Factors Facilitating Hand Hygiene Practices in Eateries of Coimbatore: A Cross-sectional Study

Introduction: Improper hand hygiene practices and eating at unsanitary eateries are a major cause for many of the life-threatening diseases. Although studies done in the past have focused on the hand hygiene of the restaurant staff, the customers' hand hygiene, which is equally, if not more important, has not been studied in detail. Aim: To assess the factors facilitating hand hygiene for the customers as well as the general hygiene in the eateries of Coimbatore, Tamil Nadu, India. Materials and Methods: A cross-sectional study was done in the eateries of Coimbatore in June 2017, after obtaining clearance from Institutional human ethics committee. A list of eateries was collected from a food delivery application and 30 of them were chosen by systematic random sample. The restaurants were further categorised into low, medium and high-price ranged eateries based on the price of a standard food item (coffee). As a mystery client, the restaurants were inspected and observations were noted in a hidden checklist, which was constructed for the purpose of this study. The checklist consisted of three major categories, the washing area (9 marks), the customer (7 marks) and the general hygiene of the restaurant (7 marks). There were 23 items in the checklist and each item, if present, was awarded a score of 1. No negative scoring was done. Hence, the maximum score an eatery could get was 23 and minimum was zero. ANOVA test was applied to compare the scores of different types of eateries. Results: The mean and standard deviation hygiene scores of the low, medium and high-cost eateries were 7.7 +/- 4.05, 11 +/- 6.02 and 14 +/- 5.43, respectively. There was a significant difference in the (hygiene and sanitation) scores between low, medium and high-cost eateries (p-value=0.04). It was found that in lower priced restaurants, most of the restaurants failed to provide adequate facilities for hand hygiene. Medium and high price range eateries were similar in the fact that they scored better with regard to general hygiene and wash area facilities. Although none of the restaurants scored a full mark higher price ranged eateries had better wash area facilities. Customer hand hygiene practices were found to be subpar in all the three categories, even though facilities were present in some medium and high-end eateries. Conclusion: It was noticed that in some of the lower end restaurants, facilities for hand hygiene were not adequate. It was also found that if adequate facilities for hand hygiene were present in a restaurant, there was a higher chance of a customer to utilise that. This was found to be true especially in higher priced restaurants. Hence, the importance of hand hygiene and awareness among customers should be emphasised.