FOOD SAFETY

“Most people do not think about foodborne illness until they become ill from unknowingly eating contaminated food. While the food supply in the United States is one of the safest in the world, each year about 76 million illnesses occur, more than 300,000 persons are hospitalized, and 5,000 die from foodborne illness. (U.S. Centers for Disease Control and Prevention)”

A wide range of communicable diseases and infections may be transmitted by infected food employees to consumers through food or food utensils. To reduce this risk, public health authorities have proposed glove use. For food safety, the U.S. Food and Drug Administration (FDA) does not believe that hand washing with soap and water or even the use of alcohol hand sensitizers may be sufficient to prevent viral transmission. The 2009 Food Code prohibition by the FDA for bare hand contact with ready-to-eat food [3-301-11(B)] is meant to be an important public health intervention intended to prevent the transmission of fecal-oral route microbial pathogens from infected food workers' bare hands to ready-to-eat foods. This calls for the use of gloves or utensils wherever appropriate.

Of greatest concern are Norovirus, Hepatitis A virus, Salmonella Typhii and Shigella species, according to the Centers for Disease Control and Prevention (CDC). These are extremely infectious fecal oral route pathogens. They are spread in high numbers especially through stools (1,000,000 viral particles/gram of feces) during peak infectivity, but with extremely low infectious dose (10-100 virus particles/gram of feces with Norovirus).

“For ASTM Food Service Glove Standard (D 7329-07), please click on http://www.astm.org/Standards/D7329.htm

In the FDA Food Code, gloves used in contact with food are covered under Title 21 of the Code of Federal Regulations (CFR). They are required to be maintained in clean, intact and sanitary conditions [110.10(b)(5)]; for repeat contact with food items they are regulated under 21 CFR 177.2600 as indirect food additives.

Essential Requirements for Food Service Gloves

Gloves are used in food handling primarily to protect consumers from infectious organisms and viral and bacterial transmissions. A glove, therefore, should be strong enough not to rip, tear, crack or break during normal use in food preparation. Besides being cost effective, a glove also must have minimal health hazards such as adverse reactions due to toxic chemical and allergen contaminations, as well as providing good fit, comfort and dexterity.

Glove Types Available

"The two main purposes for wearing gloves in the food industry are to: (i) protect the food from contamination from human hands, and (ii) to protect workers from occupational hazards, such as cuts, micro-organism, chemical burns and thermal shocks. The less expensive disposable gloves are often used for function (i) mainly in food handling/services. On the other hand, for food processing which involves both functions (i) and (ii), particularly the latter, more expensive re- usable gloves, which are usually thicker with high cut-resistance, are preferred.

Three types of inexpensive disposable gloves are commonly available and used in the food service industry. They are the polyethylene, polyvinyl and natural rubber latex gloves.

  • Polyethylene Gloves:

    These are the cheapest among the three types. They offer very poor barrier protection to both food handlers and food consumers, often splitting at the seams during use. They not only tear easily but also have extremely low resistance to heat (Food Bites, 2002; 12(2): 1-3), low dexterity, and are typically loose fitting. They are available in high, medium and low-density forms.

  • Polyvinyl (PVC) Gloves:

    Unlike polyethylene gloves, polyvinyl gloves are seamless. Although they have better fit, dexterity and heat resistance than polyethylene, they too lack the properties expected of gloves for effective barrier protection. They tend to puncture and tear easily. Studies have repeatedly demonstrated that vinyl gloves leak much more often than natural rubber latex gloves during use. Unlike polyethylene gloves, they can be used around heat sources without risk of melting.

  • Natural Rubber (NR) Latex Gloves:

    NR latex gloves are known to provide very effective barrier protection against viral and bacterial transmissions. They also have great durability, excellent comfort, fit, tactile sensitivity, and high dexterity, and withstand high heat better than vinyl and polyethylene. However, the awareness of latex protein allergy in recent years prompted the concerns about their use. Such concerns have in fact been addressed through advancements in latex glove manufacturing technologies, which have now led to the production of low-protein latex gloves with low allergy risk.

Re-usable gloves for food processing or food contact applications are often made from polyurethane, NR latex and nitrile. While nitrile gloves are less elastic and stiffer than NR latex gloves, they are resistant to many chemicals, but like many other glove types, are sensitive to alcohol degradation. Nitrile gloves have much better barrier integrity, dexterity, fit and durability than polyethylene and vinyl gloves.

