CHAPTER ONE
INTRODUCTION
The
palm (volar) which is the central region of the anterior part of the hand,
located superficially to the metacarpus. The skin in this area contains dermal
papillae to increase friction, such as are also present on the fingers and used
for finger prints (Lidwell, 2012).
The
opisthenar area (dorsal) is the corresponding to the bases of the metacarpal
bones, located in the proximal part of the palm. It is the area that sustains
most pressure when using the palm of the hand for support, such as in hand
stand (Torben, 2011).
There
are five digits attached to the hand. The four fingers can be folded over the
palm which allows the grasping of objects. Each finger, starting with the one
closest to the thumb; has a colloquial name to distinguish it from the others:
i.
The index finger ,
pointer finger, fore finger or second digit
ii.
The middle finger or
long finger or third digit
iii.
The little finger,
pinky finger, small finger or fifth digit (Stuart et al., 2010).
The
thumb (connected to the first metacarpal bone and trapezium) is located on one
of the sides, parallel to the arm. A reliable way of identifying human hands is
from the presence of opposable thumbs. Opposable thumbs are identified by the
ability to be brought opposite to the fingers, a muscle action known as opposition
(Hardy et al., 2011).
The
skeleton of the human hand consists of 27 bones: the eight short carpal bones
of the wrist are organized into a proximal row (scaphoid, umate, triquetral and
pisiform) which articulates with the bones of the forearm, a distal row
(trapezium, traphoid, capitate and hamate), which articulate with the hand. The
bases of the five metacarpal bones of the hand. The heads of the metacarpals
will each in turn articulate with the bases of the proximal phalanx of the
fingers and the metacarpophalangeal joints known as the knuckles. The fourteen
phalanges make up the fingers and thumb, and are numbered I-V (thumb to little
finger) when the hand is viewed from an anatomical position (palm up). The four
fingers each consist of three phalanx bones: proximal, middle, and distal
phalanx.
Together
with the phalanges of the fingers and thumb these metacarpal bones from five
rays or poly- articulated chains.
There
are numerous sesamoid bones in the hand, small ossified nodes embedded in tendons;
the exact number varies between people, whereas a pair of sesamoid bones is
found at virtually all thumb metacarpophalangeal joint of the thumb and at the
metacarpophalangeal joints, sesamoid bones are also common at the
interphalangeal joint of the thumb and the index finger. In rare cases,
sesamoid bones have been found in all the metacarpophalangeal joints and all
distal interphalangeal joints except that of the long finger.
The
articulations are:
i.
Interphalangeal
articulations of hand (the hinge joints between the bones of the digits)
ii.
Metacarpophalangeal
joints (where the digits meet the palm)
iii.
Intercarpal
articulations (where the palm meets the wrist)
iv.
Wrist (may also be
viewed as belonging to the forearm) (Lidwell, 2012).
Microorganisms
are very ubiquitous; they are present on the floor, body, air, toilet etc.
Bacteria being one of the microorganisms around us are among the oldest living
things on earth. Bacteria have been around for about 4 billion years. This
means that the bacteria were the dominating life form on earth for about 3.5
billion years (Popoola, 2011).
Bacteria
exist primarily as a single cell. They are characterized by having a cell wall
outside the cell membrane. The wall provides shape and rigidity to the cells.
Depending on the cell wall structure, bacteria are classified as Gram negative
and Gram positive. The cell wall of a Gram positive cell consists of many
polymer layers of peptidoglycan connected by amino acid bridges. Approximately
90% of Gram positive cell is composed of peptidoglycan. Gram negative bacteria
have a much thinner cell wall which is composed of only 20% peptidoglycan
(Lidwell, 2012).
Many
scientists still believe that bacteria are still the dominant life form. It is
estimated that kg by kg, there are more bacteria on the earth than all other
life forms combined. This includes trees and plants, animals and humans,
insects and fishes (Torben, 2010).
There
are bacteria all over the earth i.e on the land, in the air, in water, in the
soil and deep underground. There are also bacteria on every living human being,
both on the skin and in the guts. In short, life on earth is embedded in
bacterial life (Torben, 2010).
There
are bacteria around that make us sick. These diseases include cholera,
gonorrhoea, leprosy, pneumonia, syphilis, tuberculosis, typhoid fever and
whooping cough. The bacteria enter a human being’s body through its natural
openings such as the nose or mouth, or through breaks in the skin. In addition,
air, food and water carry water carry bacteria from one person to another
(Torben, 2010).
