CHAPTER ONE

INTRODUCTION

Microorganisms in their nature are present everywhere. They are present in food, air, water, soil, surfaces of some common household items. These microorganisms are unseen with the naked eyes except after culture media are used to quantify them.

With the vast presence of these microorganisms, hand contamination is very easy. Individuals can get contaminated by touching microbial surfaces especially public toilets, private toilets and through handshakes.

These microorganisms involve bacteria, fungi, viruses and moulds. The bacteria Salmonella, Shigella and Escherichia coli are among the microorganisms that cause fatal illnesses in humans. (Ganajan et al., 2013)

However, molds also readily enter indoor environments by circulating through doorways, windows, ventilation systems, and air conditioning systems. The most common indoor, airborne mould spores (e.g. Penicillium, Aspergillus, Cladosporium, and Alternaria) are deposited on humans, food items, pets, and household items, causing allergic diseases while at the same time causing non-allergic symptoms. (Ganajan et al., 2013).

Human feces are the main source of diarrheal pathogens. These pathogens are spread through handshake, flies, animals, water, air etc. They are sources of gastro-enteric infections like shigellosis, typhoid, cholera, salmonellosis and others.

Also, they are sources of some respiratory infections like influenza and pneumonia. A gram of human feces can contain 10 million viruses and 1million bacteria. (Gould D, 1994)

With the hands being a route of pathogen transfer, after touching microbial infected surfaces or after using the toilet, washing of hands with soap prevent the transmission of bacteria, viruses and protozoa that cause diarrheal diseases.

Other measures such as food handling, water purification and fly control have an impact on these diseases as well, but sanitation and hand washing provide the necessary protection against fecal contact. (Linton, 2005).

Intestinal parasitic infections remain an important health problem in Molyko, South West Region, Cameroon. The effects vary according to the species of microorganism and burdens of infection. These infections have as major route of transfer, the hands.

Individuals and children on the streets of Molyko, homes and schools are still very much infected by these pathogens. The rate of transmission has drastically increased due to poor sanitation, lack of sensitization and poor government policies (HEO,2006). These parasites are commonly transmitted through ingestion of contaminated food or water as a result of poor isolation and hygiene.

Infections occur through contact between contaminated and uncontaminated hands during handshakes or between food handlers and their customers (food restaurants, food canteens, school vendors, street vendors and bakeries).

Research has shown that individuals in Molyko are very much infected with intestinal infections due to poor hand washing methods. Children and even adults are prone to eating without washing hands. (HEO,2006).

Also, inhabitants of Molyko are very much ignorant of the fact that microorganisms are everywhere and that they are exposed to infection through touch or contact. In our society today, hand washing has proven to be a major method of preventing intestinal parasites especially among children.

Every year more than 3.5million children around the world die because of diarrhea and pneumonia. Thus, raising awareness about the benefits of hand washing in Molyko will go a long way in reducing the incidence of parasitic infections.

Equally, hand washing with soap and proper hygienic food handling prevent diarrhea diseases and parasitic infections. Hand washing is the best method to prevent pathogens that pass through oral fecal route. Hand washing can remove dirt, soil, bacteria, viruses and parasites.

1.2 Review Of Related Literature

Food handlers are the most important sources for the transfer of microorganisms from their skin, nose, and bowels to food prepared by them. Also, the preparation of food in utensils infected by handling or washing in contaminated water or flies alighting on food after feeding on infected feces or during storage of food by insects, rodents etc. However, food handlers play the leading role (Mohan, 2006).

Touching your face (especially eyes, nose, and mouth) with your hand is a method of microbial transfer to these areas. One of the best ways to prevent the spread of the illness is just to wash your hands well in soap and water.

It seems so simple, but it really does work (WHO, 2004) Hand washing is one of the ways to stop the cycle of disease especially those spread through oral-fecal route. Proper hand washing can remove dirt, soil and some other contaminants like bacteria, viruses and parasites. (Simonne,2004).