Polyurethane gloves, on the other hand, have very high tensile strength, durability and good cut resistance. Being free of chemical additives, they are expected to have reduced type IV allergy potential. Data concerning their barrier performance is not available."

Latex Protein Allergy and Food Ingestion

The pros and cons of glove use versus hand washing alone in the food service industry have been discussed and argued for many years. The U.S. Food and Drug Administration prohibits food service employees from bare-hand contact with ready-to-eat foods and requires minimal bare-hand contact for food that is not ready to eat. With more eating establishments using disposable gloves, the debate is shifting to questions about allergy concerns associated with latex gloves. Latex protein allergy affects about 1% of the general population, and latex protein sensitization as a result of direct food ingestion is exceptionally rare. Much discussion had been held on this issues by the Food Advisory Committe of the FDA as well as the Conference for Food Protection, and has come to the overwhelming conclusion that the scientific data is too weak to support a correlation between allergic reactions and food handling by latex gloves.

Recent conclusion include:

Although a study by Beezhold et al in 2000 indicated there was some transfer of latex protein from high-protein powdered gloves to some foods, the findings are far from conclusive that such transfer could cause latex allergic reactions by food ingestion for the following reasons:

  • Little evidence of a correlation between the use of latex gloves in food services establishment and latex allergic reactions.
  • No clinically verified evidence that use of latex gloves in food handling causes allergic reactions. (Conference for Food Protection 2002, 2004)

    • "The FSA (UK Food Standard Agency) advises consumers not to change what they eat or how the prepare it, as it is not clear that there actually is a transfer of allergen from latex to food outside the laborotary"

    Food Production Daily - Latex threat - it's all hype, say group - 14 August 2006.
Latex Protein Allergy and Food Ingestion

The Conference for Food Protection (CFP). In 1971, the FDA and the American Public Health Association sponsored the first Conference for Food Protection in Denver, CO. Since then, the CFP has been bringing together representatives from the food industry, government, academia, and consumer organizations to identify and address emerging problems of food safety and to formulate recommendations. Though the Conference has no formal regulatory authority, it is a powerful organization that profoundly influences model laws and regulations among all government agencies.

In April 2002, the FDA reported to the CFP that although 75 self-reported cases of food-mediated latex allergies were received from consumers in late 2000 and early 2001, these cases,

"are not clinically verified through medical records and it is possible that some of the reactions described could have been due to consumption of foods that cross react to latex protein (e.g. kiwi, bananas, buckwheat, stone fruits, potatoes, tomatoes, sweet pepper, chestnuts, spinach, etc.). "

In April 2004, the CFP re-examined the issue of latex allergy associated with glove use and subsequently concluded again that there was much uncertainty about food-borne allergens being transmitted from latex gloves and their effects on consumers. It said there was a need for more studies on this matter.

Health Risks Associated with Non-latex Food Gloves

Food service and retail establishments should be aware of the health risks associated with some synthetic gloves, particularly vinyl, when it comes to food handling. Many vinyl gloves are 30-50% DEHP (di-2 ethyl hexyl phthalate), a highly toxic chemical that is added to vinyl to give it flexibility.

Studies show negative health effects of DEHP, which can leak out of vinyl products and contaminate liquids and food.

Documented studies in animals have shown that DEHP causes testicular damage, suppresses or delays ovulation,reduces kidney and liver function, and causes respiratory distress and adverse effects on the heart. DEHP can leach out of vinyl products, such as disposable gloves, food containers and wrappers. It is particularly soluble in fluids and oil-based products and can easily contaminate liquids such as drinking water and milk or foods such as cooking oils, cheese, meat and fish, as well as certain drugs and blood products.

