Hand Hygiene, Glove Use and Food Service

While reviewing survey reports, hand hygiene and glove use during food service observations is a growing deficient practice. Food service is not only pertinent for culinary/dietary staff anymore as more providers transition to household kitchens, universal workers, and even distributing snacks outside of mealtimes.

Regulations and rules for multiple health care settings require safe and sanitary practices for preparing and distributing food, which includes hand hygiene and appropriate glove use. The rules and regulations do not direct providers on whether gloves are required to be used during food service, instead focus more on food contamination. Many culinary/dietary departments implement an approach to only using utensils, which may be a best practice to avoid staff thinking that the use of gloves eliminates contamination risks.

Food contamination in Appendix PP of the Requirements of Participation (RoP) is defined as the unintended presence of potentially harmful substances, including, but not limited to microorganisms, chemicals, or physical objects in food. Here is an example of something that is commonly cited related to food contamination:

• Staff A is going to prepare a peanut butter sandwich for a resident. They begin by washing their hands appropriately and donning gloves.
• Staff A (with the gloves on) goes to the cupboard and collects the jar of peanut butter, pulls open the drawer to obtain a utensil to spread the peanut butter, and grabs the loaf of bread. Note that Staff A has now contaminated their gloves by touching three different surfaces with their gloved hands.
• Staff A grabs a plate by touching the plate on the top with their thumb and the bottom with their other fingers. Note that Staff A has now contaminated the surface of the plate by touching with their gloved hand that was previously contaminated.
• Staff A opens the loaf of bread (once again contaminating gloves with the sac) and grabs two slices of bread with their gloved hand, placing them on the plate. Note that Staff A has now potentially transmitted microorganisms to the two slices of bread by not changing their gloves. In this step, the staff member should have used a set of tongs to get the bread slices, or opened the bag, removed their gloves, completed hand hygiene, donned new gloves and picked up the bread.
• Staff A opens the jar of peanut butter, uses the utensil to obtain an appropriate amount of peanut butter and spreads on the sliced bread. In order to control the bread from moving off the plate during spreading, Staff A holds the bread slices with their free hand while spreading the peanut butter. Note that the bread is now contaminated again by all previous microorganisms on their gloves as well as new microorganisms that were transferred from the peanut butter jar. In this step, staff should have used the tongs to hold the bread in place, or could have repeated the steps for changing gloves and completing hand hygiene once the peanut butter jar was opened.
• Staff A places the two slices of bread together to make the sandwich with their gloved hands. Note the bread was once again contaminated by touching with the same contaminated gloves. In this step, staff should have used the tongs to place the bread slices together, or if the gloved hand was not contaminated after the last glove change, they could touch the bread without contaminating.

While completing observations for infection control compliance, it is important to remind staff that gloves create a false sense of cleanliness and ability to touch things. It is important that staff are cognizant of what they are touching and ensuring that they are completing appropriate glove changes anytime gloves are used. The standard is anytime you go from a dirty surface to a clean surface, gloves must be changed.

To ensure that hand hygiene is completed adequately staff should know that anytime they put gloves on, change gloves, or remove gloves; hand hygiene must be completed. Culinary/dietary departments should strongly consider reducing glove usage and educating staff to use utensils instead of gloved hands unless they’ve followed the appropriate steps. As a reminder, when using utensils for food preparation and service, you must prevent contamination of the utensil as well. A quick example of this includes touching something that could potentially be contaminated and then touching the utensil.

Appendix PP includes a resource for additional information regarding safe food handling to minimize the potential for foodborne illness includes http://www.foodsafety.gov.