Assessment of handwashing impact on detection of SARS-CoV-2, Staphylococcus aureus, Escherichia coli on hands in rural and urban settings of Côte d’Ivoire during COVID-19 pandemic
Authors: Traoré Sylvain Gnamien , Fokou Gilbert , Wognin Affou Séraphin , Dié Semone Annick Gertrude , Amanzou Nogbou Andetchi Aubin , Heitz-Tokpa Kathrin , Tetchi Sopi Mathilde , Seko Malik Orou , Sanhoun Aimé Roland , Traoré Adjaratou , Anoh Etilé Augustin , Tiembre Issaka , Koussemon-Camara Marina , Akoua-Koffi Chantal , Bonfoh Bassirou 
Published: May 2024

Abstract
Background
Handwashing is the first line of hygiene measures and one of the oldest methods of preventing the spread of infectious diseases. Despite its efficacy in the health system, handwashing is often inadequately practiced by populations. This study aimed to assess the presence of SARS-CoV-2, Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) on hands as indicators of lack of hand hygiene during COVID 19 pandemic.

Methods
A cross-sectional study was conducted in rural Taabo and urban Abidjan (Côte d’Ivoire) from January to September 2021. A total of 384 participants from 384 households were included in the study. The total households were distributed proportionally within various municipalities in the two study areas according to the number of households in each municipality, based on data of the National Institute of Statistics from the 2014 general population census. Hand swabbing of the 384 participants within households (320 in Abidjan and 64 in Taabo) was performed for the enumeration of E. coli and S aureus, using laboratory standard method and for the detection of SARS-CoV-2 by RT-qPCR. A binary logistic regression model was built with the outcome variable presence of Staphylococcus spp. on hands of respondents that was categorized into binary variables, Staphylococcus spp. (1 = presence, 0 = absence) for the Risk Ratio estimation. Place of living, sex, handwashing, education and age group were used to adjust the model to observe the effects of these explanatory variables.

Results
No presence of SARS-CoV-2 virus was detected on the hands of respondents in both sites. However, in urban Abidjan, only Staphylococcus spp. (Coagulase Negative Staphylococci) was found on the hands of 233 (72.8%, 95%CI: 67.7–77.4) respondents with the average load of 0.56 CFU/ Cm2 (95% CI, 0.52–0.60). Meanwhile, in rural Taabo, Staphylococcus spp. (Coagulase Negative Staphylococci) and E. coli were found on the hands of 40 (62.5%, 95%CI: 50.3–73.3) and 7 (10.9%, 95%CI: 5.4–20.9) respondents with the respective average load of 0.49 CFU/ Cm2 (95% CI, 0.39–0.59) and 0.08 CFU/ Cm2 (95% CI, 0.03–0.18). Participants living in rural Taabo were less likely to have Staphylococcus spp. on their hands (RR = 0.811; 95%IC: 0.661–0.995) compared to those living in urban Abidjan.

Conclusions
No SARS-CoV-2 was detected on the hands of participants in both sites, suggesting that our study did not show direct transmission through hands. No E. coli was found in urban Abidjan while E. coli was found on the hands of participants in rural Taabo indicating poor hand washing and disinfection practices in rural Taabo. Living in urban Abidjan is statistically associated to having Staphylococcus spp. on hands. Further studies are necessary especially to understand to what extent the presence of Staphylococcus spp. on hands indicates a higher infection or fecal colonization rates in the case of E. coli.