Thurston County Health Officer Dr. Diana Yu has earned a reputation for being a nag about hand washing. Her reasons are simple. "The reality is that there are not that many diseases that we can’t prevent by hand washing," she said.

Thurston County has had a hand-washing education program in place since 1992. The program was expanded when the Washington State University Cooperative Extention took over the program. "They’ve fancied it up quite a bit," Yu said. "They teach hand washing at health fairs and in classes. They have a traveling booth."

Caroline Smith DeWaal, food safety expert for Center for Science in the Public Interest, wants another step — mandatory use of gloves. "Gloves are something you can observe," she said. "Hand washing is something done behind closed doors."

DeWaal’s organization and other consumer groups have tried to get the provision added to the FDA’s food code, essentially a set of model rules states can choose to adopt or not.

The code does call for the use of gloves or tongs in food preparation at places such as nursing homes or schools that serve the young and old, two groups that run a higher risk of death from food-borne illnesses.

Nancy Donley, president of the advocacy group Safe Tables Our Priority, is critical of the slow-moving FDA process for getting states to adopt tougher regulations. She wants each state to require certification of food managers and mandatory training for employees on food safety.

Donley acknowledged that the cost of such mandates might force some small restaurants out of business. But to her, hand washing and other food safety practices are a matter of life and death.