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IN 1938, Prince established that bacteria recovered from the hands could be divided into two categories namely resident and transient flora.
The resident flora (resident microbiota) consists of microorganisms residing under the superficial cells of the stratum corneum and can also be found on the surface of the skin staphylococcus epidermis is the dorminant species and Oxacillin resistance is extraordinary high particularly among HCINS and other resident bacteria include S.hominis and other coagulase negative staphylococci followed by coryneform bacteria (propioni bacteria, corynebacteria, dermobacteria and micrococci) among fungi the most common genus of the skin flora has two main protective functions;
Microbial antagonism and competition for nutrient in the ecosystem.
In general resident flora is less likely to be associated with infections in sterile body cavities, the eyes or non intact skin.
Transient flora (transient micro biota) which colonizes the superficial layers of the skin is more amenable to removal by routine hand hygiene. Transient microorganisms do not usually multiply on the skin but they survive sporadically multiply on the skin surface. They are often acquired by HCWs during direct contact with patients or contaminated environmental surfaces adjacent to the patient and the organism is frequently associated with HCAIS. Some types of contact during routine neonatal care are more frequently associated with higher levels of bacterial contamination of HCWs hands respiratory secretions, nappy/diaper change and direct skin contact. The transmissibility off transient flora depends on the specie present the number or microorganisms on the surface and skin moisture. The hands of some HCWs may become persistently flora such as staphylococcus aureus; Gram negative bacilli or yeast. Normal human skin is colonized by bacteria with total aerobic bacteria counts ranging from more than 1X106 colony forming units (CFU)/cm2 on the scalp 5X105 CFUS/cm2 on the abdomen to 1X104 CFU/cm2 on the fore arm. Total bacterial counts on the hands of HCWs have ranged from 3.9X104 to 4.6X106 CFU/cm2.
Fingertip contamination ranged from 0 to 300CFU when sampled by agar contact methods prince and subsequent investigators documented that although the count of transient and resident flora varies considerably among individuals it is often relatively constant for any given individual. Also among the organisms found on the hands also include staphylococci and staphylococcus aureus.
Staphylococcus aureus is a ubiquitous bacterium on human skin and anterior nares but frequently causes severe infections in humans. It is the most commonly isolated human bacteria pathogen and is an important cause of skin and soft tissue infections, endovascular infections, pneumonia, septic arthritis endocarditis, oseteomyelitis, foreign-body infections and sepsis. S.aureus is the prime pathogen of health care associated infections which is called nosocomial infections. Virulence, ability to cause a diverse array of infections, capacity to adapt to different environmental conditions and its nasal carriage which accounts for possible re-infection and also spread. Present years have been a emergence of nosocomial infection with the introduction of new and sophisticated medical instruments. The incidence of nosocomial infection are caused even more frequently by multidrug-resistant bacteria that used to be isolated much more seldom previously but are significant regarding hospital hygiene.
AIMS AND OBJECTIVES
The aim of this study is to investigate on microbial species associated with human hands, and also take note of their antibiotics sensitivity pattern.
The objectives of the study are;
The potential of health care worldwide is always associated with a potential range of safety problems. Yet despite advances in health care systems patients remain vulnerable to unintentional harm in hospitals (Nevsam et al; 2011: Mani et al; 2010).
One of the most significant, current discussions in health care delivery in hospitals is health care associated infection (HAI) sometimes called Hospital Acquired Infection (Mani et al; 2010: Momen and Fermie 2010) or nosocomial infection which is any infection a person develops as a result of treatment in hospital (Minnaar 2008).
Hand hygiene was thought to be a key factor in reducing hospital acquired infection during the cinitial development of health care system (Alkoyol 2007, and French, 2009).
The battle with HAI started when the Hungarian Obstetrican, Semmelweis (1847) observed that puerperal fever was more common on a maternity ward where physicians and medical students provide care to women in labour than it was on the ward where mid wives assisted deliveries. He noted that physicians and medical students were contaminating their hands while performing autopsies and later attending the examination of women without hand washing.
Arguably He was the first to recognize the importance of hand washing in controlling the transmission of infection (Akyol 2007: Meers et al; 1992, Trampuz and Widmer, 2004).
Interventions to improve personal hygiene, cleanliness of our hands and environment, living conditions and food led to a decrease in the number of deaths. She was one of the first who identified the relationship between nursing and infection control (Meers et al; 1992: minnaar 2008; Smith and Lokhorest 2009).
