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Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna
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Bacterial recontamination of hands following handwashing in India - Carol Devamani, LSHTM alumna

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Carol Devamani describes her study of bacterial recontamination after handwashing with soap. The findings from her research project - conducted as part of her studies at the London School of Hygiene …

Carol Devamani describes her study of bacterial recontamination after handwashing with soap. The findings from her research project - conducted as part of her studies at the London School of Hygiene and Tropical Medicine - show that rural India is a highly contaminated environment.

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  • 1. Carol Devamani
  • 2. Overview Introduction  Palamaner, Andhra Pradesh, India  Aims  Faecal Indicator Bacteria Methodology Results Strengths & Weaknesses Plates Conclusion
  • 3. Introduction Aims  Primary: Recontamination levels – HWWS  Secondary: risk factors Faecal Indicator Bacteria  Escherichia coli  Enterococcus :  Sherman’s Criteria
  • 4. Methodology CPS Agar  Urine samples Sampling Technique  Direct Finger Impression Main study : 14 mothers/caregivers Sub-study:  cross sectional survey  122 participants
  • 5. • Main study
  • 6. Methodology Photo Archiving :  random number for each plate  Photo after 24-hour incubation  Reading by one person of:  Number of contaminated fingers  Overall colony count Microbiological Testing of Colonies : CMC, Vellore Data Analysis
  • 7. RESULTS
  • 8. Distribution of the number of fingers contaminated Enterococcus E. coli 5.5 3.6
  • 9. Log Colony Count Enterococcus 20 25 20 15 2.3 15 Percent Percent 10 10 5 5 0 0 0 100 200 300 -2 0 2 4 6 entcocolony entcol2 E.coli 60 20 15 40Percent Percent 10 1.6 20 5 0 0 0 50 100 150 200 250 0 2 4 6 8 ecolicolony ecolicol2
  • 10. Recontamination - Enterococcus FINGER COUNT 6.6 LOG COLONY COUNT 2.9
  • 11. Recontamination: E.coliFINGER COUNT 3.5LOG COLONY COUNT 1.7
  • 12. Comparison between the handwashing and control arms at eachtime point (t-test)
  • 13. Sub-study : Enterococcus Effect of type of person and type of activity on number of fingers contaminated and log colony count of Enterococcus No. of fingers contaminated Log Colony Count N Difference* P value* Difference* P value* Person Male (reference) 23 - - - - Female 65 1.64 0.011 0.69 0.013 Grandmother 34 0.47 0.512 0.42 0.175 Activity None (reference) 19 - - - - Child rearing 37 2.31 0.002 0.69 0.026 Food 12 2.47 0.014 1.31 0.008 preparation Soil contact 24 0.81 0.286 0.16 0.559 Contact with Agricultural 6 0.14 0.912 0.58 0.332 products/crops Animal contact 10 1.37 0.228 0.46 0.362 Other 23 0.39 0.662 0.18 0.647 *univariate linear regression analysis
  • 14. Sub-study: E.coli Effect of type of person and type of activity on number of fingers contaminated and log colony count of Escherichia coli No. of fingers contaminated Log Colony Count N Difference* P value* Difference* P value* Person Male (reference) 23 - - - - Female 65 0.29 0.623 0.24 0.467 Grandmother 34 0.95 0.148 0.48 0.188 Activity None (reference) 19 - - - - Child rearing 37 -0.14 0.834 0.27 0.464 Food preparation 12 1.41 0.163 1.23 0.031 Soil contact 24 0.87 0.269 0.45 0.181 Contact with Agricultural 6 2.49 0.083 2.15 0.006 products/crops Animal contact 10 1.66 0.105 1.15 0.016 Other 23 -0.54 0.505 -0.003 0.995 *univariate linear regression analysis
  • 15. Strengths & WeaknessesStrengths Weaknesses Simplicity of Method  Small Sample Size  No further testing  Difficulty identifying  Only need Incubator  Reading by Single person  No additional personnel
  • 16. Colourful India all in one Plate!
  • 17. Identification: Enterococcus
  • 18. Identification: E. coli
  • 19. Baseline
  • 20. 0 hours ( post- HWWS)
  • 21. 0.5 hrs
  • 22. 1 hour
  • 23. 1.5 hours
  • 24. Conclusion Recontamination rate very quick  Within half an hour  Not useful for evaluating handwashing campaigns  But indicates environmental exposure? Routes of Transmission  Sub-study:  Enterococcus: Food Preparation, Child rearing  E.coli: Food preparation, Contact with animals, agricultural produce/crops Further Research
  • 25. Acknowledgements Wolf Peter Schmidt – LSHTM Val Curtis and Adam Biran – LSHTM Bob Aunger – LSHTM Divya Rajaraman, Kiruba Sankar, John Kenneth St. John’s Research Institute) Mary Matthews – Christian Medical College, Vellore
  • 26. Thank you

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