Hand Hygiene and Bacterial Hand Contamination in Medical Sciences StudentsHayyan Altaweila, NADRIN Hania, Habeeb Alsalema, Mahad Alsheuokha, Bader AlSedraa and Mohammad Jaberaa Mohammad Al- Mana Collage for Medical Sciences, Department of Clinical Laboratory Sciences , Al- Khobar- KSA Background: Hand washing is an important and effective way to prevent many of the infectious diseases as an acute respiratory infections. As hands of students exposed to hospital or any laboratory environment were highly contaminated with various types of bacteria known to cause nosocomial infections is observed in the present study Objective: This study aimed to evaluate the medical sciences students’ hand washing knowledge, practices, and hand bacterial contamination load.
Methods: 105 students in the Mohammad AlManaa Collage for Medical Sciences, from April to May, 2018, were eligible for the study. Participants filled in a questionnaire. The questionnaire tested the students’ hand washing knowledge (8 questions), it was prepared using previously published studies. Swabs from the hands of 105 volunteer students of 45(male) &60 female volunteer students were taken.
A sterile swab moistened with sterile demineralized water was rotated on the palmer aspect of the hand.Results: In this study Most of the participants washed their hands many times a day, they were aware about hand washing facilities and they used to wash hand after toilet, touching dirty materials and handling foods with soap and water. Hand contamination rate among students was more i.e. 45 % as compared to that rate of only 22% among female and male students respectivelyKEYWORDS:Hand washing, hand hygiene, infectious disease, and medical students* Corresponding author at: Department of Clinical Laboratory Science, Mohammad Al- Mana Collage for Health Sciences, , Al- Khobar- KSA, Email: [email protected]:Infectious diseases are the most common Couse of death for the developed world, more than 3.5 million of children whom are under 5 years die due to diarrhea and acute respiratory tract infection (WHO; 2005). Hand washing is one of the significant factors in reducing the incidence of these diseases. Hand hygiene is a critical issue globally and the most cost-effective factor in reducing the incidence of diseases (P. Mathur,et al 2011). Which are the most common adverse results as hospital acquired infections aecting approximately 5 to 10% of hospitalized patients in the developed world. In spite of being a very simple action, compliance with hand hygiene among health care providers is as low as less than 40% (Longtin et al 2011).Hand washing is an important practices which was revealed in a maternity clinic in Vienna in 1847., and Cleaning hands by medical personnel reduced maternal mortality. Many other studies were indicate that hand washing reduced the spread of infectious diseases. Hospital acquired infections in the United Kingdom currently cost around Ј1bn a year and affect nearly 10% of patients, causing over 5,000 deaths a year and taking up thousands of bed days. It has been found that the incidence of hospital acquired infection could potentially be reduced by 15% with hand hygiene (Tear et al 2001). hand washing with soap before handling food or after using a toilet was observed in only between 0% and 34.0% cases. Guidelines for hand washing was created by the Center for Disease Control and Association for Professionals in Infection Control and Epidemiology.Recent advances have increased our understanding of the human microbiome, including the skin microbiome. There have been no comprehensive review studies of recent advances in hand microbiome which mainly study the factors that influence the composition of the hand microbiome. Human skin is the first line or layer of defense against infectious microorganisms and toxic agents. These intrinsic and extrinsic factors can alter the microbial community on the skin (Zeeuwen atal.2013). However, non-pathological bacteria are detected everywhere on humans, with up to 1 — 107 bacteria per cm2 on the skin (Fredricks. 2001). Although the culture-based approach is still common, many microorganisms are difficult to cultivate and are therefore under-represented or undetected in culture-based surveys.The normal flora (resident microbiota) consists of many microorganisms under the superficial cells and tissues and can also be found on the surface of the skin. Staphylococcus epidermidis is the dominant species, and oxacillin resistance is extraordinarily high, particularly among HCWs. Other coagulase-negative staphylococci bacteria followed by coryneform bacteria (propionibacteria, corynebacteria, dermobacteria, and micrococci). The most common fungi genus of the resident skin flora, is Pityrosporum (Malassezia) spp. The main protective functions of normal flora are: microbial antagonism and the competition for nutrients in the ecosystem. Normal