Medires Publishers - Article

Abstract

Maintaining clean hands is the single most essential way to stop bacteria from spreading and lower the risk of illnesses. Practicing good hand hygiene helps to prevent illnesses and increase health safety. The purpose of this study was to determine whether Ambrose Alli University students' hands contained germs. At least one or two bacteria were isolated from each of the fifty (50) samples that were examined. The colony counts of students from each site were accurately documented, with the male hostel residents having the greatest colony counts (4.85 x 105cfu/ml) as compared to the female hostel residents. However, there was a noticeable rise among the students in the microbiology lab, which might be related to poor hand hygiene practices that weren't followed. Poor hygiene standards are indicated by the significant increase in the prevalence of Proteus sp. and Escherichia coli. One possible explanation for the low colony counts among children from the school gate could be because they bathed before arriving. Staphylococcus aureus 50 (100%), Escherichia coli 35 (70%), Klebsiella sp 15 (30%), Salmonella sp 21 (42%), Streptococcus sp 10 (20%), Bacillus sp 4 (8%), Pseudomonas sp 2 (4%) and Proteus sp 2 (4%), are among the isolates that appear most frequently. According to the survey, there has been a noticeable rise in the unsanitary habits of Ambrose Alli University students in Ekpoma, Edo State, Nigeria.

Introduction

Early in the 19th century, the idea of washing hands with any antiseptic to avoid infections most likely came together. A pharmacist stated in a paper from 1825 that doctors and other medical staff who treat patients with contagious diseases should wet their hands with liquid chloride solution; however, hand washing gradually gained recognition as one of the most crucial steps in preventing the spread of pathogens in healthcare facilities due to the seminar studies conducted by Ignaz Semmelweis and Holmes [1]. Maintaining clean hands is the single most essential way to stop bacteria from spreading and lower the risk of illnesses. According to Price [2] and Iyevhobu et al. [1], practicing proper hand cleanliness helps to prevent infections and increase health safety. Approximately five thousand young children worldwide lose their lives to diarrheal infections that can be readily prevented. Basic sanitation and personal hygiene can significantly reduce this toll [1]. Every year, a considerable amount of diseases and fatalities are attributed to unhygienic environments. It is estimated that infections associated to diarrhea alone result in two to three million deaths annually, with children accounting for the majority of these deaths. The innocent victims of the global inability to provide underprivileged people with access to basic sanitation facilities are infants and young children [3, 4].

People can better grasp the reasons behind their health problems and potential preventive measures with the aid of hygiene and health education. Most infectious diseases, such as numerous gastrointestinal ailments and infectious diarrhea, spread through the faecal-oral route. Approximately 2.2 million people, predominantly children and schoolchildren, die from diarrhea each year in underdeveloped nations, where 80% of infections are linked to inadequate personal and household cleanliness [3]. These disorders are predisposed by low health, a lack of formal education, and poor personal and household hygiene [5]. Most people's poor hygiene practices cause a variety of illnesses to spread through the hands and fingernails [1].

The bulk of illnesses linked to healthcare are caused by transient bacterial flora that colonize the skin's superficial layers and are more easily removed by frequent hand washing [6]. A hand hygiene preparation should ideally be active against coated viruses, yeasts, and bacteria at the very least. There are three options available to healthcare professionals for treating hands after contamination: (i) the social hand wash, which involves washing hands to get rid of filth, grime, and various organic materials using water and a simple, non-medicated bar or liquid soap; (ii) The hygienic or antiseptic hand wash, which entails cleaning hands with medicated or antimicrobial soap and water (a.k.a. "scrub"); the majority of antimicrobial soaps are liquid preparations with a single active agent; and (iii) the hygienic hand disinfection, which typically entails rubbing dry hands with an alcohol-based hand rub without the use of water. Numerous studies show that there is a disconnect between the optimal hand washing behaviour and the understanding of personnel and patients in healthcare settings, students in schools, and women who are child caretakers in the community and at home regarding soap use [1, 3].

According to data from multiple research, health workers comply most when they touch a patient and after being exposed to bodily fluids; they comply least when they touch the patient's surroundings and before carrying out an aseptic operation. There are also disparities in attitudes on adherence to safe practices, knowledge of the bare minimum of time required for good hand hygiene, and the necessity of washing hands before putting on and taking off surgical gloves [7]. Research has revealed a mismatch between hand washing knowledge and practice. In one study, just 24.9% of students actually washed their hands properly, despite the fact that 85.6% of students were aware that they should do so before eating and after using the restroom [3]. Another study on the frequency of hand washing among secondary school students revealed that the practice was uncommon, with hand cleaning more common following genital contact than before meals or after using the restroom [1, 8].