Handling and preparing foods with hand contact is a common way to transfer food borne hazard to and from foods. It is important to ensure that the hands of a food handler are kept clean before and after handling food. (Linton, 2005)

 1.2.1) Four Major Groups Of Microbes

Bacteria

Microbes belonging to the bacteria group are made up of only one cell. Under a microscope, bacteria look like balls, rods, or spirals. Bacteria are so small that a line of 1,000 could fit across the eraser of a pencil. Life in any form on Earth could not exist without these tiny cells.

Scientists have discovered fossilized remains of bacteria that date back more than 3.5 billion years, placing them among the oldest living things on Earth. Bacteria can inhabit a variety of environments, including extremely hot and cold areas (Gould D, 1994).

• Psychrophiles, or cold-loving bacteria, can live in the subfreezing temperature of the Arctic.
• Thermophiles are heat-loving bacteria that can live in extreme heat, such as in the hot springs in Yellowstone National Park.
• Extreme thermophiles, or hyperthermophiles, thrive at 235 degrees Fahrenheit near volcanic vents on the ocean floor.

Many bacteria prefer the milder temperature of the healthy human body. Like humans, some bacteria (aerobic bacteria) need oxygen to survive. Others (anaerobic bacteria), however, do not. Amazingly, some can adapt to new environments by learning to survive with or without oxygen.

Like all living cells, each bacterium requires food for energy and building materials. There are countless numbers of bacteria on Earth—most are harmless and many are even beneficial to humans. In fact, less than 1 percent of bacteria cause diseases in humans.

For example, harmless anaerobic bacteria, such as Lactobacilli acidophilus, live in our intestines, where they help to digest food, destroy disease-causing microbes, fight cancer cells, and give the body needed vitamins. Healthy food products, such as yogurt, sauerkraut, and cheese, are made using bacteria.

Some bacteria produce poisons called toxins, which also can make us sick.

Viruses

Viruses are among the smallest microbes, much smaller even than bacteria. Viruses are not cells. They consist of one or more molecules of DNA or RNA, which contain the virus’s genes surrounded by a protein coat. Viruses can be rod-shaped, sphere-shaped, or multisided. Some viruses look like tadpoles.

Unlike most bacteria, most viruses do cause disease because they invade living, normal cells, such as those in your body. They then multiply and produce other viruses like themselves. Each virus is very particular about which cell it attacks.

Various human viruses specifically attack particular cells in your body’s organs, systems, or tissues, such as the liver, respiratory system, or blood. Although types of viruses behave differently, most survive by taking over the machinery that makes a cell work.

Briefly, when a piece of a virus, called a virion, comes in contact with a cell it likes, it may attach to special landing sites on the surface of that cell. From there, the virus may inject molecules into the cell, or the cell may swallow the virion.

Once inside the cell, viral molecules such as DNA or RNA direct the cell to make new virus offspring. That’s how a virus infects a cell. Viruses can even “infect” bacteria. These viruses, called bacteriophages, may help researchers develop alternatives to antibiotic medicines for preventing and treating bacterial infections.

Many viral infections do not result in disease. For example, by the time most people in the United States become adults, they have been infected by cytomegalovirus (CMV). Most of these people, however, do not develop CMV-disease symptoms. (WHO, 2004).

Other viral infections can result in deadly diseases such as AIDS (acquired immunodeficiency syndrome) or Ebola hemorrhagic fever.

Fungi

A fungus is actually a primitive plant. Fungi can be found in air, in soil, on plants, and in water. Thousands, perhaps millions, of different types of fungi exist on Earth. The most familiar ones to us are mushrooms, yeast, mold, and mildew. Some live in the human body, usually without causing illness. Fungal diseases are called mycoses.

Mycoses can affect your skin, nails, body hair, internal organs such as your lungs, and body systems such as your nervous system. Aspergillus fumigatus, for example, can cause aspergillosis, a fungal infection in your respiratory system

Penicillin Mold Fungus

Some fungi have made our lives easier. Penicillin and other antibiotics, which kill harmful bacteria in our bodies, are made from fungi. Other fungi, such as certain yeasts, also can be helpful. For example, when a warm liquid, such as water, and a food source are added to certain yeasts, the fungus ferments. The process of fermentation is essential for making healthy foods like some breads and cheeses.

