Handwashing Violations in Georgia Food Sales Establishments: Automatic vs. Traditional Handwashing Sinks
Amy Hoover
Metro District Manager -
Georgia Department of Agriculture
Abstract
Handwashing is essential in food sales establishments to minimize the spread of foodborne illnesses via hands. The state of Georgia allows the use of automatic handwashing sinks with motion sensors in retail food sales establishments. The purpose of this study was to determine if firms that utilize automatic handwashing sinks with motion sensors are at an increased risk of violations due to the malfunction of sensors, inconvenience of waiting for sinks to engage, or inability of water to reach proper temperature for handwashing at set intervals, as compared with traditional handwashing sinks. A combination of qualitative and quantitative surveys was sent to inspectors with the Georgia Department of Agriculture to collect data on the types of firms which utilize automatic and traditional handwashing sinks, along with the opinions inspectors have concerning automatic and traditional handwashing sinks in the firms which they regulate. This information was reviewed to establish if there was a difference in violations and perceptions between these two types of sinks. Due to a limited amount of data received concerning firms that use automatic handwashing sinks, determining if there was a difference in violation amounts and types between firms with automatic and traditional handwashing sinks was difficult. Based on the qualitative survey results received from GDA inspectors, there were mixed opinions on which sinks they preferred to see in firms they regulated.
Keywords: Food sales establishment, automatic handwashing sink, traditional handwashing sink
Handwashing Violations in Georgia Food Sales Establishments: Automatic vs. Traditional Handwashing Sinks
Background
Handwashing is essential in food sales establishments to minimize the spread of foodborne illnesses via hands. The state of Georgia allows the usage of automatic handwashing sinks with motion sensors in retail food sales establishments. They differ from traditional handwashing sinks in the sense that they are triggered by motion sensors, as opposed to manually releasing a lever to access a steady stream of water for handwashing. Limited research is available concerning how the handwashing violations between automatic handwashing sinks and traditional handwashing sinks compare.
There are a variety of known ways that hands can acquire pathogens, including eating, touching contaminated objects, and using the restroom. The Centers for Disease Control and Prevention (CDC) recommends that hands be washed: before, during, and after, preparing food; before and after eating food; before and after caring for someone who is sick; before and after treating a cut or wound; after using the toilet; after changing diapers; after blowing your nose, coughing, or sneezing; and after touching an animal (CDC, 2022). Handwashing may prevent many of these foodborne illnesses. According to the CDC, feces can spread a variety of pathogens including Salmonella, E. coli O157, norovirus, adenovirus, and hand-foot-mouth disease (CDC 2020). Washing hands with soap removes pathogens, which is vital to prevent the spread of infections. Some of the ways that infections spread to humans through fecal matter is through frequent touching of the face, spreading from hands to food and drink, and transference to objects. (CDC, 2020).
The U.S. Food and Drug Administration (FDA) estimates there are about 48 million cases of food poisoning annually. Furthermore, these incidences result in an estimated 128,000 hospitalizations and 3,000 deaths each year (FDA 2022).
The Georgia Department of Agriculture has modeled regulatory requirements from the 2017 FDA Food Code. It states that:
“Food employees shall clean their hands in a handwashing sink or approved automatic handwashing facility and may not clean their hands in a sink used for food preparation or ware washing, or in a service sink or a curbed cleaning facility used for the disposal of mop water and similar liquid waste.” (2-301.15)
This regulation allows for both traditional handwashing sinks, along with automatic handwashing sinks to be used in regulated facilities in Georgia.
Problem Statement
The effectiveness of automatic handwashing sinks in comparison to traditional handwashing sinks leading to handwashing violations within Georgia food sales establishments is unknown.
Research Questions
What are the handwashing violations observed by inspectors within retail food sales establishments that result from, and are related to traditional handwashing sinks?
What are the handwashing violations observed by inspectors within retail food sales establishments that result from and are related to automatic handwashing sinks?
How do handwashing violations within retail food sales establishments using traditional handwashing sinks compare to handwashing violations within retail food sales establishments using automatic handwashing sinks?
How do GDA inspectors view traditional handwashing sinks and automatic handwashing sinks at the firms they regulate?
How does the level of food safety risk, associated with handwashing violations, in retail food establishments, using traditional handwashing sinks, compare to the level of food safety risk associated with handwashing violations in establishments using automatic sinks?
