MOST COMMON INFECTIOUS BACTERIA FROM THE HANDS OF

HEALTH CARE WORKERS IN TERTIARY CARE HOSPITAL.

BY
ABDUL QADEER
2018-GCUF-077837
Research paper required in the partial fulfillment of the requirements for the degree of
BACHELORS IN MEDICAL LABORATORY TECHNOLOGY

DEPARTMENT OF ALLIED HEALTH SCIENCES

CENTER OF ADVANCED STUDIES IN HEALTH AND TECHNOLOGY
An Affiliated Institute of
GOVERNMENT COLLEGE UNIVERSITY, FAISALABAD

September 2022

Center of Advanced Studies in Health and Technology, Rawalpindi.

Affiliated with
1
 GOVERNMENT COLLEGE UNIVERSITY FAISALABAD

CERTIFICATE BY SUPERVISORY COMMITTEE

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GCUF-077837 in partial fulfillment of the requirement for the award of degree B.Sc. (Hons) in
Medical Laboratory Technology to Government College University Faisalabad, is a record of candidate
own work carried out by his under our supervision. The matter embedded in this research is original and
has not been submitted for the award of any other degree of this level.

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2
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We recommend it be processed for evaluation by the external examiner for the award of the degree.

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3
 DECLARATION

The work reported in this thesis was carried out by me under the supervision of Ms. Amaila Qaisar
Department of Allied Health Sciences, at Centre of Advanced Studies in Health and Technology, an
affiliated institute of Government of College University Faisalabad.
I hereby declare that the title of thesis Most common infectious bacteria from the hands of workers in
tertiary care Hospital and the contents of thesis are the product of my own research and no part has
been copied from any published source (except the references, standard mathematical or genetic
models /equations /formulas /protocols etc). I further declare that this work has not been submitted for
award of any other degree /diploma. The University may take action if the information provided is
found inaccurate at any stage.

4
 Dedicated to

MY INSPIRING PARENTS ESPECIALLY TO MY MOTHER, MY SIBLINGS HAFIZ

MUHAMMAD TOUQEER, Dr. QURAT-UL-AIN, MUHAMMAD SIRAJ MUNIR, NOOR-UL-
AIN & HASSAN RAZA & MY UNCLE MALIK ABID HUSSAIN FOR THEIR ENDLESS LOVE,
SUPPORT, AND ENCOURAGEMENT, ROLE MODELS, CATAPULTS, CHEERLEADING
SQUAD, AND SOUNDING BOARDS I HAVE EVER NEEDED.THANK YOU FOR THE
CONFIDENCE YOU HAVE ALWAYS HAD IN ME.

THANK YOU FOR YOUR TREMENDOUS ENCOURAGEMENT, SUPPORT,

AND PRAYERS.

5
 ACKNOWLEDGEMENT

All praise is due to ALLAH, whose is what is in the heavens and what is in the earth, and to
Him is due (all) praise in the hereafter; and He is the Wise, the Aware.
I would like to express my sincere gratitude to my honorable research supervisor, Ms. Amaila
Qaisar. Her expertise, support, guidance, concern and constant efforts helped me throughout my
journey. Her humble and understanding nature was a great emotional support for me. I could not
have imagined having a better supervisor and mentor than her and I certainly cannot thank her
enough for the time and effort she has invested in this thesis.
And, most importantly, I would like to thank my parents for allowing me to realize my own
potential. All the support they have provided me over the years is the greatest gift anyone has ever
given me. My journey would not have been possible without their unparalleled love and support and
I dedicate this milestone to them.