The microorganisms that colonize hands can be classified into two types: the transient flora, which colonizes the superficial layers of the skin and can be more easily removed with regular hand hygiene, and the resident flora, which lives underneath the stratum corneum's superficial cells. On the skin, transient microorganisms typically do not grow but rather survive [6]. The organisms are most commonly linked to healthcare-associated infections (HCAIs), and they are typically obtained by health care workers (HCWs) through direct contact with patients or their surrounding contaminated environmental surfaces [9].

Health care acquired infections (HCAI) can be caused by microorganisms (germs) such as viruses, fungi, parasites, and, most commonly, bacteria [4]. According to Iyevhobu et al. [6], healthcare-associated infections (HCAIs) can be caused by endogenous microorganisms, which are already present on the patient's skin and mucosa, or exogenous microorganisms, which are spread from other patients, healthcare providers, or the surrounding environment. Microorganisms are typically transferred from the source to the patient through the hands of healthcare professionals, but patients themselves may potentially be the source [1]. Microorganisms typically spread from one patient to another, between bodily sites, and from the patient's surroundings or vice versa. During patient treatment, the hands of healthcare professionals may gradually get colonized by germs and possible diseases. Longer care periods increase the degree of hand contamination and possible dangers to patient safety when hand hygiene is neglected [5].

Materials And Methods

Geographical Description of the Study Area

In Ekpoma, the Esan West Local Government Area of Edo State, Nigeria, this study was conducted. With a surface area of 17,450 sq. km and a population of 3.1 million, Edo state is situated in the South-South geopolitical zone of Nigeria, between longitudes 06o 04IE and 06o 43IE and latitudes 05o 44IN and 07o 34IN. In the semi-urban town of Ekpoma, the main industries are agriculture, trade, public service, and education.

Collection of samples

From the student residences, a total of 100 hand swabs from 50 students were gathered. A sterile cotton swab-stick dampened with autoclaved normal (0.85%) saline was used to obtain hand swabs from the patients. Samples were taken from the palmar creases and interdigital spaces by gently moving the swab stick over the areas for 6-7 seconds. Before beginning this process, the participants were also asked when they had previously cleaned their hands. These swabs were placed straight into aseptic saline solutions of different dilutions, and 0.2 mL of each dilution was spread uniformly on sterile MacConkey agar plates before being incubated for 24 hours at 37 0C. Different types of colonies were isolated and the amount of CFU was counted after incubation. Standard biochemical tests were used to identify the various colonies, which were sorted and chosen based on their morphology and cultural traits.

Salmonella-Shigella agar (S-S agar), Mannitol salt agar, MacConkey agar, Deoxycholate agar (XLD agar), and other media were prepared in accordance with manufacturer's instructions and sterilized using an autoclave at 121 0C for 15 minutes, while glassware was sterilized in a hot air oven at 160 0C for 90 minutes.

Bacterial isolation: The pour plate method was used to isolate the bacteria. To isolate the bacteria, 0.1 ml and 1.0 ml of each sample were aseptically inoculated in a Nutrient Agar and incubated for 24 hours at 37 0C. In order to isolate pure cultures, the bacteria were sub-cultured into recently produced medium (CLED).

Identification of Isolates: Mucoid yellow to whitish blue colonies of Klebsiella spp., deep yellow opaque colonies of S. aureus, greenish colour colonies of Proteus spp., motility, oxidase test, and cultural characteristic by subculturing on CLED were among the culture characteristics that were tentatively identified by Gram staining, motility, and oxidase test. Salmonella-Shigella agar (S-S agar), Xylose Lysine Deoxycholate agar (XLD agar), Mannitol salt agar, and Salmonella spp. agar were used for the subculturing of several bacterial pathogens. For further intestinal pathogens, use MacConkey agar and different specialized biochemical assays. The organisms were identified using the following tests: Motility, Oxidase, Urease, Sugar Fermentation, Indole, Catalase, and Coagulase, in accordance with Cheesbrough's [10] protocols.

Results

The study's objective is to identify and assess the amount of bacteria on the palms of the hands of Ambrose Alli University students in Ekpoma, Edo State, Nigeria. This investigation is restricted to the extraction and analysis of microorganisms from students' palms. The study involved the examination of fifty (50) student palm samples. Of these, five were obtained from the school gate, ten from the microbiology laboratory, ten from the female hostels on the main campus (Female Hostel 1 and Female Hostel 2), with five samples from each hostel, and twenty-five from the male hostels (Male hostel 1 (10), Male hostel 2 (10), and Male hostel 3 (5)) (Table 1). The colony counts of the bacteria isolated are presented in Table 2.