Methodology
This study utilized two surveys, which were sent to retail food compliance specialists at the Georgia Department of Agriculture. The first survey sent was intended to determine which food sales establishments have automatic handwashing sinks. This survey asked compliance specialists the following: facility name, facility ID, facility address, city, county, method of contact (phone call/onsite), and the time of assessment. Additional questions inquired about the availability of an automatic handwashing sink (yes/no); the sink’s location (bathroom, kitchen/deli, bakery, seafood area, meats area, other); photos of sink(s); the date/time of assessment; and the investigator’s name. This information was used to identify facilities that had automatic handwashing sinks. Inspection reports for these firms for January 2019 through December 2022 were retrieved from Tyler Digital Health Department (a software database used to create inspection reports) along with inspection reports from an equal number of similar type firms utilizing traditional handwashing sinks to compare violations between the two sets of data. The firms that were analyzed included convenience stores with food service components, grocery stores with food service components, and food sales areas with food service components.
When reviewing these inspection reports, the following were examined: handwashing violations that result from and are directly related to traditional handwashing sinks; handwashing violations that result from, and are directly related to automatic handwashing sinks; and, how handwashing, within retail food sales establishments using traditional handwashing sinks, compares to handwashing violations within retail food sales establishments using automatic handwashing sinks.
The second survey collected qualitative data from GDA inspectors. GDA inspectors were asked to rank the following questions using a Likert scale from Strongly Agree, Agree, Neither Agree nor Disagree, Disagree, and Strongly Disagree:
I think firms that utilize automatic handwashing sinks with motion sensors are more likely to have handwashing violations than firms with traditional (manually operated) handwashing sinks.
I think firms that use traditional handwashing sinks (manually operated) are more likely to have handwashing violations than firms with automatic handwashing sinks with motion sensors.
I prefer to see automatic handwashing sinks with motion sensors at firms I regulate.
I prefer to see traditional handwashing sinks that are manually operated at firms I regulate.
Results
GDA regulates just over 20,000 retail food sales establishments. From the first survey, 287 surveys were received from inspectors. Of these surveys collected, 12 indicated that a firm which had a food preparation component utilized automatic handwashing sinks. These 12 represented just over 4% of all surveys received. These firms included four convenience stores with a food preparation component and eight grocery stores/markets with a food preparation component. Examples of food preparation components included deli, meat cutting/packaging areas, produce cutting/packaging areas, seafood cutting/packaging areas, and bakeries. The handwashing violations at these firms were compared with a random selection of firms with the same type of operations that used traditional handwashing sinks from Jan. 1, 2019, through Dec. 31, 2022.
The handwashing violations studied were from the Rules of the Georgia Department of Agriculture, Chapter 40-7-1 Retail Food Sales and included: Clean Condition (40-7-1-.05(1)), Cleaning Procedure (40-7-1-.05(2)), When to Wash (40-7-1-.05(3)), Where to Wash (40-7-1-.05(4)), Hand Antiseptics (40-7-1-.05(5)), Preventing Contamination from Hands (40-7-1-.10(1)), Handwashing Sinks-Installation (40-7-1-.26(3)), Handwashing Sinks-Numbers and Capacities (40-7-1-.26(7)), Handwashing Sinks-Locations and Placement (40-7-1-.26(12), Using a Handwashing Sink-Operations and Maintenance (40-7-1-.26(15)), Handwashing Cleanser Availability (40-7-1-.32(2)), Hand Drying Provision (40-7-1-.32(3)), Handwashing Aids and Devices-Use Restrictions (40-7-1-.32(4)), and Handwashing Signage (40-7-1-.32(5)), (Georgia Department of Agriculture, 2019).
Firms from the group with automatic handwashing sinks reflected four handwashing violations, including one citation for Using a Handwashing Sink-Operations and Maintenance (40-7-1-.26(15)) (i.e. handwashing sink is accessible at all time to employees), one citation for Handwashing Sinks-Installation (40-7-1-.26(3)) (i.e. a handwashing sink shall be equipped to provide water of at least 38° C) , and two citations for Handwashing Signage (40-7-1-.32(5)) (i.e. a sign or poster notifying employees to wash their hands was not provided or clearly visible). Firms from the group with traditional handwashing sinks reflected 11 handwashing violations, including one citation for Handwashing Sinks-Locations and Placement (40-7-1-.26(7)) (i.e. handwashing sinks in easily accessible food preparation areas), four citations for Using a Handwashing Sink-Operations and Maintenance (40-7-1-26(15)) (i.e. handwashing sink is accessible at all time to employees), three citations for Handwashing Cleanser Availability (40-7-1-.32(2)) (i.e. no soap at handwashing sink), and three citations for Hand Drying Provision (40-7-1-.32(3)) (i.e. no paper towels at handwashing sink.). Graph 1 shows the frequency these violations occurred in both firms with automatic handwashing sinks and firms with traditional handwashing sinks.