TABLE OF CONTENTS
6
CHAPTER NUMBER TOPICS PAGE NO

Chap #01 INTRODUCTION 12

Chap#02 LITERATURE REVIEW 15

Chap#03 MATERIALS AND METHOD 19

STUDY DESIGN 20

STUDY DURATION 20

STUDY SITE AND SETTING 20

SAMPLE SIZE 20

SELECTION CRITERIA 20

SAMPLING TECHNIQUE 21

DETECTION OF BACTERIA 21

IDENTIFICATION OF BACTERIA 21

RESULTS 27

Chap#04 DISCUSSION 31

Chap#05 CONCLUSION 35

REFERENCES 37

TABLE OF ABBREVIATION

7
SERIAL NO ABBREVIATION FULL NAME

1 HCPs Health Care providers

2 HCW Health care worker

3 NHCW Non-health care worker

4 HO House officer

5 MO Medical officer

6 ICU Intensive care unit

7 HAIs Healthcare-associated

Infections

8 NIs Nosocomial infections

9 CONS Coagulase negative

staphylococcus aureus

10 MRSA Methicillin-resistant

staphylococcus aureus

11 MSSA Methicillin sensitive

staphylococcus aureus

12 NCU Neonate care unit

13 NICU Neonate intensive care unit

LIST OF TABLE

8
 Serial no. Tables Page no.

01 Gender wise distribution 27

02 Sample wise distribution 28

03 Distribution of microorganisms isolated 29

from The Hands of health care workers

in a tertiary care

Hospital

ABSTRACT

9
Background

Careful hand hygiene of healthcare workers is recommended to reduce the transmission of

pathogenic microorganisms to patients. Hands are used during work shifts may act as vehicles

for pathogens.

Objective

To assess the colonization rate of healthcare workers' Hands.

Methods

A prospective observational study was conducted in THQ JATOI, District Muzaffargarh.

Healthcare workers include doctors, nurses, and healthcare assistants. Samples from both Hands

of HCWs are taken for microbiology during work shifts. Samples were taken with a swab in a

standardized modality.

RESULTS

90 healthcare workers and 10 medical students in the final year participated in the study. One

hundred swabs samples were taken from each participant. 92% HCWs’ hands were positive for

bacteria. The overall prevalence of Hands contaminated bacteria was 92%, Staphylococcus

aureus (32%), MRSA

(28%), E. coli (12%), Proteus (10%) Klebsiella species (06%) and Pseudomonas aeruginosa

(04%) respectively.

CONCLUSION

10
This study reveals the contamination of HCWs’ Hands by potential pathogens in our hospital.

Hands are potential vectors that may lead to cross-contamination between HCWs, patients, and

the community. Hand sanitization and washing are important components to include in hospital

infection control and prevention.

Keywords: Potential pathogens; Microbiological colonization; HCWs’ Hands

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Chapter 1
INTRODUCTION

12
 INTRODUCTION

Infection transmission through contaminated hands of health care workers (HCW) is a common

pattern seen in most healthcare settings [1, 2]. Failure to perform appropriate hand hygiene

practices is a leading cause of healthcare-associated infections (HCAI) and the spread of

multiresistant organisms and has been recognized as a significant contributor to outbreaks of

infectious diseases by the World Health Organization (WHO) [3] Hand washing is the first line

of defense and is one of the oldest methods of preventing the spread of disease. Public health

officials pay attention to the Health Care Workers (HCWs) in hospitals and in places related to

human activity by urging people to wash their hands more frequently to fight to occur of

infectious diseases. In terms of definition, hand washing is a process of hand cleaning using

water and/or soap for physically or mechanically removing bacterial pathogens, dirt, and organic

material [4]

Researchers reported different kinds of isolated microorganisms from the surface of Hands. In

some cases, those microorganisms belong to the normal skin flora, but researchers have also

isolated and given special attention to microorganisms that can cause nosocomial infections

(5-6). those infections are increasing day by day and are causing increased morbidity and

mortality in hospitalized patients. Not only do they affect the general patients’ health but they are

also a huge financial burden (7). The presence of nosocomial microorganisms is one of the main

problems in the intensive care unit (ICU) today as well.

13
Hands must be washed with soap and running water after handling chemicals, biohazardous

materials, or animals, before leaving the laboratory; and before eating. In most situations,

thorough washing of hands with ordinary soap and water is sufficient to decontaminate them, but

the use of germicidal soaps is recommended in high-risk situations [8, 9]. Alcohol-based hand

rubs should be used to decontaminate lightly soiled hands when proper hand washing is not

available.

Nevertheless, medical students, who are participating in the work of the clinic, could also

transmit microorganisms-potential causes of nosocomial infections through their hands maybe

even more often (10).

This study aimed to determine the presence (species) of microorganisms in the hands of health

care workers and medical students, to investigate their awareness of the presence of

microorganisms and the way of cleaning their Hands, as well as to find the frequency of

microorganisms isolated.

14
 Chapter 02
REVIEW OF LITERATURE

15
REVIEW OF LITERATURE

HCWs’ hands could play an important role in the transmission of microorganisms from HCWs to

patients. Hand hygiene and reduction of environmental contamination are essential to control

microbe transmission. Health care professionals’ hands can be easily and quickly contaminated

by microorganisms from the hospital environment, patients, and medical devices since they use

them for a medical dictionary, hand reference for drug, laboratory, and imaging results, and other

work-related issues as they deal with patients having different illnesses [11, 12 and 13]. Health

care professionals constantly handle mobile phones without disinfection in their bags and

pockets or on their hands in a clinical setup.

