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Original Article
Professor and Head, 4Associate Professor, Department of Community Medicine, KPC Medical College, Kolkata, 2SRO, Centre for Community
Medicine, AIIMS, New Delhi, 3Associate Professor, Department of Community Medicine, Kempegowda Institute of Medical Sciences (KIMS),
Bangalore, India
Abstract
Background: Contaminated hands play a major role in fecaloral transmission of diseases. In 1847, Dr Semmelweis
Ignac pointed to the link between infection and unclean hands, and demonstrated that washing hands could
reduce transmission of puerperal fever (child birth fever), a dreaded disease with high mortality in those days.
Materials and Methods: A cross-sectional study was conducted to find out the extent of germs present in hand, and
also the students perception on hand washing. This was assessed by questionnaire as well as by collection of swab
from hand and performing bacteriological culture in the laboratory. Results: In regard to students perception about
the dirty areas of the hands, it was observed that majority (78%) felt palm was likely to be more dirty while less than
70% felt that web spaces could harbor dirt. Almost 86% reported that they washed hands before eating lunch, but
only 21.3% said they always used soap while 47.3% never used it. Availability of soap all the time in the school was
reported by only 18.4% students. The swabs of 61% children showed potential pathogens. The commonest of these
was Staphylococcus aureus which was seen in 44% samples. Conclusion: The students hands were contaminated
before taking food. Although they washed hands before meals, they hardly used soap due to non-availability of soap.
The school authority should be asked to keep soaps in the toilets for hand washing.
Introduction
Contaminated hands play a major role in fecaloral
transmission of diseases. In 1847, Dr Semmelweis Ignac
pointed out the link between infection and unclean
hands, and demonstrated that washing hands could
*Corresponding Author: Dr. Sandip Kumar Ray,
Professor and Head, Department of Community Medicine,
KPC Medical College, Kolkata, India.
E-mail: sandip89@hotmail.com
Website: www.ijph.in
DOI: 10.4103/0019-557X.92408
PMID: ***
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294
Ray SK, et al.: Bacteria in Hands and Handwashing among School Children
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Ray SK, et al.: Bacteria in Hands and Handwashing among School Children
Results
A total of 208 children were included in the study. Both
questionnaires were filled in and swabs were taken.
Among the study participants, 161 (77.4%) were females.
The mean age of the children was 12.8 years, with a
range of 919 years.
In regard to students perception about the dirty areas of
the hands, it was observed that majority (78%) felt palm
was likely to be more dirty while less than 70% felt that
web spaces could harbor dirt [Table 1].
Almost 86% of children reported that they always washed
their hands before eating lunch. It was interesting to note
that 47.3% students never used any soap while 30.9%
students used it occasionally and only 21.3% always used
soap for hand washing.
Regular hand washing before taking dinner was reported
by 88% children. 52.2% said that they always used soap
for hand washing before taking dinner.
It was reported by 97.6% of the students that they always
wash hand after defecation, while only 72.9% of them
Table 1: Students perception of the dirty areas of the hands
Contaminated areas of the hands
Palm
Fingers
Finger tips
Nails
Web spaces
Dorsum of the hand
Numbers of
students
Percentage*
162
158
155
149
144
94
77.9
76.0
74.5
71.6
69.2
45.2
Multiple responses
295
used soap. About 97% students said that they had hand
washing facilities near toilets at their homes and 85% of
such facilities were provided with soap.
Around 99.5% students reported that hand washing
facility was present near the toilet of their own schools
and only 18.4% of these toilets were provided with soap
[Figure 1]. It was reported that handkerchief was used
by 63% of children for drying hand. It was reported by
52.4% of students that they used soap while washing
hands on the last occasion. On the contrary, 46.6% of
the participants said they did not use soap when they last
hand washed [Figure 2].
In regard to the importance of hand washing, about 33.2%
of the children said that it removes dirt and makes the
hands clean, 40% said it prevents diseases and keeps
them healthy, and 51.4% children said that hand washing
should be done as hands have germs and hand washing
removes the germs. There were multiple answers by each
individual student.
Hand swabs were taken from all the 208 students. The
swabs of 127 (61%) children revealed potential pathogens.
The commonest of these was S. aureus which was seen in
44% of samples. This bacterium is associated with skin
and respiratory diseases as well as food poisoning. The
commonest coliform bacterium noted was Enterococcus
faecalis: in 49 (24%) samples, followed by E. coli in 25
(12%) samples and Klebsiella sp. in 14 (7%) samples.
