Food Protection Trends - August 2008 - 577

potential in the reduction of food contamination. However, as is the case with most antimicrobial chemicals, the use of chlorine dioxide is coupled with the risk of development of resistance. Disadvantages of gloves. Gloves only reduce the transfer of microorganisms (such as fecal microorganisms) from hands to food and are no improvement over bare hands in terms of cross contamination (69). Additionally, wearing gloves can give food operators a false feeling of safety and possibly reduce awareness of food contamination caused by contaminated gloves (40). As with soaps and disinfectants, the frequent use of gloves is not favorable to maintaining healthy skin. Larson et al. (57) observed a correlation between skin damage and the frequency of glove use. Wearing gloves during longer periods of time can also cause eczema, skin irritation, or contact dermatitis. As previously discussed, skin damage results in an increased number of microorganisms on the hands and reduced efficacy of handwashing or hand disinfection. Another major disadvantage of glove use is the occurrence of latex allergy. The number of people who are allergic to latex is estimated at 1–2%. Only a small percentage of this group of people show a very strong allergic reaction (61). However, frequent use of latex gloves increases the risk of latex allergy. Conversely, allergic reactions to synthetic gloves are reported only sporadically. Direct latex allergy is caused by an immune response that produces specific antibodies (IgE) against enzymes present in natural latex. Latex allergy can be triggered by direct contact with latex gloves but can also be induced by inhaling latex glove powder. Because of immunological cross reactivity, latex allergy can also result in allergies against kiwi, banana and avocado (15). It is worth noting that contamination of food with latex is reported only sporadically. Therefore, latex is rarely identified as a hidden food allergen, and the risk of developing latex allergy by food consumption is virtually nonexistent (43, 110). Late or attenuated allergy is caused by some chemicals that are added during glove production, such as carbamates, thiuramcompounds, and mercaptans. Presence of such chemical additives can cause contact dermatitis. This phenomenon is not restricted to latex gloves and can also occur with use of synthetic gloves (116). To prevent latex allergy, the use of nitril gloves, vinyl gloves, latex gloves with low protein content, or latex gloves provided with a synthetic inner layer can be considered. However, the use of vinyl can result in risks that are yet unknown, such as possible migration of chemicals (e.g., phthalates) in food (43). The use of powderless latex gloves can also reduce the risk for latex allergy, but without the moisture-reducing powder there is a higher risk of eczema. These alternative gloves also cost more than latex gloves with powder. In addition, food companies can reduce the risk of latex allergy by reducing the number of people that wear gloves to a minimum and by encouraging employees to maintain good skin health when gloves are worn for long periods of time (43, 61, 116). Other measures to improve good hand hygiene Jewelry. The avoidance of wearing jewelry is an essential measure of good personal hygiene practice, for several reasons. First, microorganisms are found in higher amounts on skin covered by rings than elsewhere. It has been demonstrated that the amount of microorganisms increases with the number of rings worn. Second, microorganisms can survive longer under rings, even for a couple of months, because the rings provide a protected environment. Finally, wearing rings considerably reduces the efficacy of handwashing or hand disinfection (85, 107, 115). An increased number of microorganisms is also detected on the skin when other jewelry, such as wrist watches or bracelets, are worn. Because the scientific data concerning the impact of wearing watches or bracelets are scarce, there is not sufficient evidence to warrant prohibiting the wearing of watches or bracelets on the basis of hygienic reasons. Nevertheless, wearing watches or bracelets may still result in the physical contamination of food, and the same holds true for body piercings that are not covered with clothing, e.g., nose or eyebrow piercings. Therefore, bracelets, wrist watches, or piercings should be prohibited (46). Nails and nail art technology. The highest numbers of microorganisms are found under fingernails. It is therefore strongly recommended that fingernails be kept short. Furthermore, long nails can cause breakage or leakage of gloves, penetrating the physical barrier. The highest reduction of microorganisms under fingernails is obtained when hands are washed with water and soap, using a special fingernail brush. The use of alcohol gels is the least effective method of reducing microorganisms under finger nails (46, 53, 79, 90). Artificial nails are usually longer and harbor significantly more microorganisms than natural nails. In addition, hand hygiene techniques used to reduce the number of microorganisms are less effective in the case of artificial nails (63). Based on the scientific data available, nail art technology, such as nail piercings, decorative nail stones, artificial nails, nail extensions, and nail polish, should also be prohibited (46). Improving skin health. Frequent washing, disinfecting and frequent use of gloves dehydrates the skin, which results in skin damage. A healthy skin is essential in maintaining good hand hygiene, for several reasons. Damaged skin is a better environment for the survival and/or proliferation of microorganisms. Furthermore, it has been demonstrated that the efficacy of hand washing and disinfection is reduced. Finally, skin damage also impacts on the structure of the microbial community, which may decrease the natural barrier function of the skin, thereby allowing entry of pathogenic microorganisms. In order to prevent contamination in the food environment, damaged skin should be treated and appropriately covered (58). Good skin hydration is a prerequisite for healthy skin and a better protection against microbial pathogens. Frequent use of lotions, emollients or hydrating hand creams results in a significant protection against massive colonization of skin by microorganisms. However, oil-based products can have adverse effects on the physical barrier function of latex gloves or the efficacy of antimicrobial agents in soaps (59). It is also worth noting that tattoos do not appear to have an effect on hand hygiene (46). AUGUST 2008 | FOOD PROTECTION TRENDS 577

Food Protection Trends - August 2008

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