Protozoa

Protozoa are a group of microscopic one-celled animals. Protozoa can be parasites or predators. In humans, protozoa usually cause diseases.

1.2.2) Control by Hand washing

The simple act of washing hands with soap gives a significant health advantage. Based on an analysis of 17 studies which they judged to be of high quality, Curtis and Cairncross (2003) found that interventions which promote hand washing with soap were associated with a decreased risk of diarrhoeal disease by nearly half (47%: P<0.05 with confidence interval 24-63%).

They estimated that if the practice of hand washing with soap were universal, about 1 millions lives currently lost to diarrheal disease could be saved each year. The research highlighting the reduced risk of diarrheal disease related to hand washing with soap includes:

• Han and Hlaing (1989): 30% reduction in diarrheal morbidity in Burma;
• Pinfold et al. (1996) median reduction of 35% (range of 30-89%) in northeast Thailand;
• Khan (1982): 84% reduction in the incidence of shigellosis in Pakistan;
• Birmingham (1997), overall reduction 39% among young children in Burundi.

In the past five years, it has been recognized that handwashing with soap provides health benefits beyond reducing diarrheal diseases. In 2001, Ryan et al published a study that attracted international attention with its focus on respiratory illness.

An intervention was organized so that military recruits in a US training facilitywere encouraged to wash their hands 5 times a day. The 44,000 recruits were split into intervention and control groups.

The program involved education, provision of hand washing materials and a relaxation of rules; for example, sinks did not have to be wiped dry after hand washing. The study found that the risk of respiratory infection was reduced by about 45% among the recruits under training in 1997 and 1998compared to 1996.

Interestingly, those who reported washing hand fewer than three times a day; had significantly more hospital admissions (odds ratio was 11, 95% confidence level 2.7 to 46).

A recent research by Luby et al (2005) in Pakistan demonstrated an impact on diarrhea as well as acute respiratory-tract infections and impetigo. Selected at random were about 300 households as controls, 300 households with hand washing promotion using plain soap and 300 assigned to antibacterial soap.

The findings showed that children 1 to 5 years in households that received plain soap and hand washing promotion had a 50% lower incidence of pneumonia than controls (95% CI -65% to -34%). Also compared with controls, children younger than 15 years in households using plain soap had a 53% lower incidence of diarrhea (CI -65% to -41%) and a 34% lower incidence of impetigo. There was no significant difference between the children using plain and antibacterial soap.

How can hand washing with soap prevent colds and pneumonia?

Cairncross (2003) describes two possible links. The first is that pathogens such as enteric viruses, causing ‘gastric flu’ can also irritate the epithelial cells in the lungs.

The second possible connection is that we can unwittingly give ourselves an infection through the skin of our hands. For example, Cairn cross sights a study (Corley et al. 1987) in which children aged 4–8 years were trained not to touch their nose and eyes so frequently, leading to a 47% reduction in laboratory diagnosed common cold infections.

He also notes that those viruses such as the cold virus can remain viable on surfaces for several hours, that the number needed to cause infection can be very small, and that people can pick up virus particles on their hands by touching objects and surfaces contaminated by infected people.

Interestingly, in an article titled ‘If there is another outbreak of SARS, how can I protect myself?’ on the SARS website

(http://library.thinkquest.org/03oct/00738/outbreak.html#contentoutline), it is recommended that people “frequently wash their hands with soap and water or use alcohol-based hand rubs. One must also avoid touching one’s eyes, nose, and mouth.”

Hand washing appears to be relevant no matter how anal cleansing is done. Han et al (1986) showed that hands easily become contaminated after defecation, even with the use of cleansing paper (reported by Curtis, 2000).