BACTERIAL CONTAMINATION ON HCWs’ HAND

There are some reports which indicate that giving low emphasis on regular disinfection of hands

and poor hand washing practices by health professionals predispose their and other individuals’

Hands to the colonization of bacteria [14, 15]. A study in the US revealed more than 80% of the

common bacteria that make up our bacterial “contamination” end in HCW’s hands [19]. A total

of 56 studies were included (from 24 countries). Most studies identified the presence of bacteria

(54/56), while 16 studies reported the presence of fungi. One study focused solely on

16
RNA viruses. Staphylococcus aureus and Coagulase-Negative Staphylococci were the most

numerous identified organisms present on hand. These two species and Escherichia coli were

present in over a third of studies both in Hospital settings and community samples.

Methicillinresistant S. aureus, Acinetobacter sp., and Bacillus sp. were present in over a third of

the studies in Hospital settings.

The NI affects vast numbers of patients globally, significantly raising mortality rates and

financial losses. In high-income countries, the incidence is high enough, between 3.5% and 12%,

while in middle and low-income countries (LMICs), such as Palestine, it varies from 5.7% to

19.1% [13].

I caused by multidrug-resistant bacteria are a growing problem in many healthcare institutions

[16]. Instruments, hands, MPs, and other inanimate hospital objects used by the HCW may serve

as vehicles and reservoirs for the NIs. However, the incidence of such infections can be reduced

by maintaining proper hygiene between the HCW and the hospital environment [17, 18, and 19].

Health care workers of ICUs are expected ion to do hand hygiene before and after providing

Health Care facilities. Multidrug-resistant microorganism causing hospital-acquired infection is a

growing concern in many healthcare institutions. The burden of nosocomial infection rises and

poses a greater risk of increased mortality and morbidity among the patients.

M are used without restriction in healthcare facilities regardless of their microbial load.

Attempting to avoid NIs, it is worth studying and identifying pathogens on Hands to improve the

quality of healthcare. Hands’ potential to become a nosocomial infection source has been studied

before [6]. Studies that investigated the contamination of clinicians’ Hands in developed

countries, like the USA and the UK, reported a level of overall Hands contamination (pathogenic

and non-pathogenic organisms) ranging from 75 % to 96 % [5,8,10]. The most common isolated

17
organisms were coagulase-negative staphylococci (CoNS) and Micrococcus; while between 9 %

And 25 % of Hands were contaminated by other pathogenic bacteria known to cause has,

including methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA &

MRSA), and Pseudomonas species [25, 26]. In addition, studies in healthcare settings in

developing countries, including India, Nigeria, and Turkey, demonstrated that 42 % to 97 % of

clinicians’ hands are contaminated. Cons were the most common isolated organisms; while other

microorganisms Escherichia coli, Acinetobacter species, Pseudomonas species, and MRSA,

were isolated from 8 % to 31 % of the clinicians’ Hands. [20, 21, 22].

Few studies have investigated the contamination of clinicians’ hands in the Middle East. In Saudi

Arabia, Various studies in healthcare settings, including wards and ICUs, have shown that

43.6 % to 96.5 % of Hands were contaminated by bacteria or other microorganisms. The most

common isolated organisms were also CoNS but 8 % to 14 % of the clinicians’ Hands harbored

other organisms known to cause HAIs, including Staphylococcus aureus, Enterococcus, and

Gram-negative bacilli [23-24]. In Kuwait, only one small study in one hospital has attempted to

describe the contamination of clinicians' Hands. This study examined the bacterial profile of 84

Hands belonging to 84 conveniently selected clinicians in various wards and did not focus on

settings with vulnerable patients for infections, such as patients in ICUs and NICUs [25]. In this

study, we aimed to investigate the prevalence of contamination of HCWs Hands in ICUs, PICUs,

and NICUs, describe the microbiological profile of contaminated Hands in our setup.

INFECTION CONTROL PRACTICES

The infection control practices and simple measures such as proper hand hygiene practice and

regular decontamination and cleaning of Hands with alcohol-containing disinfectant (70%

18
isopropyl alcohol) may reduce the risk of hospital-acquired infection caused by these devices.

