Evaluation of the impact of antimicrobial hand towels on hand contamination with <em>Escherichia coli</em> among mothers in Kisumu County, Kenya, 2011–2012

Poor hand hygiene contributes to diarrhea in developing countries. Handwashing with soap reduces diarrhea risk, but drying hands on contaminated towels can compromise the benefits of handwashing. In response to the challenge of keeping hands clean, an antimicrobial hand towel was developed and shown to be promising in the laboratory, but has not been adequately tested in the field. We evaluated the effectiveness of an antimicrobial towel in two randomized, double-blinded crossover trials among mothers with children<5 years old in 125 households in western Kenya. In trial 1, we randomly assigned mothers to use either the treated towel or an identical untreated (placebo) towel and made surprise home visits at random times once a week for three weeks. At each visit, we tested hands for Escherichia coli using sterile hand rinses, then switched towel types in the two groups and repeated three weekly rounds of E. coli testing. In crossover trial 2, we compared E. coli contamination of maternal hands immediately following three different handwashing/drying procedures: soap and water + treated towel, water only + treated towel, and soap and water + air dry. There was no statistically significant difference in the level of E. coli contamination on maternal hands by type of towel used during trial 1 (odds ratio for treated vs untreated towel: 1.14, 95% confidence interval 0.83–1.56). In trial 2, there were no significant differences in E. coli contamination of maternal hands by handwashing/drying procedure. In these trials, use of antimicrobial hand towels did not prevent E. coli contamination of mothers’ hands in Kenyan households during random testing and offered no advantages over standard handwashing and drying practices. Handwashing with soap and clean water and drying with clean towels are recommended.

在发展中国家，手部卫生不良会导致腹泻。用肥皂洗手可降低腹泻风险，但用受污染的毛巾擦手会削弱洗手的益处。为应对保持手部清洁这一挑战，一种抗菌毛巾被研发出来，在实验室中显示出良好前景，但尚未在实地进行充分测试。我们在肯尼亚西部125户有5岁以下儿童的母亲中进行了两项随机、双盲交叉试验，以评估一种抗菌毛巾的有效性。在试验1中，我们随机安排母亲使用经处理的毛巾或相同的未经处理的（安慰剂）毛巾，并在三周内每周随机时间进行一次突击家访。每次家访时，我们用无菌手部冲洗液检测手上的大肠杆菌，然后两组交换毛巾类型，并重复进行三周的大肠杆菌检测。在交叉试验2中，我们比较了三种不同的洗手/擦干程序后母亲手上大肠杆菌的污染情况：肥皂和水 + 经处理的毛巾、仅用水 + 经处理的毛巾以及肥皂和水 + 自然晾干。在试验1中，使用不同类型毛巾的母亲手上大肠杆菌污染水平没有统计学上的显著差异（经处理毛巾与未经处理毛巾的比值比：1.14，95%置信区间0.83 - 1.56）。在试验2中，不同洗手/擦干程序的母亲手上大肠杆菌污染情况没有显著差异。在这些试验中，在随机检测期间，使用抗菌毛巾并不能防止肯尼亚家庭中母亲的手受到大肠杆菌污染，与标准的洗手和擦干做法相比没有优势。建议用肥皂和干净的水洗手，并用干净的毛巾擦干。