MICROBIOLOGICAL METHODS FOR ASSESSING HANDWASHING PRACTICE IN HYGIENEBEHAVIOR STUDIES

Personal hygiene, especially handwashing, is frequently mentioned as a n important aspect of diarrhoeal disease prevention in water and sanit ation programmes. Handwashing practice is difficult to assess but the microbiological analysis of hands shows promise as an indicator of thi s behaviour. Most methods for isolating bacteria from the hands have b een developed for use in hospitals in order to investigate the spread of nosocomial infections. However, reliable and inexpensive methods wh ich need only limited expertise are needed for use in developing count ries where diarrhoeal diseases remain a major health risk. Techniques for sampling hands and bacteriological analysis methods are discussed with special emphasis on practical considerations for conducting tests in developing countries. Several studies have used these methods succ essfully and have investigated hygiene behaviour and how living condit ions affect behaviour and the role of hands in diarrhoeal disease tran smission. We recommend the use of impression plates for isolating faec al indicator bacteria from the hands and also recommend faecal strepto cocci as an indicator of faecal contamination.