Carol Devamani
Overview Introduction    Palamaner, Andhra Pradesh, India    Aims    Faecal Indicator Bacteria Methodology Results ...
Introduction Aims    Primary: Recontamination levels – HWWS    Secondary: risk factors Faecal Indicator Bacteria    E...
Methodology CPS Agar    Urine samples Sampling Technique    Direct Finger Impression Main study : 14 mothers/caregive...
• Main study
Methodology Photo Archiving :    random number for each plate    Photo after 24-hour incubation    Reading by one pers...
RESULTS
Distribution of the number of fingers contaminated   Enterococcus                       E. coli       5.5                 ...
Log Colony Count                                                                      Enterococcus                        ...
Recontamination - Enterococcus FINGER COUNT                          6.6 LOG COLONY COUNT                          2.9
Recontamination: E.coliFINGER COUNT                            3.5LOG COLONY COUNT                            1.7
Comparison between the handwashing and control arms at eachtime point (t-test)
Sub-study : Enterococcus    Effect of type of person and type of activity on number of fingers          contaminated and l...
Sub-study: E.coli       Effect of type of person and type of activity on number of fingers            contaminated and log...
Strengths & WeaknessesStrengths                      Weaknesses Simplicity of Method          Small Sample Size    No f...
Colourful India all in one Plate!
Identification: Enterococcus
Identification: E. coli
Baseline
0 hours ( post- HWWS)
0.5 hrs
1 hour
1.5 hours
Conclusion Recontamination rate very quick    Within half an hour    Not useful for evaluating handwashing campaigns   ...
Acknowledgements Wolf Peter Schmidt – LSHTM Val Curtis and Adam Biran – LSHTM Bob Aunger – LSHTM Divya Rajaraman, Kiru...
Thank you
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 and Tropical Medicine - show that rural India is a highly contaminated environment.

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

  1. 1. Carol Devamani
  2. 2. Overview Introduction  Palamaner, Andhra Pradesh, India  Aims  Faecal Indicator Bacteria Methodology Results Strengths & Weaknesses Plates Conclusion
  3. 3. Introduction Aims  Primary: Recontamination levels – HWWS  Secondary: risk factors Faecal Indicator Bacteria  Escherichia coli  Enterococcus :  Sherman’s Criteria
  4. 4. Methodology CPS Agar  Urine samples Sampling Technique  Direct Finger Impression Main study : 14 mothers/caregivers Sub-study:  cross sectional survey  122 participants
  5. 5. • Main study
  6. 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. 7. RESULTS
  8. 8. Distribution of the number of fingers contaminated Enterococcus E. coli 5.5 3.6
  9. 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. 10. Recontamination - Enterococcus FINGER COUNT 6.6 LOG COLONY COUNT 2.9
  11. 11. Recontamination: E.coliFINGER COUNT 3.5LOG COLONY COUNT 1.7
  12. 12. Comparison between the handwashing and control arms at eachtime point (t-test)
  13. 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. 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. 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. 16. Colourful India all in one Plate!
  17. 17. Identification: Enterococcus
  18. 18. Identification: E. coli
  19. 19. Baseline
  20. 20. 0 hours ( post- HWWS)
  21. 21. 0.5 hrs
  22. 22. 1 hour
  23. 23. 1.5 hours
  24. 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. 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. 26. Thank you

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