Improving Handwashing Performance with Technology

There’s an old adage in the foodservice industry that says what gets measured is what gets done. And that applies to even the most basic tasks such as handwashing.

Peter Fulgenzi, executive chef for Indiana University Health North Hospital and Saxony Hospital in Indianapolis, knew the foodservice staff was washing their hands. He wanted to know, however, just how well things were going and he wanted to do it before this became a food safety issue.

“Food is a pretty intimate thing. You have to be gentle because one incident can ruin your reputation,” he says. “We try to employ the mother standard with our staff. In other words, we ask ‘would you serve that to your mother’? It’s a good standard to provide people with a real quality product.”

Fulgenzi oversees a rather expansive foodservice operation that spans multiple healthcare campuses that includes coffee bars, restaurants, patient room service, catering and more. Overall, the foodservice department serves 3,500 to 4,000 meals daily and has staff working 20 hours a day.

The Indiana University Health team started with a solid foundation in that it had previously developed a standard that calls for 30 seconds of soap, water and friction each time an associate washes their hands. And any time an associate returns to the back of the house, say from delivering a room service tray or taking out the trash, they are required to wash their hands within three minutes. While these standards represent good examples of best practices in handwashing, there was no way to tell how well the team was measuring up.

So the foodservice department implemented a system that uses the RFID chip in an associate’s badge to track when they enter and exit the kitchen, the number of hand washing incidents, water flow — including the duration, and soap use. And if the system does not recognize someone washing their hands, it takes a picture and includes this data in a report Fulgenzi receives.

After implementing the system, the Fulgenzi found the results to be eye opening. “When we started monitoring, our results were abysmal. I started monitoring myself and it was not good,” he recalls.

In fact, only 25 percent of the time the associates were in compliance with the foodservice operation’s standard. “When we were able to determine how long people were washing we realized we thought we were a lot better than we were,” he says. “But once we educated people they got into it and want to do the right thing.”

Today, that compliance rate stands at 98 percent. “Technology made a huge difference in the behavior of our people and it has really stuck,” Fulgenzi says. “This is our way to document that we are absolutely doing the right thing. We want to stop people from thinking they were in the right when they were not.”

In recognition of their efforts, Handwashing for Life, an institute devoted to advancing the science of hand hygiene with the purpose of reducing the incidence of foodborne illness caused by poor hand hygiene practices, presented IU Health with its first Five Star Hand Hygiene Award. And IU health also received a Food Safety Leadership Award from NSF. “We received this recognition because we created something that was measurable and indisputable,” Fulgenzi adds. “We had objective goals that were being met.”

Monitors throughout the foodservice operation’s back of the house display the handwashing data so the associates can follow their progress during their shifts. “The staff can see where they are as a group. And as a group they rally to the cause to make sure their performance is in line,” Fulgenzi says. “It gives them the opportunity to really work as a team and they work better together because we have given them a real common ground.”

Overall, Fulgenzi feels the system’s unobtrusive nature — it did not require any extra steps to comply — made it pretty easy for the staff to improve their performance “Some systems require you to swipe a card to say you are there or identify yourself to the hand sanitizer. That does not help because you are adding steps,” he points out. “We should do what we are doing naturally.”

So is the next goal to be 100 percent compliant? Probably not. “There will always be reasons we are not totally compliant. For example, if a dietician walks into our kitchen to talk with someone, they might not need to wash their hands because they are not touching anything food related,” Fulgenzi points out. “Or if someone is taking trash in and out they might not wash their hands on each trip as they complete this task.”

Next up for Fulgenzi and his foodservice team is implementing a new cloud-based system to monitor the staff’s handwashing prowess. “Jim Mann and Handwashing for Life is a wealth of knowledge and they really have helped me with the new system we are implementing,” he adds.

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