Hand hygiene product use by food employees in casual dining and quick-service restaurants

•Food employees used soap over five times more frequently than hand sanitizer.•Casual restaurants had similar hand hygiene rates to quick-service restaurants.•Handwash sinks near warewash areas had the highest rates of hand hygiene.•Hand hygiene events at ready-to-eat product sinks occurred only 6.8 times per day.•Regimen use, the preferred hand hygiene method, was the lowest of all methods. Hand hygiene product usage characteristics by food employees when hand sanitizers are made available are not well understood. To investigate hand hygiene product usage in casual dining and quick-service restaurants, we placed automated monitoring soap and sanitizer dispensers side-by-side at handwash sinks used by food employees in seven restaurants. Dispenses were monitored, and multiple dispenses that occurred within 60 s of each other were considered a single hand hygiene event. This resulted in 186,998 events during the study (149,779 soap only, 21 985 sanitizer only, and 15,234 regimen [defined as soap followed by sanitizer at the same sink within 60 s]) over 15,447 days of use. Soap was the most frequently used hand hygiene method by food employees in both restaurant types. Regimen use, despite being the preferred hand hygiene method by both restaurant chains, was the least used hand hygiene method. When pooled over restaurant types, the median daily usage for soap was statistically significantly highest of all methods at 23.5 dispenses per sink per day (p