    References:
  • Tsumura Y., Ishimitsu S., Kaihara A., Yoshii K., Nakamura Y and Tonogai Y. Di-(2-ethylhexyl)phthalate contamination of retail packed lunches caused by PVC gloves used in the preparation of foods. Food Additive Contamination, 2001; June:18(6), 569-579.
  • Peterson J.H. and Breindah R. Plasticizers in total diet samples, baby food and infant formulae. Food Additive Contaminations, 2000; 17(2): 133-141.
  • Fay M., Donohue J.M. and De Rosa C. ATSDR evaluation of health effects of chemicals. VI. Di(2-ethylhexyl)phthalate. Agency for Toxic Substances and Disease Registry, Toxicol. Ind. Health, 1999; 15(8):651-746.
  • Adibi J.A. et.al. Prenatal exposures to phthalates among women in New York City and Krakow, Poland, 2003; Environmental Health Perspect. 2003; 111:1719-1722.
  • Arcadi, R.A. et al. Oral toxicity of DEHP during pregnancy and suckling in the Long Evan rat. Food and Chemical Toxicology, 1998: 36:963-970.
  • Ward, J.M., et al. Receptor and non-receptor mediated organ specific toxicity of DEHP in peroxisome proliferators-activated receptor alpha-null mice. Toxicology and Pathology, 1998; 26: 240-246.
  • Davis, B.J., et al. Di(2-ethylhexyl) phthalate suppresses estradiol and ovulation in cycling rats. Toxicol. Appl. Pharmacol., 1994, 128:216-223.
  • Fredricsson et.al. Human sperm motility is affected by plasticizers and disel particle extracts. 1993, Pharmacol. Toxicol. 72(2): 128-133
  • Kevy, S. and Jacobson, M. Hepatic effects of a phthalate ester plasticizer leached from poly(vinyl chloride) blood bags following transfusion. Environmental Health Perspectives, 1982; 45: 57-64.
  • Rock, G. et al. Hypotension and cardiac arrest in rats after transfusion of mono(2-ethylhexyl) phthalate (MEHP) a contaminant of stored blood. The New England Journal of Medicine, 1987; 316: 1218-1219.
  • In 2002, the FDA warned, "Precautions should be taken to limit the exposure of the developing male to DEHP"
Japan bans use of gloves with DEHP in food handling

In 2000, the Japanese Ministry of Health was so concerned about DEHP leaching into food that it banned the use of vinyl gloves containing DEHP in food service kitchens. The action was taken after research by the Japan National Institute of Health Sciences demonstrated that:

"The DEHP in foods packed ... using vinyl gloves was found to increase drastically when compared with that of the foods before packing," and "the use of PVC [vinyl] gloves caused a sharp increase in the DEHP level in foods."

For an English translation of the Ministry's directive, click here:
Translation of directive from the Japan Ministry of Health, Food Chemical Unit of the Bureau of Hygiene, June 14, 2000.

Experts Speak Out

Dr. Charles E. Reed, Emeritus Professor of Medicine, Mayo College of Medicine, testifying before the CFSAN, August 27, 2003:
  • The first point that is important here is that gloves are different. These [low-protein latex] gloves have practically very small amounts of allergens. These [high-protein latex] gloves have a thousand times more. The difference is how the gloves are made. It is not really appropriate to say that all gloves are alike. What we needed to do at Mayo was get rid of these [high-protein] and buy these [low-protein], which we did, and we thought we solved the problem pretty well. But to say that we should ban all [latex] gloves because there are bad ones is just not appropriate."
  • All the data you have been hearing is out of date. It goes back to this time before we really understood the problem, before manufacturers had changed and gotten more of them to do manufacturing processes that provide good gloves, fewer making bad gloves."
  • "The amount of allergen in [latex] gloves has very substantially reduced. They are not all bad."
John Schultz, Vice President of Food Safety, Marriott Corporation, testifying before the CFSAN, August 27, 2003:
  • "We have been using latex or natural rubber gloves within our company for the past 13 years. We use them extensively. We use them for obvious reasons I am sure you have heard in the past couple of days, but we use them so that we do not pass on to our guests pathogenic organisms, specifically things like Staphylococcus aureus and Hepatitis A."
  • "We have a minimum concern raised by our associates regarding allergenic reactions from their use. Our chefs are very close to their people and I talk to our chefs on an ongoing basis. They call me very, very frequently and I have never heard of any cases other than sometimes a minor rash reaction or hives from an associate wearing latex gloves within our facilities. Again, we use millions of them."
  • "We look at the examination-quality glove as having significantly lower protein content which has been linked to allergenic reaction from their use. We manage the protein levels which we feel is what is impacting our low rate of reaction to the [latex] gloves."
  • "I think that, in my use of latex gloves, and we use the examination quality...if you want to define 'better' for me, it [latex] gives me better tactile when I deal with plates. It also provides a little better strength, I would say. It does hold up within the operation better than vinyl."
Doris Rittenmeyer, National Manager of Safety Management Services, Food Handler, Inc., testifying before the CFSAN, August 27, 2003:
  • "With appropriate standards for the manufacturer, high-quality, low-protein, natural rubber latex can be an option to reduce the risk of latex allergies associated with food."

"A ban on rubber gloves in the food industry will fuel the existing unrealistic fear."

-Dr. Charles Reed, Professor Emeritus of Medicine, Mayo Clinic,
Testimony before CFSAN, August 27, 2003