flora is less likely to be associated with infections, but may cause infections in sterile body cavities, the eyes, or on non-intact skin (WHO.2009). Normal human skin is colonized by bacteria, with total aerobic bacterial counts ranging from more than 1 — 106colony forming units (CFU)/cm2 on the scalp, 5 — 105 CFUs/cm2 in the axilla, and 4 — 104 CFU/cm2 on the abdomen to 1 — 104 CFU/cm2 on the forearm. Total bacterial counts on the hands of HCWs have ranged from 3.9 — 104 to 4.6 — 106 CFU/cm2. Fingertip contamination ranged from 0 to 300 CFU when sampled by agar contact methods (Pittet D, et al.1999).This study aimed to determine the gender differences in hand hygiene among students and Hand bacterial contamination load.Materials and Methods A cross-sectional study was undertaken on March 2018 in the Collage of Mohammad Al Manaa for Medical Sciences. Dammam, Saudi Arabia. On the basis of WHO’s concept of Five Moments for Hand Hygiene (Allegranzi, etall.2007) activities commonly undertaken by medical students during clinical phase were selected, and a questionnaire was designed (Table 1)(Ahmet Ergin et all.2011) Participants were asked to fill in a questionnaire which was prepared by previous published articles. The questionnaire included questions on student’s socio-demographic characteristics and information on students’ social hand washing knowledge, practices, and skills. It was piloted on a small group of students. There were 8 questions to evaluate hand washing knowledge, to assess hand washing practice, and to estimate hand washing skills. Bacterial swab immediately were taken from the student hand and inoculated on CLED media for bacterial load study.The study was conducted at Department of Clinical Laboratory Science. Swabs from the hands of (105) volunteer students of, 45(male) & 60 female volunteer students were taken. A sterile swab moistened with sterile demineralized water was rotated on the palmer aspect of the hand. The swabs were immediately inoculated and streaked onto nutrient agar (Sandeep Kokate, 2015). Plates were incubated aerobically at 37C for 24 hours. Isolated organisms were processed & identified according to standard bacteriological technique (Collee JG, 1996).Statistical analysis: SPSS was used for statistical analysis. Percentages and means were calculated as usual. T-test and ANOVA were used for determining the differences between means where appropriate. A linear regression model was the method of choice in order to see the UN confounded associations.TABLE 1: Self-designed questionnaire used for assessment of hand hygiene awareness.Variables Categories Frequency Percent (%)Gender M FAge Aware about hand cleaning Yes NoHand washing habit after toilet With soap and waterYes NoHand washing habit after touching dirty materials With soap and water Yes NoHand washing habit before handling food With soap and water Yes NoFinger nail status Trimmed Semi-trimmedRegular Medical Checkup Checked Not checkedHygiene training Trained Not trainedPresence of rings Observed Not observedResults In total 105 students participated in the study, the mean age (±SD) was 20.1±1.6.the rate of 45 male student (43%) and 60 female students (57%). All students (100%) were aware about hand cleaning, hand washing habit after toilet with soap and water, after touching dirty material and after handling food in both male and female students, which may indicate that all student are aware as medical sciences student on hand hygiene activities( table 2&3).Female students were 55% of semi- trimmed finger nails wile male students were 44%, date indicated that 53% of student were regular medical checked up in both male and female students. Fifty percent of students were wearing rings in their fingers. The rate of 80, 73% of student had been trained on hygiene as male and female students respectively.The distribution of answers with regards to hand washing knowledge, practices and skills questions are displayed in Table 2, Table 3, respectively. The tables show that all number of participants significant succes to provide correct answers to the questions on hand washing.In this study Most of the participants washed their hands many times a day, they were aware about hand washing facilities and they used to wash hand after toilet, touching dirty materials and handling foods with soap and water. And this may agree with another study determined only 41.5% of participants washing their hands 11 times a day which was recommended ast the cut off point for proper hand washing in the study (Uner S, 2009). These findings may indicate widespread insufficient hand hygiene in the population. Also, low scores related to participants’ social hand washing knowledge, practice and skills may indicate a need of an extensive public health education program on the topic ( Hamadah R,etal. 2015).discussionResults shows the comparison between genders on the correct