COMPARISON OF BACTERIAL FLORA ON THE HANDS OF HEALTHCARE WORKERS AND NON-HEALTHCARE WORKERS

ABSTRACT

The hands serve as reservoirs of microbial flora hence play an important role in infection transfer. This project work was carried out to demonstrate and compare the bacterial flora on the hands of health care workers (HCW) and non-health care workers (NHCW), their antibiotic susceptibility pattern and the efficacy of SmartansTM alcohol based hand sanitizer (ABHS) in hand hygiene. The samples were collected twice in sterile polyethylene bags before and after the use of hand sanitizer, plated on MacConkey agar, Nutrient agar and Blood agar after serial dilution within 5 hours of collection and incubated for 24 hours. Antibiotic susceptibility pattern of the isolates was tested. Probable organisms isolated include Coliforms, Staphylococcus sp and Pseudomonas sp. A students t-test was used to analyze the mean heterotrophic count of the isolates (p>0.05). Amongst the isolates, Escherichia coli was the most prevalent in both HCW and NHCW. The least occurring specie on NHCW was Proteus sp whereas there was no growth of Enterobacter sp recorded for HCW. Although exposure to environmental flora is important in developing a natural immune system, proper hand hygiene practice with the use of hand sanitizers is one of the ways to curb the prevalence of bacterial flora that could be of major clinical significance.

TABLE OF CONTENTS

Title page

Certification i

Dedication ii

Acknowledgement iii

Table of Contents iv

List of Tables v

List of Figures vi

Abstract vii

CHAPTER ONE

1.1 INTRODUCTION 1

1.2 Aim 2

1.3 Objectives 2

CHAPTER TWO

LITERATURE REVIEW 3

2.1 Historical view of hand hygiene 3

2.2 The hand: a vector 4

2.3       Choice for hand hygiene agents 5

2.4       Agents commonly used for hand hygiene 6

2.5       Interaction between hand hygiene products 13

2.6       Dispensing of hand hygiene products 13

2.7       Effective hand hygiene techniques 14

2.8       Alcohol-based hand rubs 14

2.9       Handwashing 15

2.10     Hand wipes 16

2.11     Drying methods 17

2.12     Barriers to effective hand hygiene 17

2.12.1 Natural fingernails and nail enhancements as barriers to effective

hand hygiene 19

2.12.2 Jewellery as a barrier to effective hand hygiene 20

2.12.3 Other barriers to effective hand hygiene 21

2.13     Compliance to hand hygiene 21

CHAPTER THREE

3.1 MATERIALS AND METHODS 25

3.2 Bacteriological analysis 25

3.3       Antibiotic susceptibility 26

3.4       Biochemical testing 27

3.5 Data analysis 28

CHAPTER FOUR

RESULT 29

CHAPTER 5

5.1 Discussion 36

5.2 Conclusion 37

5.3 Recommendation 37

REFERENCES 39

LIST OF TABLES

Tables             Title Page

1 Identification and characteristics of isolated organisms 31

2 Prevalence of isolates in CFU/G before the use of hand sanitizer 33

3 Prevalence of isolates in CFU/g after the use of hand sanitizer 34

4 Antibiotic susceptibility of isolates from hands of NHCW 35

5 Antibiotic susceptibility of isolates from hands of HCW 36

LIST OF FIGURE

Figure Title Page

1 Frequency of occurrence of isolates from hands of HCW and NHCW 32

CHAPTER ONE

1.1 INTRODUCTION

Hands play a major role in infection transfer both in health care institutions and other settings (Aiella et al., 2002).

Hand hygiene is the most effective measure for interrupting microorganisms which cause infections within and outside the health care setting.

In 2002, Centers for Disease control and prevention (CDC) reviewed the recommendation for hand hygiene to include the use of alcohol-based products for standard hand hygiene (Boyce and Pittet 2002).

Several studies have compared the bacterial flora on the hands of patient care and non-patient care personnel and patients versus health individuals. Since the publishing of data addressing these issues in the last few decades, hand hygiene regimes within the hospital has changed dramatically. As lower level of hand hygiene are practiced outside the clinical setting, it was hypothesized that the hands of individuals in the non-health care systems would have higher overall bacterial count’s and fewer antibiotic resistance organisms than in health care workers. Despite the increased attention directed to hand hygiene especially in clinical setting the threat of infectious disease in developing countries remains very high. Studies have shown that there are about 2-3 million deaths worldwide each year from diarrheal diseases, (WHO, 2000) many of which could have been prevented.

Hand washing with soap has been estimated to save a million lives a year (Wendt, 2001). Limited or non-existence of basic sanitary infrastructures presents an extra hurdle in developing countries. This has differentiated the approach to hand hygiene in developing and developed countries.

However, a new public health campaign amongst others led by the World bank and the water sanitation programme in collaboration with many other partners, has been set up to address increased hand hygiene in some developing countries.

Another retraining factor of inadequate compliance to hand hygiene recommendation in developing countries is the lack of scientific evidence to basic question such as: How should hand be washed, when should they be washed, which product should be used and for how long (Weeks, 1999).

Most hand hygiene data concerning microorganism are for bacteria, viruses are also extremely important and as far more difficult to investigate.

The overall aim of hand hygiene studies is to provide evidence that adherence to hand hygiene practices result in a decrease in microbial load and infection.

1.2 AIM

This study is aimed at demonstrating the bacterial flora present on the hands of health care workers as compared to the hands of non-health care worker and the need for persistent hand hygiene.

1.3 OBJECTIVES

1. To evaluate the bacterial load on the hands of workers in the health care system and those in non-health care systems.

2. To study the antibiotic susceptibility pattern of the isolates

3. To determine the efficacy of alcohol based hand sanitizers in antiseptic hand rub.

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