Hand Hygiene and the Gram Technique - Lab Report Example

HAND HYGIENE AND THE GRAM TECHNIQUE; APPLICATION IN CHIROPRACTIC PROFESSION Student name: Registration number: Module code: Module title: Tutor: Date of submission: INTRODUCTION Since time immemorial, man has sought to establish various ways of identifying different kinds of microorganisms. In 1883, Christian Joachim Gram, a Danish microbiologist, first introduced the technique that is named after him. The method is used globally to differentiate between gram positive and gram negative bacteria by the variations in their cell walls. Due to the thick layers of peptidoglycans on the surfaces of gram-positive bacteria, the counterstain in the gram test does not penetrate, and it retains the colour of the first stain, crystal violet that is purple. In the current world, the technique is used to establish the critical differences in the two types of bacteria. Determining their characteristics helps researchers and scientists to know the virulence of microbes, as Gram-negative bacteria are more resistant to antibiotic treatments. Mainly, the antibiotics can not penetrate the cell walls of the gram-negative bacteria, and their efficacy is limited to them. There exists credible evidence that hand hygiene is one of the greatest determinants of cross-infections in clinical health (Mathur, 2011, Patrick, et al. 1997, Ellingson et al. 2014). Healthcare-associated infections (HCAIs ) have shown that a lot of care needs to be taken when handling patients. Although there are myriad ways of preventing cross-infections, hand hygiene is the least costly and among the most effective ways (Mathur, 2011). Moisture on the surfaces of the hand increase the probability that hands will transmit diseases, and hands should be dried after washing to reduce the probability of disease transmission (Patrick et al 1997). Strict and emphatic stress on washing hands has proven that a broad range of Microorganisms can be done away within healthcare facilities. Clinicians and health practitioners should wash their hands with antimicrobial soaps before handling medicine and touching the patients (Ellingson et al. 2014). The first major attempt at doing away with the transmission of diseases through hands was in 2005, and it was emphasised in 2009 by the World Health Organization (Mathai et al., 2010). Though hands hold a lot of microbes from the everyday activities carried out, there are some products designed to take care of the hand hygiene (Mathai et al., 2010). Washing hands, therefore, plays a great role in preventing some infections from hospitals, clinics and other Chiropractic service providers. Knowledge of how to prevent the infections of patients from the hands of medical personnel is therefore critical. The practical aims to show what a large number and diversity of bacteria are inoculated from dirty hands, hands washed with water only and also hands washed with soap. Hand hygiene is one of the minimum requirements of a health practitioner. To prevent and lower the cases of the rampant clinical infections, it is imperative that the highest level of hygiene is observed in the hospitals, in particular by those who treat the patients or those who come into contact with the foods used by patients. The use of soap and several recommended disinfectants is one of the methods of reducing bacterial translocation using hands (Patrick et al. 1997).This is not only critical to the health of patient but it also to the chiro practitioner's themselves. This useful had collected data from students within the class and used the gram technique to analyse the types of microorganisms likely to be found existing in the hands of clinicians or any other person. We seek to answer; are hands carriers of bacteria? OBJECTIVES 1. To have better skills in the gram staining procedure 2. To have comprehensive knowledge on how the biochemical properties of bacteria affect their reaction to gram staining 3. To determine the effects of poor hand hygiene to health and everyday life 4. Familiarise with the gram staining technique 5. To understand the effects of soaps and detergents in inhibiting bacterial growth 6. To know the great varieties of bacteria carried by human hands in the course of their interactions MATERIALS AND REAGENTS (REQUIREMENTS) Activity 1 Nutrient agar plates Water Soap Incubator RESULTS (Activity 1) Type of bacterial inoculum Time used washing hands (seconds) Pre-wash count colonies Post-wash count colonies Unwashed hands 5 ˃40 N/A 5 ˃20 N/A 5 13 N/A 5 5 N/A 5 9 N/A 5 17 N/A 5 33 N/A Hands washed with water only 5 ˃40 27 5 ˃20 17 5 13 16 5 5 4 5 9 6 5 17 8 5 33 30 Hands washed with water and soap 10 31 21 5 100 15 10 35 23 10 10 11 5 35 1 10 1 13 15 5 6 15 16 32 4 17 5 5 45 32 5 30 ˃100 10 23 0 15 4 3 15 ˃60 ˃50 10 6 1 15 22 5 10 34 5 Activity 2 Crystal violet (primary stain) Safranin (counter stain) Gram’s Iodine (Mordant) 95% ethanol (decolorizer) Microscope Microscope slides Oil immersion Staining rack Filter papers Bunsen burner or spirit lamp Cotton Bacterial cultures were grown on Nutrient Agar Soap Wire loop RESULTS (Activity 2) Bacterial inoculum color shape Gram positive or negative Colony size (millimetres) Unwashed hands Purple Pinkish-red Bacillus Coccus Cocci Positive Positive negative 2mm 3mm Hands washed with water only purple Bacillus Cocci Diplococci Positive Positive positive 9mm 1mm Red Cocci Clustered Cocci Negative Negative 2mm 2mm Hands washed with soaped water Pinkish-red Dark purple Red Cocci Cocci Rods Bacillus Cocci Negative Positive positive negative negative 3mm 9mm 2mm 1mm 1mm DISCUSSION In this study, we focused on the types of bacteria likely to be found on the hands of health practitioners as they offer treatment to their patients. In the first activity, we sought to establish the fact that clean as they may seem, the human hands are covered by layers upon layers of bacteria, and possibly other microorganisms. The macro biology of the first practical (inoculating bacteria) showed that many microbes are being transferred by the human body as they carry out their day to day activities. About healthcare, it has been shown, by this practical, that unless aseptic techniques are employed in treatment, patients may go home with other illnesses after the primary one is gone. The second activity narrows down to an inquest into the types of bacteria. Crystal violet dye is used because of the positive charges that enable it to bind to the negative charges on the surfaces of bacterial walls, caused by Teichoic acid. Gram’s iodine is used as a mordant to form a complex between Crystal violet and Iodine, allowing it to stick to the walls of the bacteria in the smear. 