Despite the magnitude of HAI problems and the importance of adherence to infection control policies, hand hygiene practice has remained unacceptably low (Takabashi and Turals Jolo; Trampuz and Widmer 2004).
Hand hygiene compliance rates in different developed countries rarely exceed 50% (Mani et al. 2010; Maxfield and Dull 2011: OH and French 2009) for instance figures show that in USA it is 50%, in Switzerland 42% and in UK 32% (Takahashi and Turale 2010). Hence, poor compliance has resulted in high morbidity and mortality. In the USA there are between 1.7 and 2 million people who contract HAI and 58 to 99 thousand deaths attributed to HAI annually.
Furthermore, HAI affects nearly 10% of hospitalized patients and presents major challenges in health care facilities. Consequently, annual medical expenses have increased in the USA to approximately and 4.5billion (Maxfield and Dull 2011; Smith and Lokhorst 2009; Trampuz and Widmer 2004). Hand hygiene practice among HCWs is considered to be the single most clinical and lost effective measure to prevent HAI, a view recognized internationally (Momen and Fernie 2010; OH and French 2009; Takahashi and Turale 2010). The world health organization is strongly emphasized. The essential need for hand hygiene during health care delievery to avoid possible infection and subsequent complications; hence the clean care is safe care programme launched by WHO in 2005 as part of the first Global patient safety challenge. This programme offers new guidelines on hand hygiene training observation and performance reporting in health care settings.
Transient flora on the other hand, colonies the superficial skin layers for a short time. The hands of HCWs are activities or equipments. However, these microorganisms are easily removed by mechanical methods such as friction in hand washing. Staphylococcus aureus and candida species are examples of transient flora. These bacteria have the ability to induce HAI among patients and HCWs (Akyol 2007; Canharm 2011: Werner 2007).
Taking into consideration the above information regarding transient and resident bacteria effective hand hygiene, either by hand washing with antimicrobial soap or alcohol based rub is evidently the way to minimize the cross infection risk effective hand washing is the application of a plain (non-antimicrobial) or antiseptic (anti microbial) soap onto wet hands; then vigorous rubbing together of both hands to form leather covering all the surface of the palms, tops of the hands, base of the fingers, between the fingers back of the fingers, finger tips, finger nails, thumb and wrists for one minute (Akyol 2007; Canham 2011; Trampuz and Widmer 2004)artificial finger nails should be short, artificial finger nails or extenders are potential trap for bacteria and should be avoided. New nail polish on natural nails does not aggravate microbial load however chipped nail polish can harbor bacteria (Can ham 2011) wearing jewellery, such as rings or hand watches, could lead to the bacterial colonization on the skin underneath them.
After soaping and rubbing, hands should be rinsed thoroughly to remove all the leather. Rinsing with hot water should be avoided because it could cause skin dryness (Kampt and Loffler 2010; Mani et al., 2010, Smith 2009 reports that hand position hands down, hands laternal) during hand washing procedure and water flows showed no difference in microbial counts.
MICROBIAL SPECIE FOUND ON OUR HANDS
Is of two types
Is our normal skin flora. It consists of relatively fixed types of microorganisms regularly found in a given area and when washed or sanitized promptly re-establish themselves. They rarely cause infections except when introduced into the body through invasive procedures.
Consists of microorganisms derived or contacted from or contracted from the environment including patients, equipment and staff generally survive on the skin of the hands for less than 25hours and generally do not produce disease or establish themselves permanently on the best.
Transient flora may colonize, proliferate and produce disease in other body sites and persons who can be removed by hand decontamination with soap and water or an alcohol based preparation.
MRSA AND VRE
Methicillin resistant staphylococcus aureus (MRSA) can colonize the bowel without causing signs and symptoms of infection. Infections caused by MRSA and VRE are similar to those caused by antibiotic sensitive staphylococcus aureus and Enterococcus. Which includes; soft tissue infections, bacteremia, fistula infections, ostemyelitis, pneumonia, septicaemia and endocarditis common pathogens include gastrointestinal pathogens like Clostridium difficile and Norovirus.
Signs and symptoms are patients or staff with unexplained diarrhea or vomiting.
During Norovirus outbreaks up to 60% of the infected/symptomatic population is staff.
Hand washing with soap and water is best.
Good hand hygiene is one of the best single most effective measures for preventing the spread of organisms that cause infection.
WHY HAND HYGIENE IS SO IMPORTANT
Hands move microorganisms from one person or place to another so it can be avoided through the following measures.
Three ways to clean your hands.
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