Characterizing the microbial load on the hands of children and students: a Systematic Review with Meta-Analysis Restricted; Files Only
Espinoza, Joel (Spring 2023)
Published
Abstract
Hands play a critical role in infectious disease transmission. However, proper hand hygiene behaviors and practices do well to mitigate the spread of pathogens via hands. The presence of microbes on hands can vary by these practices which, in turn, vary across populations based on a combination of environmental and individual-level factors. Furthermore, children and students are uniquely susceptible to hand-mediated disease transmission, yet measures of the microbial load on the hands of children and students remain understudied. This study aims to describe the existing quantifications of microbial loads on the hands of children and students globally, and to assess the relationship between the microbial load on their hands and the setting the samples were collected. Initially, 1370 journal articles were abstracted across three scientific databases which ultimately yielded nineteen studies that met our screening criteria of providing a numeric concentration of the microbial load measured directly from the hands of children and students. A meta-analysis using concentrations from seven of the nineteen articles was conducted to evaluate the association between the microbial load on the hand of a child or student and having been sampled in an outdoor setting compared to an indoor setting. Descriptive analyses of the eighty-nine measurements of the microbial load derived from the nineteen articles included with this review revealed bacteria were the most commonly measured organism comprising 85% of identified measures. These concentrations of the microbial loads, however, appeared to vary greatly across many different microorganisms: bacteria ranged from [0-8.6] log10 CFU per two hands, helminths [0-385] Eggs per two hands, and one protozoa [0-58.3] cysts per 2 hands. Logistic regression analyses found a statistically significant increase (β1= 2.27, 95% CI [0.21, 4.23], p = 0.0323) in average log10 CFUs per 2 hands contaminated with generic E. coli that were sampled outside compared to those sampled indoors. The results of this study may inform future cross-sectional studies quantifying the microbial load on the hands of children and students, and the meta-analysis indicates that further investigation may yield greater insight into the association of setting with the microbial load.
Table of Contents
Chapter 1. Literature Review……………………………………………………………………...1
1.1. The Role of Hands in Pathogen Transmission…………………………………………….1
1.2. Hand Hygiene and the Prevention of Infection...………………………………………….3
1.3. Child and student susceptibility to hand-mediated diseases.…………………………..….5
1.4. Needs Assessment…………………………...…………………………………………….8
1.5. Goal Assessment and Significance………………………………………………………..8
Chapter 2. Methods……………………………………………………………………………....10
2.1. Identification………………………………...…………………………………………...10
2.2. Screening……………………………………....…………………………………………10
2.3. Database Extraction and Formatting……………………….……………………...……..13
2.4. Data Analysis…………………………...………………………………………….…….16
Chapter 3. Results………………………………………………………………………………..17
3.1. Characteristics of samples abstracted from selected……………………...……………...19
3.2. Characterization of sampled microbes ……………………………………..……………22
3.3. Meta-analysis……………………...……………………….……………………...……..24
Chapter 4. Discussion and Public Health Implication…………………………………………...26
4.1. Main Findings..……………………………...…………………………………………...26
4.2. Strengths and Limitations..…………………....…………………………………………28
4.3. Implications………………………..……………………….……………………...…….30
4.4. Conclusion……………………………...………………………………………….…….31
Appendix A..……………………………………………………………………………………..32
Appendix B..……………………………………………………………………………………..37
References………………………………………………………………………………………..38
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File download under embargo until 18 May 2024 | 2023-04-20 10:21:51 -0400 | File download under embargo until 18 May 2024 |
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