The
reservoir of any organism, which may be animate or inanimate objects, in the
epidemiology of any bacterial disease is very important (Daniel et al., 2012). The pathogens live and or
multiply in the reservoir on which their survival depends. Pathogens live on
fomites. Many epidemiological studies have confirmed that many contaminated
surfaces played a major role in the spread of infectious diseases (Hendley et al., 2012; Noble, 2013). The human
surface tissue (skin) is constantly in contact with the environmental
microorganisms and become readily colonized by certain microbial species. The
adult human is covered with approximately 2m2 of skin, with surface
area supporting about 1012 bacteria (Mackowiak, 2012). The normal microbiota of
the skin include among others; coagulase negative Staphylococci, Diphtheroids, Staphylococcus aureus, Streptococci (various
species), Bacillus spp., Mallassesia furfur
and Candida spp. Others include Mycobacterim
spp. (Occasionally), Pseudomonads and,
Enterobacteriaceae (occasionally)
(Roth and Jenner, 2010). The normal Microbiota is harmless and may be
beneficial in their normal location in the hostin the absence of coincident
abnormalities. They can produce disease condition if introduced into foreign locations
or compromised host (Ekrakene and Igeleke, 2012).
Contamination
of environmental objects and surfaces is a common phenomenon. The presence of
viable pathogenic bacteria on inanimate objects has been reported by earlier
investigators. Several studies of the human environment have demonstrated
colonization and contamination of objects such as door handles, faucets, phone,
money, fabrics and plastics (Bures et al., 2011; Michael et al., 2011; Despina
et al., 2014; Famurewa& David, 2015). People come into daily contact with
all sorts of fomites, with an increasing rate of bacterial infection (Eguia&
Chambers, 2012). Human beings have a marked tendency to pick up microorganisms
from environmental objects and the hand has been shown to play a role in the
transmission of organisms has been reported as a potential vehicle for their
transmission (Neely &Maley, 2010; Gerba, 2010; Famurewa & David, 2012;
Fatma et al; 2010, Fraser & Girling, 2012; Gholamreza et al., 2012).
Furthermore, microorganisms found to contaminate fomites have also been shown
to persist on environmental surfaces for varying periods of time ranging from
hours to months and it has also been illustrated that they can still be
detected and recovered from surfaces after routine conventional cleaning (
French et al., 2011). In addition, cross infection of microorganisms between
environmental surfaces and a host has equally been established (Hardy et al.,
2012). The ability of plastics and other inanimate objects to support viable
microorganisms for a prolonged period of time is well documented (Staurt et
al., 2010) and such environmental surfaces and objects, especially those in
close proximity with persons frequently touched, pose a threat to human health
and are a cause for concern. One such inanimate object in the environment that
is currently in frequent contact with the hands is the interface of a computer
system.
Several
investigations have assessed the degree of microbial contamination and the
types of contaminating organisms on palms (Schultz et al., 2012; Issmat et al.,
2013 Anderson & Palombo, 2013). Some authors have demonstrated such
contamination on the computer keyboard and mouse (Steffen et al., 2012).
Concern has been raised that contact with contaminated computer keyboards might
serve as a mechanism for contaminating the palms with potential pathogens,
leading to cross-contamination of users (Steffen et al., 2010; Anderson & Palombo
2011). One study conducted in a hospital established the fact that the
colonization rate of computer user interfaces was greater than that of other
fomites tested in the hospital (Schultz et al., 2013).
Accordingly,
these may be additional reservoirs for the transmission of microorganisms and
become vehicles for cross contamination. While the contamination of hand has
thus been established, most of the above studies were single-centred, having a
narrow perspective as they either focus on hospital and health care facilities
or were specific to the isolation of a particular microorganism, species or
strain or specific to only one type of interface. In view of these findings,
the growth and detection of opportunistic pathogens on hand shakers, survival
of bacteria on surfaces and a low rate of compliance with good hygiene
practice, it is imperative to examine the extent of bacterial contamination on
palms shakes by different people under everyday conditions and in various types
of institution or organization and to investigate probable sources of high
contamination rates (Schultz et al., 2012).