Graph 1
Handwashing Violations Cited
From the second survey, 18 of 34 surveys were returned from GDA field inspectors concerning their opinion on these two types of sinks. The survey revealed the following: When responding to the statement “I think firms that utilize automatic handwashing sinks with motion sensors are more likely to have handwashing violations than firms with traditional handwashing sinks,” 10% stated Strongly Agree, 40% stated Agree, 20% stated Neither Agree nor Disagree, 20% stated Disagree, and 10% stated Strongly Disagree. When responding to the statement “I think firms that use traditional handwashing sinks are more likely to have handwashing violations than firms with automatic handwashing sinks with motions sensors,” 0% stated Strongly Agree, 20% stated Agree, 20% stated Neither Agree nor Disagree, 40% stated Disagree, and 20% stated Strongly Disagree; When responding to the statement “I prefer to see automatic handwashing sinks with motions sensors at firms I regulate,” 0% stated Strongly Agree, 22% stated Agree, 22% stated Neither Agree nor Disagree, 56% stated Disagree, and 0% stated Strongly Disagree. When responding to the statement “I prefer to see traditional handwashing sinks that are manually operated at firms I regulate,” 0% stated Strongly Agree, 56% stated Agree, 22% stated Neither Agree nor Disagree, 22% stated Disagree, and 0% stated Strongly Disagree. Graph 2 shows how inspectors responded to the statement “I prefer to see traditional handwashing sinks that are manually operated.”
Graph 2
Handwashing Sink Preference
Conclusions
Analysis of the research has led to the following conclusions:
From the sample set acquired from the survey meant to establish types of firms, the only common violation noted were Using a Handwashing Sink-Operations and Maintenance.
The group with automatic handwashing sinks also had citations for Handwashing Sinks-Installation and Handwashing Signage.
The group with traditional handwashing sinks had the addition of Handwashing Sinks-Location and Placement, Handwashing Cleanser Availability, and Hand Drying Provisions in addition to the shared violations.
The surveys indicated that more violations were observed at traditional handwashing sinks than at automatic handwashing sinks, however, due to the limited sample size this is difficult to accurately determine.
From the information received from the survey, the majority of inspectors believe that automatic handwashing sinks were more likely to have more violations and that a majority preferred to see traditional handwashing sinks in the firms they regulate.
Recommendations
Based on the results and conclusions of the research, recommendations include:
Additional research on the number of traditional handwashing sinks in use and the handwashing violations associated with them.
Additional research on the number of automatic handwashing sinks in use and the handwashing violations associated with them.
Additional research on whether the level of risk associated with automatic handwashing sinks versus traditional handwashing sinks is significantly different.
A more focused scientific study to be undertaken which observes employee practices in establishments with automatic handwashing sinks.
Acknowledgements
I would like to thank the following:
IFPTI
My IFPTI mentor, Doug Saunders
Natalie Adan
Chris Peasley
Colby Brown
The GDA Inspectors who filled out surveys
My husband, Jonathan Hoover
References
Centers for Disease Control and Prevention (2020, September 10). Show me the science-Why wash your hands? Centers for Disease Control and Prevention. https://www.cdc.gov/handwashing/why-handwashing.html
Centers for Disease Control and Prevention (2022, March 14). When and how to wash your hands. Centers for Disease Control and Prevention. https://www.cdc.gov/handwashing/when-how-handwashing.html
U.S. Food and Drug Administration (2017). Food code, U.S. Public Health Service, 2017. https://www.fda.gov/food/fda-food-code/food-code-2017
U.S. Food and Drug Administration. (2022, February 17). Safe food handling
https://www.fda.gov/food/buy-store-serve-safe-food/safe-food-handling
Georgia Department of Agriculture (2019, September 16). Rules and regulations of
Georgia Department of Agriculture. Chapter 40-7-1. Retail Food Sales.
40-7-1-Retail-Food-Sales---Effective-Date-10-17-2019.pdf (georgia.gov)
Author Note
Amy Hoover, Metro District Manager
Georgia Department of Agriculture
This research was conducted as part of the International Food Protection Training Institute’s Fellowship in Food Protection, Cohort XI.
Correspondence concerning this article should be addressed to:
Amy Hoover, Georgia Department of Agriculture, 19 Martin Luther King, Jr. Dr., S.W. Atlanta, GA 30334
Funding for the IFPTI Fellowship in Food Protection Program was made possible by the Association of Food and Drug Officials.