There is an urgent need to educate and stress awareness among the HCWs about the potential

role of hands in the transmission of infectious agents in and outside the hospital. The infection

control committee can step forward to make clear-cut guidelines regarding Hand Hygiene in

healthcare setup. There is a need to use Hands with protective material against bacterial

contamination.

19
 CHAPTER 03
MATERIALS AND METHODS

20
 MATERIALS AND METHODS

STUDY DESIGN:

Descriptive cross-sectional study

STUDY DURATION:

Two months after the approval of the research proposal.

STUDY SITE AND SETTING:

Tehsil Head Quarter District Muzaffargarh

SAMPLE SIZE:

A total of 100 samples from both Hands of Health Care Professionals are taken.

SELECTION CRITERIA

INCLUSION CRITERIA:

• HCWs were physicians, residents in training, nurses, and any other person who has a

hospital position as lab technicians and radiology staff.

EXCLUSION CRITERIA:

• We excluded people who clean their hands at the time of analysis and those who cleaned their hands

once they heard about our study, and those whose hands were contaminated by our hands during

sample collection were also excluded.

• Hands of diseased persons and non-healthcare professionals were excluded.

21
 SAMPLING TECHNIQUE:

• A consecutive random sample was collected from the random participant’s Hands during or
after shift Work.
• Hands samples were collected by rolling sterile cotton swabs on both hands.
• Sterilized cotton swab moisten by sterile normal saline was rotated to swipe from hands.
• The Hands swab was placed immediately into sterile normal saline in a sterile container And
transported to the Microbiology laboratory.

ISOLATION AND IDENTIFICATION OF BACTERIA

The steps followed were:

• Hundred samples were collected from the Hands of health care professionals and medical
students of Tehsil Head Quarter Jatoi District Muzaffargarh.
• Each sterile swab was moistened with sterile saline and then the swab was rotated on
both sides of the Hands.
• After collection, swabs were immediately inoculated into brain heart infusion broth and
incubated aerobically at 35C for 24 hours (4) and further sub-cultured on MacConkey
agar, blood agar and incubated at 35C for 24 hours.
• All agar plates were observed for growth and colony morphology.

• After incubation time was over, colonies that grew on plated media were subculture to
obtain a pure culture from each isolated type of colony. Microorganisms were further
identified by Gram stain and biochemical tests.

22
 SWAB METHOD FROM HANDS

GRAM STAINING

Gram staining is a bacteriological laboratory technique used to differentiate bacterial species into

Two large groups (gram-positive and gram-negative) based on the physical properties of their cell

Walls. Gram-positive bacteria have a thick mesh-like cell wall made of peptidoglycan (50–90% of
cell envelope), and as a result are stained purple by crystal violet, whereas gram-negative

bacteria have a thinner layer (10% of cell envelope), so do not retain the purple stain and are

counterstained pink by safranin.

23
An evenly spread smear of the specimen was prepared on the slide. The slide was allowed to

airdry in a safe place and stained by the Gram technique. Smear was examined under a

microscope using 100x.

DISK DIFFUSION TEST

Disk diffusion testing is widely used to detect methicillin resistance in staphylococci, and

cefoxitin is currently considered the best marker for mecA-mediated methicillin resistance.

This test is performed by disc diffusion method using Mueller Hinton agar and after 18-24 hours

incubation at 35C final sensitivity result is recorded as per the latest CLSI 2021 (clinical

laboratory standard guideline.

Cefoxitin zone diameters according to CLSI guideline 2021 are given as

➢ Zone diameter for MRSA < 21mm ➢ Zone

diameter for MSSA = 21 mm or > 21mm.

24
 CATALASE TEST

This test is used to differentiate those bacteria that produce enzyme catalase, such as

staphylococci, from non-catalase-producing bacteria such as streptococci.

25
 CITRATE TEST

This test is used to assist in the identification of enterobacter. This test is based on the ability of

an organism to use citrate as its only source of carbon.

A positive citrate test reaction is obtained with Klebsiella on pneumonia and a negative reaction

in Escherichia coli. The bright blue color will indicate a positive citrate test. No change in color

of the medium indicates a negative citrate test.

26
 OXIDASE TEST

The oxidase test is used to assist in the identification of Pseudomonas, Neisseria, Vibrio, and

Pasteurella, all of which produce cytochrome oxidase.