95% ethanol/alcohol is used as a decolorizer. It also functions to destroy the outer membranes of the Gram-negative bacteria, exposing the peptidoglycan layers. Technically, the alcohol interacts with the walls of both types of bacteria. Alcohol washes off the Crystal Violet Iodine complex from the walls of gram-negative bacteria, decolourising the walls. On the other hand, alcohol dehydrates the peptidoglycan layers in gram-positive bacteria, allowing them to absorb the complex, and enabling them to retain the purple colour of the original stain. The gram-negative bacteria keep the colour of the counterstain, Safranin, because they do not have any other colour deep within the peptidoglycan layer. The oil immersion value, ×100, is used because it contains more lenses than any other magnification. Because of the oil used, it allows observation to be very clear. There were, however, some errors in the experiment because of cracked Petri plates and other incongruences that could allow some other microorganisms to be in contact with the test microbes. Therefore the likelihood of contamination in the plates that fetched lower or higher than expected can not be ruled out entirely. An inquest into the efficacy of soaps as compared to designated hand sanitizers has proven that washing hands physically deals with dirt and does nothing much to the microbial cells coating the surfaces of hands. Use of sanitizers, therefore, has emerged as the most effective method of washing hands. In the absence of both water and soap, the alcohol content in the sanitizer is known to disrupt the infective coatings on viruses and bacteria. Furthermore, this efficacy is achieved within a shorter time (30 seconds). An experiment conducted in 2011 proved that Enterococcus and Enterobacter species of bacteria have a presence in the three categories of our study in unwashed hands, their presence was 44%, 23% in hands washed with plain water and 8% in hands washed with antibacterial soaps (Maxine et al. 2011). CONCLUSION From the two activities that constituted this experiment, it is apparent that hands are potential carriers of many types of bacteria. If anything, it has emerged that they carry more than is expected. Unwashed hands showed the highest number of bacteria. Washing hands with water only has no significant difference as the numbers remained relatively the same. However, it is evident that washing hands with soap removes substantial amounts of bacteria. As the results show, plates, where inoculation was done after washing hands with soap, have low levels numbers of colonies. Most of these colonies, after the gram test, are observed to be gram negative. This is because most gram-negative bacteria are resistant to disinfectants and antibiotics. The efficiency of this practical could be minimised by the use of aseptic techniques such as working near the flame to reduce the chances of contamination. Studies in the recent past have revealed that hands are the easiest routes through which pathogens are transmitted. Pathogens enter through the fecal-oral route, beginning from contact with the hands. As such, hand-washing is one of the easiest methods of preventing the transmission of diseases from hospital personnel to the patients, or even among the patients. Patients who do not wash their hands are more prone to diseases like dysentery as compared to those who strictly follow hand-washing guidelines. This practical focused on three main aspects of hand-washing, and soap proved to be among the substances that could be used to reduce the harshness of bacterial transmission in the chiropractic profession. However, more accurate studies are not devoid of the fact that some soaps are not effective antibacterial agents. In conclusion, it is worth noting that monitoring hand-washing tendencies could be the most difficult aspect of chiropractic. This is as a result of the fact that most people, including medical personnel, will tend to change their practices when they are under observation. These should be strict guidelines as to why hands should be washed, with a set-out methodology of doing the same. This practical has explored the fact that hands hold a substantive amount of bacteria that can be eliminated using effective methods such as washing with soap and sanitizers. References  Erasmus, V., Daha, T., Brug, H., et al. (2010). A systematic review of studies on compliance with hand hygiene guideline in hospital care. Journal of Infection Control and Hospital Epidemiology, Volume 31 issue no. 3.  [Accessed on May 12, 2017]. Available from https://www.ncbi.nlm.nih.gov/pubmed/20088678  Mathai, E., Allegranzi, B., Kipatrick, C., & Pittet, D. (2010). Prevention and control of healthcare-associated infections through improved hand hygiene. Indian Journal of Medical Microbiology, volume 28, issue no. 2. [Accessed on May 18, 2017]. Available from https://www.ncbi.nlm.nih.gov/pubmed/20404452 Mathur, P. (2011). Hand hygiene: Back to the basics of infection control. The Indian Journal of Medical Research,  volume 134, issue number 5, 611–620. Accessed on May 12, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/ Maxine, B., Emma, C., Peter, D., Gaby, J., Val, C., and Wolf-Peter, S. (2011). The Effect of Handwashing with Water or Soap on Bacterial Contamination of Hands. Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine. International Journal of Environmental Research and Public Health, Volume 8 pp 97-104. [Accessed May 22, 2017]. Available from https://spiral.imperial.ac.uk/bitstream/10044/1/41260/2/ijerph-08-00097.pdf Patrick, D., Findon, G., & Miller, T. (1997). Residual moisture determines the level of touch-contact associated bacterial transfer following hand-washing. Journal of Epidemiology and Infections, volume 119, pp 319-325. Cambridge University Press. [Accessed May 27, 2017]. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809004/pdf/9440435.pdf Ellingson, K., Haas, J., Aiello, A., Kusek, L., Maragakis, L., Olmsted, R., Yokoe, D., et al. (2014). Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. Journal of Infection Control and Hospital Epidemiology, volume 35, issue no. 8, pp 937-960. [Accessed May 27, 2017]. Available from http://www.jstor.org/stable/10.1086/677145 . Read More