Fecal Hand Oral

Where we are … Virus, the Model Food Code & Compliance Intervention: Vaccine Industry Compliance Hep A Small scale usage Hep A Increased usage Model Food Code

Las Vegas: Hand Hygiene Capital of the World The war on virus - Hep A report

Structural Classification of Viruses EnvelopedNon-Enveloped Adenovirus Hepatitis A Norovirus Papillomavirus Poliovirus Rhinovirus Rotavirus Hepatitis B virus Hepatitis C virus Herpes Virus HIV Influenza viruses Respiratory Syncitial Virus SARS-CoV

The Non-enveloped Virus Problem 30.9 million cases of foodborne illnesses/year* 23 million from norovirus* Lack of new vaccines “ The majority of viruses for which hand transmission plays a critical role are non-enveloped. ” Dr. Macinga *Mead et. al., Emerging Infectious Diseases, 1999, 5:607.

Where we are … Virus, the Model Food Code & Compliance Intervention: Alcohol Hand Sanitizer Where water is readily available Industry Compliance Only after handwashing Usage by few A light soiling alternative to handwashing (Synergized Alcohol Formulae, min 3 log reduction) Usage by many Model Food Code

In vitro Virucidal Efficacy Method: Quantitative Suspension Test (30 sec) 1 E.J. Fendler et. al., “Efficacy of Alcohol-Based Hand Sanitizers Against Fungi and Viruses”; Infection Control and Hospital Epidemiology, Feb. 2002, 23, 2, p D.M. Macinga et. al., “Inactivation of Viruses Using a Synergistically Formulated Alcohol-Based Hand Sanitizer”, IAFP Annual Conference, July 2007 Non-enveloped Enveloped Improved efficacy vs. non-enveloped viruses TypeVirus Log10 Reduction Current 1 New 2 Feline Calicivirus F-91.00≥4.75 Mouse Norovirus1.16≥ 3.68 Adenovirus type Hepatitis A * Poliovirus type Rhinovirus type ≥ 3.25 Rotavirus WA≥ 5.75≥ 4.75 Influenza A≥ 6.25≥ 5.25 Influenza B≥ 5.75≥ 4.25 Avian Influenza (H5N1)≥ 3.50≥ 3.75 Respiratory Syncytial Virus≥ 2.50≥ 1.50

In vitro Virucidal Efficacy: Fingerpad Method: Quantitative Suspension Test (30 sec) * * * * * Complete inactivation below detection limit *

More Viral Efficacy Data Research is on the rise Hand sanitizer efficacy and viral detection are hot spots In-vivo data presented and in press Stay tuned …

Where we are … Virus, the Model Food Code & Compliance Intervention: Alcohol Hand Sanitizer- SaniTwice Process Where water is not readily available Industry Compliance Usage in special situations (military) A light soiling alternative to handwashing A moderate soiling alternative to handwashing when used with a nailbrush (Synergized Alcohol Formulae, min 3 log reduction) Usage by many Model Food Code

Where we are … Virus, the Model Food Code & Compliance Step 1 – Apply alcohol hand-sanitizer generously. Step 2 – “ Wash ” vigorously for 20 seconds. Step 3 – Wipe off / dry with a disposable paper towel. Step 4 – Re-apply alcohol hand-sanitizer according to label instructions. Introducing SaniTwice TM For light to moderate soiling, when water is not readily available.

SaniTwice Study - NEHA Participants: 44 FDA, USDA, CDC, Operators & Academia Test Method: 1. Contaminate hands with UV tracer. 2. Use SaniTwice method. 3. Measure residues using UV light. Results: “Surprised with the level of cleaning.”

Break this chain! … manage as if you have an ill employee on every shift. Fecal Hand Oral

“Not reasonably safe”

Jaundice (Yellowing of the Eyes & Skin) Health Monitoring, Ill employee exclusion

Where we are … Virus, the Model Food Code & Compliance Intervention: Handwashing Industry Compliance “Handwashing compliance is no longer about training or the Food Code, it’s about filling the voids in operational standards and management information systems.” Jim Mann Almost everything covered Poor Almost everything covered (See Issue Incubator) Measurement, documentation, QA/audited systems Model Food Code

Management Information Initiative Maricopa County, RTE…variance program Participating Operators: 210 Independent & chain restaurants: Taco Bell, Burger King, Arby’s, Jack-in-the-Box, Sonic, Kona Grill, KFC, Cold Stone Creamery & more “ Operators are rewarded for taking control of their handwashing, making it a system which they monitor and document.” David Ludwig, Maricopa County

Hand Hygiene: A Game of Chance … or a managed system

ProGrade™: Each employee periodically demonstrates their handwashing proficiency. Handwashing … establishing your Safe Level for quality Handwashing … establishing your Safe Level for quality

Handwashing Frequency MyQ ™ - Safe Level Worksheet

Documented Success “ What gets measured gets done.” 5. Monitor

Contact us: Jim Mann Executive Director The Handwashing For Life® Institute 1216 Flamingo Parkway Libertyville, IL