On our hands: A systematic review of fecal contamination and enteric pathogen detection on human hands
Cantrell, Molly.
2021
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Thesis (M.S.)--Tufts
University, 2021.
Submitted to the Dept. of Civil Engineering.
Advisor: Amy Pickering.
Committee: David Gute, and Jeffrey Griffiths.
Keyword: Environmental health.
Despite a significant decrease in diarrheal deaths over the last few decades (an estimated 36% decrease from 1990 to 2016), morbidity continues to be a significant ... read moreproblem worldwide. The transmission of enteric pathogens occurs through contamination of, and subsequent exposure to food, water, flies, surfaces (or fomites), hands, and fields (or soils). The purpose of this thesis is to present evidence on enteric pathogen transmission through hands, a relatively understudied environmental pathway. The objectives are to describe the prevalence and levels of contamination of fecal indicator bacteria (FIB) and enteric pathogens on hands, and to compare contamination levels between five subgroups (country income level, age group, gender, urban/rural, and climate classification). Seventy-eight studies were identified with 48 different types of FIB and enteric pathogens. The most commonly reported pathogens were adenovirus, rotavirus, enterovirus, and norovirus. E. coli and fecal coliforms (FC) were the most commonly reported indicators. The average E. coli and FC prevalence on hands were 43.8% and 45.6%, and mean contamination levels were 1.59 and 2.22 log10CFU/hand, respectively. We found that low-income countries had significantly greater E. coli and FC prevalence than high-income countries. Within low/lower-middle income countries, E. coli prevalence and concentration were higher in urban settings as compared to rural areas. Climate classifications could only be compared in upper-middle/high income settings, but may be associated with E. coli and FC prevalence. This review highlighted gaps in evidence of hand contamination in rural high-income settings as well as contamination by gender. Additionally, we found that hand rinse samples are likely more sensitive at detecting fecal indicator bacteria than swab and impression samples. This review suggests that hands are frequently contaminated with fecal bacteria, especially in urban low-income settings.read less - ID:
- sf268k38j
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