Field trial of a low cost method to evaluate hand cleanliness

Division of Bacterial and Mycotic Diseases, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Tropical Medicine & International Health (Impact Factor: 2.33). 07/2007; 12(6):765-71. DOI: 10.1111/j.1365-3156.2007.01847.x
Source: PubMed


To evaluate a simple low cost method for measuring hand contamination as an objective assessment of handwashing practices.
As part of a larger randomized controlled trial of handwashing promotion with soap conducted in squatter settlements of Karachi, Pakistan, a randomly selected subset of 52 mothers in households receiving soap and handwashing promotion and 28 mothers in control households directly pressed three fingers of their right hand onto MacConkey agar plates on weekly unannounced visits from April to September 2002, and monthly from October 2002 to March 2003. The MacConkey plates were incubated at 44 degrees C for 24 h, and evaluated for growth of thermotolerant coliform bacteria.
The proportion of samples that had detectable thermotolerant coliforms (50%) was similar in households that received soap and control households (52%, P = 0.40). In the week after evaluation of the mothers' hands, the proportion of households that reported diarrhoea was similar regardless of whether or not the mother had thermotolerant coliforms detected by direct finger imprint (18.6%vs. 19.1%, Relative Risk 0.99, 95% CI 0.96, 1.03).
A three finger direct imprint test using MacConkey agar for thermotolerant coliforms was not a useful method to assess regular handwashing practices with soap in Karachi. Developing better measures of handwashing behaviour remains an important research priority.

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    • "The efficacy of handwashing interventions to interrupt transmission of enteric pathogens can be assessed by measuring the concentration of fecal indicator bacteria from hand rinse specimens. The concentration of these organisms are associated with the occurrence of diarrhea and so provide a proxy measurement of the efficacy of handwashing promotion interventions [Luby et al., 2007; Pickering et al., 2010]. There is no analogous assay to assess the efficacy of handwashing interventions on interrupting respiratory virus transmission. "
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    ABSTRACT: As one step in developing a measure of hand contamination with respiratory viruses, this study assessed if human rhinovirus (HRV) was detectable on hands in a low income non-temperate community where respiratory disease is a leading cause of child death. Research assistants observed residents in a low income community in Dhaka, Bangladesh. When they observed a resident sneeze or pick their nose, they collected a hand rinse and anterior nare sample from the resident. Samples were first tested for HRV RNA by real-time RT-PCR (rRT-PCR). A subset of rRT-PCR positive samples were cultured into MRC-5 and HeLa Ohio cells. Among 177 hand samples tested for HRV by real-time RT-PCR, 52 (29%) were positive. Among 15 RT-PCR positive hand samples that were cultured, two grew HRV. HRV was detected in each of the sampling months (January, February, June, July, November, and December). This study demonstrates in the natural setting that, at least after sneezing or nasal cleaning, hands were contaminated commonly with potentially infectious HRV. Future research could explore if HRV RNA is present consistently and is associated sufficiently with the incidence of respiratory illness in communities that it may provide a proxy measure of respiratory viral hand contamination. J. Med. Virol. 9999: XX–XX, 2014. © Published 2014. This article is a U.S. Government work and is in the public domain in the USA.
    Full-text · Article · Apr 2014 · Journal of Medical Virology
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    • "Luby and colleagues found that a simple microbiological method with three fingers directly imprinting a MacConkey agar for thermotolerant coliforms was unable to distinguish between households who were given soap during a large randomized handwashing trial and control households [8]. They concluded that the method was unsuitable for the evaluation of handwashing practices. "
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    ABSTRACT: Handwashing is thought to be effective for the prevention of transmission of diarrhoea pathogens. However it is not conclusive that handwashing with soap is more effective at reducing contamination with bacteria associated with diarrhoea than using water only. In this study 20 volunteers contaminated their hands deliberately by touching door handles and railings in public spaces. They were then allocated at random to (1) handwashing with water, (2) handwashing with non-antibacterial soap and (3) no handwashing. Each volunteer underwent this procedure 24 times, yielding 480 samples overall. Bacteria of potential faecal origin (mostly Enterococcus and Enterobacter spp.) were found after no handwashing in 44% of samples. Handwashing with water alone reduced the presence of bacteria to 23% (p < 0.001). Handwashing with plain soap and water reduced the presence of bacteria to 8% (comparison of both handwashing arms: p < 0.001). The effect did not appear to depend on the bacteria species. Handwashing with non-antibacterial soap and water is more effective for the removal of bacteria of potential faecal origin from hands than handwashing with water alone and should therefore be more useful for the prevention of transmission of diarrhoeal diseases.
    Full-text · Article · Dec 2011 · International Journal of Environmental Research and Public Health
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    • "The promotion of improved hand hygiene continues to be a key public health goal both in low and high income countries, in communities and in health care settings. Most previous research has been done into specific populations such as primary carers and healthcare workers [3-6], but little work has been done to investigate the carriage rate of the general population [7-9]. "
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    ABSTRACT: A previous study found that the prevalence of contamination with bacteria of faecal-origin on the hands of men differed across UK cities, with a general trend of increased contamination in northern cities. The aim of this study was to (1) confirm the north-south trend (2) identify causes for the trend. Hand swabs from commuters (n = 308) at train stations in 4 cities were tested for the presence of faecal bacteria. The prevalence of hand contamination with faecal bacteria was again higher in cities in the north compared to the south (5% in London, 4% in Birmingham, 10% in Liverpool and 19% in Newcastle). Contamination risk decreased with age and better personal hygiene (self-reported). Soil contact and shaking hands increased contamination with faecal bacteria. However, in multivariable analysis, none of these factors fully explained the variation in contamination across cities. The study confirmed the north-south differences in faecal contamination of hands without finding a clear cause for the trend. Faecal contamination of hands was associated with personal hygiene indicators suggesting that microbiological testing may contribute to evaluating hygiene promotion campaigns.
    Full-text · Article · Jan 2011 · BMC Public Health
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