The tweeting, texting, multitasking public increasingly expects food and beverage service in nontraditional locations — many of them without handsinks and running water. Whether we're talking about large, catered outdoor events on a campus or field applications like those the military faces in the deserts of the Middle East, hand hygiene technology has lagged well behind the pace of expanding mobile food service.

In the past, onsite operators in this situation have often sought to comply with health regulations that insist they have water available for handwashing by supplying a mostly inconvenient, ineffective trickle of water dispensed from coffee urns and the like.

Even that is not an option in many military situations, as was the case several years ago, when the new Iraqi police force was being trained at a temporary location where its foodservice tent had no running water. Its food safety advisors were led to test some alternate methods that would provide staff with an option that would be more effective than the use of standard alcohol hand sanitizers. And that in turn led The Handwashing for Life Institute to a no-water hand-cleansing and -sanitizing protocol dubbed SaniTwice^®.

Mobile hand hygiene

In this case, awkward, expensive, portable handsinks were not an option, and the matter was urgent. Our early trials to add a friction factor to hand sanitizers evolved into a simple and timely solution using a pinch of chemistry and a dash of physics.

After both hands were contaminated with E. coli, the one on the right was treated using the SaniTwice method. Both were then touched to agar plates and incubated. E. coli flourished on the un-cleansed hand print while the SaniTwice hand shows no significant growth.

We tested a procedure in which a foodservice worker applied an excess of Food Code compliant alcohol hand sanitizer and vigorously scrubbed for 20 seconds, just as he would do with handwashing when water is available, so that its emulsifiers and emollients might have time (and temperature) to loosen soils. Then the hands, still wet, were wiped clean with a pattern-embossed paper towel (for increased friction) to pull away the soil. This was followed by a second application of hand sanitizer, this time used according to label instructions, allowing the hands to air dry.

In that case, there was neither time nor budget for laboratory confirmation. The solution made sense and the physical demonstrations were convincing: SaniTwice became a reality in the Iraqi desert.

From one desert to another

Two years later, Handwashing For Life^® was approached by a major Las Vegas hotel that wanted to improve handwashing effectiveness at its catered events. We studied the possibility of adding larger water reservoirs and full plumbing hook-ups to portable bars, as well as installation of on-board water heaters.

The SaniTwice® Protocol STEP 1: Hands are vigorously “washed” 15-20 seconds with 3-5 ml of hand sanitizer. STEP 2: While wet, sanitizer is rubbed off with textured paper towel. STEP 3: Second application of 1.5 ml of hand sanitizer is used according to label directions.

As prototypes of these portable behemoths were tested on-site, it became apparent that their size and weight were taxing the stewards just to get the units to typical large-venue food and beverage service locations. Introducing running water and drains brought their own risks of cross-contamination, slips and falls, as well as the hazards of temporary electrical lines. All these options limited placement of the service bars.

The SaniTwice protocol was presented as a possible solution. It offered some clear advantages, but both the operator and the health department would not proceed based only on field research that had come from the military experience. They insisted on documented effectiveness data.

An independent laboratory was selected and a research project initiated. You can examine the results of this study and another that followed 16 months later at www.handwashingforlife.com/handsonsystem/sanitwice