1.2.3) Value of interventions promoting hand washing

A small amount of research is available pointing to the effectiveness of interventions that improve hand washing practices. It shows that new, improved behaviours can be sustained. Hoque et al. (1996) found lower numbers of faecal colony-forming bacteria on hands and continued hand washing practices of women in intervention are compared to control areas (P<0.001), four years after the conclusion of an intervention in Bangladesh.

Another longitudinal study carried out in 6 countries (Ghana, Kenya, Uganda, India, Nepal, SriLanka) demonstrated that hygiene behaviors, including hand washing with soap, are sustained beyond the end of an intervention (Shordt et al, 2004). For the studies in five countries, 25 comparisons were made between hygiene practices including hand washing among people where the projects ended in 1998 or 2000.

The results showed that in only two out of 25 comparisons made did the people practice safe hygiene behaviors more where the projects ended in later (2000) than where the projects ended in earlier, 1998. This implies that, in terms of behavior sustainability, the amount of time since the projects ended did not make much of a difference.

In 17 cases spread across four countries comparison was made of hygiene behavior changes between two data collection dates (2001 and 2002) about a year apart. In only one of the 17comparisons was there a significant decrease over the one-year period.

Thus, the time between surveys did not make much of a difference, providing more evidence about the sustainability of hygiene behaviors. Recent research also points to the cost-effectiveness of hygiene promotion programs related to handwashing.

1.3 Statement Of A Problem

Intestinal parasitic infections are very common among individuals in Molyko. This prevalence is increasing daily due to poor sanitary condition and dirty habits of inhabitants. Many household locations are very vulnerable to microbial exposure, particularly in family dwellings where many facilities are shared. (HEO,2006)

1.4)   HYPOTHESIS

1.4.1) Null Hypothesis

(Ho)Variety of microorganisms are found on hands of individuals in Molyko.

1.4.2 Research Question

This project will go ahead to answer the question; What are the pre-dominant hand microorganism on samples obtain from different individuals in Molyko and how can hand washing with soap be the best method of control in Molyko.

1.4 Rationale

Microorganisms exist everywhere. Microbes have probably always cause infections and diseases in human. The body parts of healthy humans and animals are hosts to a variety of microbes known as resident microbes. But through contact with other objects, the body also picks up other microbes known as transient microbes.

A typical person’s hand can carry 10,000 to 10 million bacteria, some resident and some transient. When humans or animals are sick or infected with specific microbes, the number of microbes may increase.

The microorganisms from human and animal sources can be transmitted to hands, other people, foods and anything else that the hands comes in contact with and vice versa. And these microbes can cause diseases to human body.

These microorganisms are the major source of illness among adults and children in Molyko (HEO,2006). This alone has been the reason why cases of cold, flu and diarrhea are registered every day in hospitals around Molyko.

In 2010, many Cholera cases were registered and there were some death cases. Inhabitants of Molyko are very much ignorant of the fact that microorganisms are everywhere and that they are expose to infection through touch or contact. Furthermore, the poor sanitary methods use in Mini-Cites in Molyko widen the scope of spread. These behavioral acts are very common among children and adults in Molyko. (HEO,2006.

With these reasons, there is need in carrying out this research project. This study will be a great contribution to the medical field because it aims to limit the spread of communicable diseases and reduce the number of microbes that causes different diseases. This research may also be beneficial to the following groups of people.

For the community: More awareness on fighting disease-causing microbes will be ensued.

Department of Health: They will be able to promote proper hand hygiene against microbes that can cause disease.

For the future researcher: This study can serve as a basis for their upcoming research, especially on microbes and other microbial research.

1.5 OBJECTIVES   

1.5.1 General Objectives

To isolate, identify hand microorganism and then use hand washing as a method of control in Molyko.

1.5.2 Specific Objectives

1. To isolate the different microorganism present on samples obtained from the hands of individuals in Molyko, South West Region.
2. To identify the various microorganisms isolated.
3. To compare the level of microbial growth and types of microorganisms isolated from hands before and after hand washing with soap.