responses to each question of the WHO Hand Hygiene Knowledge Questionnaire for HealthCare Workers. As shown, males and females have the same rate of correct responses on almost all of the items except in all questions. Data reflects the comparison of the frequency distribution of the responses on attitude among students. It can also be seen that majority of the students have good knowledge on which type of hand hygiene method should be used before doing any interventions such as abdominal palpation, and giving injections, or during daily facilities( Jonas Preposi Cruz,2015).Hand contamination rate among students was more i.e. 45 % as compared to that rate of only 22% among female and male students respectively (Table 3). This indicates the higher rate of hand contamination among medical female students which is really a cause of concern. Khodavaisy et al 2011(10). It was also reported that 73.1 % rate of hand contamination of health care workers. Almost all studies concerning hand hygiene have indicated the frequent contamination of HCWs hands (Jonas Preposi Cruz, 2015) (Khodavaisy, et al.2011).Organism isolated from hands of students was CONS which is a skin commensal but can cause infection under special circumstances (Table 4& Figure 1). Although CONS were also isolated from students but the organisms known to cause nosocomial infections such as staphylococcus aureus , gram negative non fructose fermented spp. & pseudomonas spp. were also isolated from hands of students. And such a difference between hand contamination of female and male could be because of exposure of students to laboratory environment during their clinical and practical classes. Our findings agree with the other data indicating an increased number of microbe especially with nosocomial pathogens (Jonas Preposi Cruz,2015)(Brunetti L, 2006).ConclusionAs hands of students exposed to hospital or any laboratory environment were highly contaminated with various types of bacteria known to cause nosocomial infections is observed in the present study. The study suggests that there is a potential of the hands in the transmission of infection from one person to others during study day or practical classes, which can result in transmtion of some community-acquired infections with possible public health implications and should be the cause of concern. Hand hygiene practices should be in calculated and impressed in all universities students.AcknowledgmentsThis work was done with the collaboration of internship students in the Clinical Laboratory Science department – Mohammad Al Manaa Collage for Medical Sciences. KSA.References: Ahmet Ergin.2011. 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BMJ. 2001 Aug 25;323(7310):411-2. ). World Health Organization. World Health Report 2005: make every mother and child count. Geneva: WHO; 2005.Uner S, Sevencan F, Basaran E, Balci C, Bilaloglu B. Determining of per-sons’ knowledge and attitudes on social hand washing who were admitted to a primary health care center. TAF Prev Med Bull. 2009;8(3):207-16WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009.Zeeuwen, P. M. Kleerebezem, H. Timmerman, J. Schalkwijk Microbiome and skin diseases Curr. Opin. Allergy Clin. Immunol., 5 (2013), pp. 514-520 Table 2. Answers to the questions about Female participants’ hand washingVariables Categories Frequency Percent (%)Gender Female60 57%Age NA NAAware about hand cleaning Yes No100% 0%Hand washing habit after toilet With soap and water Yes No100% 0%Hand washing habit after touching dirty materials With soap and water Yes No100% 0%Hand washing habit before handling food With soap and waterYes No100% 0%Finger nail status Trimmed Semi-trimmed45% 55%Regular Medical Checkup Checked Not checked53 47Hygiene training Trained Not trained73 27Presence of rings Observed Not observed55 45Table 3. Answers to the questions about Male participants’ hand washingVariables Categories Frequency Percent (%)Gender Male 45 43%Age NA NAAware about hand cleaning Yes No100% 0%Hand washing habit after toilet With soap and water Yes No100% 0%Hand washing habit after touching dirty materials With soap and water Yes No100% 0%Hand washing habit before handling food With soap and waterYes No68% 32%Finger nail status Trimmed Semi-trimmed56% 44%Regular Medical Checkup Checked Not checked53 47Hygiene training Trained Not trained80 20Presence of rings Observed Not observed52 48Table 4: Organisms isolated from hands of students (n=105):Gender Plate code Result Female 02 Gram positive, gram negative 07 Gram positive, gram negative011 Gram positive, gram negative018 Gram positive019 Gram positive021 Gram positiveMale 010 Gram positive012 Gram positive013 Gram positiveTable 5: Hand contamination rate of studentsNumber of male student with contaminated handsN (%) Number of female student with contaminated handsN (%)12(22%) 25(45%)Figure 1: Organisms isolated from hands of students