Presence of Group A streptococcus, which is a potential
respiratory and skin pathogen, was noted in 5 (2.4%)
samples. Commensal flora growth, which is generally
non-pathogenic to immunocompetent individuals,
Figure 2: Use of soap for washing hands on the last occasion before the hand
swab was taken
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Ray SK, et al.: Bacteria in Hands and Handwashing among School Children
Discussion
The study demonstrated the presence of pathogenic
microorganisms on the hands of 61% of the children
studied. The study from Amravati, Maharashtra, had
also demonstrated the presence of potential pathogens
on hands of students between 3 years (Kindergarten) and
24 years (Postgraduates), studying in various educational
institutes. The isolates included Staphylococcus
sp. (23%), E. coli (20%), Klebsiella sp. (10%),
Micrococcus sp. (9%), Proteus sp. (7%), Citrobacter
sp. (7%), Streptococcus sp. (7%), Enterobacter sp.
(6%), Enterococcus sp. (4%), Pseudomonas sp. (3%)
and Salmonella sp. (2%). The authors also demonstrated
reduction in hand contamination after hand washing.10
In the current study, practice of hand washing was
found to be high; however, soap usage was found to be
suboptimal, as has been seen in other studies from other
countries.7 The present study findings are similar to a
study11 on knowledge, attitude and practices of school
children conducted in Ethiopia, which found that though
most students reported hand washing before meals, i.e.
99.0%, only 36.2% reported using soap during hand
washing. Availability of soap at handwashing facilities,
especially in schools, was low. This study more or less
corroborated with the present study findings. About 50%
children exhibited the knowledge that hand washing
removes germs. About 30% children did not know
that nails or web spaces can be dirty areas in hands.
Further, the present study also corroborated with the other
studies on bacterial content in hands as well as diseases
caused by the improper hand washing practices. Ray
et al.,12 observed a decrease in colony count following
hand washing with soap in 60% of the samples in a
study conducted in areas around Kolkata. The evidence
suggested that hand washing with soap reduced the
bacterial count in majority of the respondents. At the
same time, an increase in colony count was seen in 30%
samples that were either pond water users or food servers
from a canteen using dirty clothes for drying hands after
washing. Therefore, to have a real impact, particularly
in reducing the incidence of diseases, three aspects of
hand washing seem to be important: washing hands with
soap and following all steps diligently, using clean water
and drying hands with a clean cloth. A study in Karachi,
Bangalore
(N = 108)
Kolkata
(N = 100)
Total
(N = 208)
Potential pathogens
Staphylococcus aureus
Escherichia coli
Enterococus faecalis
Klebsiella
Commensal ora
Sterile culture
62 (57.4)
41 (37.96)
20 (18.51)
13 (12.03)
04 (3.70)
48 (44.44)
None
65 (65)
51 (51)
05 (05)
36 (36)
10 (10)
29 (29)
06 (06)
127 (61)
92 (44)
25 (12)
49 (24)
14 (7)
77 (37)
06 (3)
Conclusion
The students hands were contaminated before taking
food. Although they washed hands before meals, they
hardly used soap due to non-availability of soap at
schools. Children are often targeted for hygiene behavior
as it is felt that habits that develop at their impressionable
age would continue into their adulthood. However, in
the absence of infrastructure which includes water and
soap for hand washing, inculcating this habit would not
be possible. It was found that the students hands were
contaminated before taking food. The schools should
be told to keep soaps in the toilets for hand washing.
Schools should help in this regard which is not a costly
affair. However, teachers should tell the students that
drying hand after washing with soap should be done by
clean dry clothes, otherwise effect of hand washing with
soap will be lost and students will suffer from diarrhea
dysentery and pneumonia even after hand washing.
Acknowledgments
Authors deeply acknowledge Lifebuoy of Hindustan Lever
limited (HLL) for the support rendered for carrying out the
study with an intention to improve hand washing practices
among the school children, in collaboration with Indian
Public health Association. The authors also acknowledge with
gratitude the respective Principals of KPC Medical College,
Kolkata, and Kempegowda Institute of Medical Sciences
(KIMS), Bangalore, for permitting them to conduct the study
as well as for ethical clearance.
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Ray SK, et al.: Bacteria in Hands and Handwashing among School Children
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
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Cite this article as: Ray SK, Amarchand R, Srikanth J, Majumdar KK. A
study on prevalence of bacteria in the hands of children and their perception
on hand washing in two schools of Bangalore and Kolkata. Indian J Public
Health 2011;55:293-7.
Source of Support: Hindustan Lever Ltd., Conflict of Interest: None declared.