A piece of filter paper is soaked with a few drops of oxidase reagent. A colony of the test

organism is then smeared on the filter paper. When the organism is oxidase-producing, the

phenylenediamine in the reagent will be oxidized to a deep purple color.

27
Finally, based on the mentioned adapted identification scheme, isolated microbes were grouped

for data analysis.

RESULTS

The present work was conducted on 100 samples of hands from medical students and HCWs at

Tehsil Head Quarter Jatoi District Muzaffargarh.55 males and 45 females were included in this
study as shown in table 01

Gender Number Percentage

Male 55 55%

Female 45 45%

Total 100 100%

GENDER

28
 55%
45%

MALE FEMALE

100 HCWs hands were randomly selected from each of the hospital departments: Radiology,
laboratory, Dialysis unit and Medical Units. This study enrolled the Hands contamination of 15 house
officers,15 medical Officers, 15 nurses, 15 laboratory technologists, 10 phlebotomists, 10 medical
students And 20 from HCWS working in ICU as shown in table 02.

HCWs Total Sample Positive Sample Negative Sample

Hos 15 15 0

MOS 15 15 0

Nurses 15 12 3

Medical Students 10 6 4

Laboratory 15 15 0

Technologist

ICU workers 20 20 0

29
 Phlebotomist 10 9 1

TABLE 03:-DISTRIBUTION OF MICROORGANISMS ISOLATED FROM

THE HANDS SAMPLES OF HEALTH CARE WORKERS (n=100=TABLE 03:-

DISTRIBUTION OF MICROORGANISMS ISOLATED FROM THE HANDS
SAMPLES OF HEALTH CARE WORKERS (n=100)

Microorganis House Medica Nurse Lab ICU Medical Phlebotomis Total

m l s t perce
Officer Technologis Worker Student n tage
s Officer t s s s
s

Staphylococcus 5 4 7 4 7 1 4 32

Aureus (15.6%) (12.5%) (21.8%) (12.5%) (21.8%) (3.12%) (12.5%) (32%)

MRSA 4 6 3 6 5 2 2 28

(14.2%) (21.4%) (10.7%) (21.4%) (17.8%) (7.14%) (7.14%) (28%)

Escherichia Coli 1 1 0 2 3 2 2 12

(8.3%) (8.3%) (0%) (16.6%) (25%) (16.6%) (16.6%) (12%)

30
Proteus spp. 2 2 1 2 1 1 1 10

(20%) (20%) (10%) (20%) (10%) (10%) (10%) (10%)

Klebsiella 2 1 0 1 2 0 0 06

(33.3%) (16.6%) (0%) (16.6%) (33.3%) (0%) (0%) (6%)

Pseudomonas 1 1 0 0 2 0 0 04

(25%) (25%) (0%) (0%) (50%) (0%) (0%) (4%)

Total 15 15 12 15 20 06 09 92

(92%)

8%
10% Staph auerus
32% MRSA

10% E. Coli
Proteus Spp.
Klebsiella
12%
Psuedomonas.
28%

PIE CHART DISTRIBUTION OF ISOLATED MICROORGANISMS FROM THE

HANDS SAMPLES OF HCWs AND MEDICAL STUDENTS.

31
CHAPTER 04
DISCUSSION

32
 DISCUSSION

This study aimed to investigate the bacterial contamination of the Hands of HCWs at THQ Jatoi.

The study found that the Hands of HCWs generally harbor several bacterial organisms, and

therefore represent a potential threat to the transmission of HAIs. The potential for transmission

of healthcare-associated pathogens via Hands and electronic devices (e.g. personal digital

assistants, handheld computers, and bedside applications) has been reported previously.

This study showed that the rate of bacterial contamination of the Hands of HCWs was 92%.

Comparable results have been reported from other studies conducted in India (south and

southwestern regions) [31, 32], Ethiopia [41, 42], Egypt [10], Turkey [09], and Nepal [08], in

which the number of contaminated hand ranged between 70% and 100%. However, other studies

conducted in Ethiopia and the western region of India reported lower contamination levels of

30% and 62%, respectively [35,36]. The differences in contamination levels may be attributed to

differences in geographical locations, methods used, sample sizes, and hand handling and

hygiene practices of the sampled populations.