Table 1: Sampling Location of Students

Table 2: Colony Counts of Bacteria (cfu/ml)

Table 3 shows the Mean±SD of Colony Counts of Bacteria isolated. It was observed that Male hostel 2 has the highest prevalence (0.9 x105±1.7 cfu/ml) in the study and among the male hostels sampled, followed by Male hostel 3 (2.2 x104±2.0 cfu/ml), Microbiology Laboratory (0.9 x104±0.7 cfu/ml), School Gate and Male hostel 1 has similar counts of 0.5 x104±0.6 cfu/ml, Female Hostel 1 (0.4 x104±0.4 cfu/ml) and Female Hostel 2 (0.3 x104±0.4 cfu/ml).

Table 3: Mean±SD of Colony Counts of Bacteria (cfu/ml)

Table 4 presents the frequency of occurrence of the bacteria isolates. It was observed that al the samples had Staphylococcus aureus (100%), Escherichia coli was isolated from 35 samples (70%), Klebsiella sp 30%, Salmonella sp 42%, Streptococcus sp 20%, Bacillus sp 8% while Proteus spp and Pseudomonas sp were 4%

Table 4: Frequency of Occurrence of the Isolates

Discussion

In comparison to residents of female dormitories, the colony count of students residing in Male Hostel 2 was observed to be significantly higher at 4.8 x105±1.7 cfu/ml (Table 2). Nonetheless, there was a notable rise in the number of pupils sampled in the microbiology lab, which might be related to improper hand hygiene practices. This investigation supports previous research that found women to be generally more sanitary than men [11]. Poor hygiene standards are indicated by the significant increase in the prevalence of Proteus spp. and Escherichia coli.  One possible explanation for the low colony counts among children from the school gate could be because they bathed before arriving. Since the hand is the primary organ utilized for controlling the environment and for selecting germs in a variety of settings, the fact that at least one or two bacteria were recovered from each of the fifty samples that were analyzed may indicate the degree of exposure and subsequent cross-contamination. Table 4 displays the frequency of occurrence of the isolates, which include: Bacillus spp 4 (8%), Pseudomonas spp 2 (4%), Proteus spp 2 (4%), Salmonella spp 21 (42%), Klebsiella spp 15 (30%), Streptococcus spp 50 (100%), and Escherichia coli 35 (70%).

Given that Streptococcus sp and Staphylococcus aureus are common skin microorganisms, it is possible that their high prevalence in all hand swabs is due to their normalcy. The majority of Staphylococcus aureus found on hands indicates that pupils may not be practicing good hygiene [1, 6]. This suggests that there may be a risk of sickness, but it does not prove it. Although they may have a tendency to be pathogenic, these organisms are native to humans and may be easily and quickly recovered in huge quantities from the body surfaces. Regarding the origin of these bacteria, several theories might be put up. This genus of organisms is widely distributed throughout the hand as typical flora. Staph. aureus is a somewhat frequent contaminant found in and on numerous environmental things, yet these organisms have some degree of connection to human contamination. Given that they are typically found in the hand and skin, these bacteria may withstand heat, cold, and drying [6]. Once more, it's possible that the person maintaining the dispenser handled the cleaned towel incorrectly. These organisms can be dangerous, however their mere presence on towels does not imply the presence of a public health risk. Instead, they indicate environmental contamination, such as dust. Iyevhobu et al [12], however, notes that despite their thorough and thorough searches, a number of researchers were unable to locate these creatures in significant quantities on the skin of healthy individuals.

The university administration, medical educators, and health professionals may need to consider the implications of our findings when developing initiatives to encourage hand cleanliness among students and the general public.

Conclusion

Thus, it can be inferred from the data that the normal flora in the palms of the students under study is more prevalent than the comparatively high bacterial loads. This suggests that the students' level of hygiene is low. Maintaining good hand hygiene can lower infections linked to medical care and potentially avoid sickness. An integral part of good hand hygiene practices should be drying hands properly after washing. The survey revealed that there had been a noticeable rise in unsanitary behaviours among Ambrose Alli University, Ekpoma students.

Ethical Approval and Consent to Participate

The approval for this study was given by the ethical committee of Health Research Ethics Committee of Ambrose Alli University, Ekpoma, Edo State, Nigeria. Informed consent was obtained from each participant prior to specimen collection.

Availability of Data and Materials

The authors declare consent for all available data present in this study.

Conflict of Interest

The authors declare no conflicts of interest. The authors alone are responsible for the content and the writing of the paper.

Funding

This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors’ Contributions

The entire study procedure was conducted with the involvement of all writers.

Acknowledgements

The authors would like to acknowledge the management of Ambrose Alli University (AAU), Ekpoma, Edo State, Nigeria for creating the enabling environment for this study. Thanks to all the Laboratory and technical staff of St Kenny Research Consult, Ekpoma, Edo State, Nigeria for their excellent assistance and for providing medical writing support/editorial support in accordance with Good Publication Practice (GPP3) guidelines.

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