Finger licking good? An observational study of hand hygiene practices of fast food restaurant employees and consumers

Purpose: Appropriate hand hygiene technique is a simple and effective method to reduce cross contamination and transmission of foodborne pathogens. This study aims to investigate the frequency of hand hygiene activities among food handlers and consumers in fast food restaurants. Methodology: Twenty-five fast food restaurants and cafes were visited between May – August 2017 in North West England. A hand hygiene observational tool was adapted and modified from previous studies. The observational tool was designed to record 30 sequential hand activities of consumers and employees. Each transaction consisted of an observed action (e.g. touch with bare hands), object (e.g. exposed ready-to-eat foods) and observed hand hygiene practice (e.g. handwashing or cleaning with wipes or sanitisers). Adenosine triphosphate (ATP) swabs of hand-contact surfaces of restaurants’ restrooms were carried out. Findings: Findings revealed that both food handlers and consumers have low hand hygiene compliance rate in fast food restaurants. Consumers were more likely to clean their hands with napkins after handling exposed ready-to-eat (RTE) food. Food handlers were observed to change into new gloves without washing their hands before handling exposed RTE food. The mean results for all hand-contact surfaces in restrooms were higher than 30 Relative Light Units (RLUs) indicating unhygienic surfaces. Male restroom exit doors’ adenosine triphosphate (ATP) levels were significantly higher than females. Originality: This study revealed the lack of hand hygiene practices among food handlers and consumers at fast food restaurants and cafes. Restroom hand-contact surfaces revealed high ATP level indicating unhygienic surfaces. This can potentially re-contaminate washed hands upon touching unhygienic surface (e.g. exit door panel/handle) when leaving the restroo