Palms
are the highways to the transmission and spread of bacteria, pathogens, and
viruses that cause diseases, food-borne illness, and infections resulting from
hospital treatment (nosocomial). Infectious germs on the palms are the most
common ways that people spread infection. This is caused by rubbing their nose
or eyes with their fingers or palms, which have been contaminated with the cold
virus and other bacteria.
Numerous
studies support the finding that hand washing reduces both the carriage of pathogens
on the palms and nosocomial infections (Steere & Mallison, 2012; Cooper et
al., 2013; Rother, 2014). However, several studies have found that hand washing
is poorly practiced outside the healthcare profession, indicating a need in the
community (CDC, 2010).
According
to the Centres for Disease Control (CDC) (2010), hand washing is the simplest,
most effective measure for preventing the spread of bacteria, pathogens, and
viruses. Each with this knowledge, many Americans do not wash their hands. Recent
studies by the American Society for Microbiology (2013) indicate that only 67%
of Americans wash their hands after going to the bathroom, 78% after changing
diaper 77% before handling or eating food. Forty five per cent of Americans
report that they do not wash up after petting an animal, 31% after coughing or
sneezing, and 20% after handling money.
Hand
washing guidelines set by regulatory agencies for hospitals, food preparation,
pre-schools, and day cares have been in place for two decades. However regulation
alone has not successfully changed hand washing behaviours. Several
investigative studies have concluded that adhere to recommended hand hygiene
procedures of healthcare organizations has been unacceptably poor (Pittet,
2010; WHO, 2012). Others studies have determined that the factors affecting
adherence to proper procedures is rooted in individuals behaviour, that hand
cleansing patterns are most likely established in the first 10 years of life ,
and that an individual’s religious and cultural background influences their
perceptions about hand washing (WHO, 2012).
Most
cold and flu viruses are spread because people touch surfaces in their
immediate area and then touch their faces, and other people. The likelihood for
illness to transfer from the habit that people do every day like handshaking is
important (Jawetz et al., 2013).
The
transient microorganisms are organisms that are found on and within the
epidermal layer of the skin as well as other areas of the body where they do
not normally reside. Almost all disease- producing organisms belong to this
category. They are organism that may take advantage of some disturbance in the
normal resident micro flora to gain a foothold and cause infections and
symptoms of disease or illness. Transient microorganisms (bacteria, yeast, molds,
viruses and parasites) can be any type from any source with which the body has
had a contact and are found on the palms or hands, fingertips and under finger
nails. An example of such organisms is Pseudomonas
aeruginosa. The transient flora consists of non-pathogenic or potentially
pathogenic micro organism that inhibits the skin or mucous membranes for hours,
days or weeks. It is derived from the environment; it does not produce disease
and does not establish itself permanently on the surface. Members of the
transient flora are generally of little significance so long as the normal
resident flora is disturbed. Transient microorganisms may colonize, proliferate
and produce disease (Jawetz et al., 2014). Beside bacteria, the skin is also
the home to yeast (candida) and fungi. The proportions of microbes vary over
the body’s skin due to differences in pH, oxygen, water and secretions (Jawetz
et al., 2014).
Health
care associated infections are an important cause of morbidity rate which
measures the number of individuals that become ill due to a specific time
interval. It is am incidence rate and reflects the number of new cases in the
general population. Each year, more than 2 million patients acquire health care
associated infection resulting in 90,000 deaths (CDC, 2012).
Studies
have suggested that hand shaking may contribute to cross contamination because
of the acquisition of transient hand carriage by individuals during contact
with the contaminated surfaces.
The
palms have become reservoirs for pathogens because of the increase in hand
shaking. In similar study carried out by Anderson and Palombo (2009) who
revealed the contamination of palms by microorganisms. He revealed that the
bacteria that were detected on palms were similar to those from the toilets
which are well known causes of human illness.
Wilson
(2012) also showed that some palms may harbor more harmful bacteria than a
toilet seat and serve as carriers of infections agents as he said poor personal
hygiene and uncleanliness could also be the cause.
This
project work was undertaken to ascertain the microbiological assessment of
different palms of students in University of Ilorin metropolis. The bacteria
and the fungi isolated were reported, the occurrence of the bacterial isolates
as well as the fungi were determined and reported. This finding reveals why
hand washing should not be taken for granted.
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