33
The most common bacterial hand contaminants isolated in this Staphylococcus aureus and

coagulase –ve Staphylococcus epidermidis. This finding was in agreement with studies

conducted in different parts of the world, which reported CoNS to be the predominant HCWs’

hand contaminant (although with different isolation rates) In the present study, CoNS isolates

were lower (50%) compared with reports from Italy (97%) [05], Iran (82.4%) [09] Saudi Arabia

(60.5%) [07] and Ethiopia (58.8%) [2], and higher compared

With reports from India (30.5%) [05], Ethiopia (37.1%) and Nigeria (42.9%) [40]. CoNS are

normal skin flora and are relatively harmless in otherwise healthy individuals. However, they

have been implicated in several HAIs, such as bacteremia in immuno-compromised patients,

neonates,

And surgical wound infections in patients with implanted valve prosthetic devices and catheters [38].

Additionally, CoNS have been shown to resist drying (they can remain viable for months on

inanimate surfaces) and can multiply rapidly in warm environments [36]. The isolation rate of S.

aureus (32%) from the Hands of HCWs was in line with other studies conducted in India and

Ethiopia, which reported rates of 29.5%. A previous study on the hand and nasal carriage of S.

aureus at the THQ Jatoi, District Muzaffargarh found an overall carriage rate of 17.1%. Carriers

serve as a source of infection to themselves and others; for example, by direct contact or by

contamination. S. aureus is one of the most common causes of HAIs, often of Wounds (surgical)

or bacteremia associated with catheters. Among the least isolated bacterial organisms in this

study were E. coli (12%), Pseudomonas spp. (04%), Klebsiella sp. (06%)

And Proteus sp. (10%). The presence of E. coli suggests fecal contamination (a direct indicator

That other Enterobacterales could be carried on Hands) as shown by the presence of Klebsiella

sp. in this study. IN this study, bacterial contamination of Hands was not influenced by

profession, age group, gender, Hand disinfection, or work area. This finding supports other
34
studies which found no significant correlation between hand contamination and other variables

such as gender, age, use of hands in the work area, disinfection practices, and restrictions the

present study found no significant.

Difference between bacterial colonization of Hands disinfection, several studies have reported a

positive association between these two factors. The difference could be attributed to the lack of

standardized guidelines regarding Hands disinfection in healthcare

Settings, leading to improper disinfection of Hands, as well as the reliability of participants'

responses. The reason for these high contamination rates among HCWs is believed to be the

unconscious handling devices while providing health care services. (33) Also, there is a lack of

awareness about nosocomial infections and the lack of awareness about contamination of Hands

by infectious microorganisms among HCWs. (39) Although HCWs endeavor to comply with

hand hygiene in hospitals, as we found in this study, many of them never clean their Hand

through detergents. Consequently, we believe that these devices may become vectors for

nosocomial pathogens. Unfortunately, HCWs are not conscious of this potential threat,

especially in developing countries. (40) This study reveals that all HCWs’ Hands are frequently

used in the hospital by other individuals, especially family members. Currently, Children and

other individuals who use HCWs’ Hands may be colonized or infected by nosocomial pathogens.

(37) Unfortunately, no guidelines exist telling HCWs how to mitigate the risk of microbial

contamination of their hands in developing and developed countries. Health institutions should

encourage efforts to prepare such guidelines. (32) Restriction of the use of handshaking and

proper sops in the clinical setting, regularly cleaning of these devices with wipes containing

antiseptics such as 0.5% chlorhexidine–70% isopropyl alcohol, and strict hand hygiene before

35
and after the patient work may offer a solution. (34) Furthermore, recommendations to prevent

the cross-contamination of Hands should be developed and added to hospital infection control

36
CHAPTER 05
CONCLUSION

37
 CONCLUSION AND RECOMMENDATION

This study reveals the contamination of HCWs’ Hands by potential Pathogens in our hospital.
The HCW were found to have potential pathogens on their hands most common of which was
Gram Positive Staphylococcus aureus (32%) out of which MRSA (28%) is a resistant pathogen
Causing known Nosocomial infection in hospital setting.

It is better to develop and implement hand washing guidelines in the hospital. The use of

devices that are not so important for patient care and cause the transmission of pathogens like

cell phones by HCWs should be limited or banned in the clinical setting, ICUs, laboratories,

and places that have a high risk for contamination with their hands and potential pathogens in

hospitals. Periodic cleaning of hands either by hand rubbing as well as frequent hand-washing

should be encouraged as a means of curtailing any potential disease transmission. The study

recommends that frequent and proper hand washing techniques should be adopted so that

HCW would not contaminated with Nosocomial infection in hospital setting.

38
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