# Monitoring the Effectiveness of a Preschool Hand Hygiene Intervention Using Flow Cytometry to Determine the Reduction in the Microbiological Counts

## TL;DR

This study shows that a handwashing intervention significantly reduced germs on preschool children's hands, potentially lowering disease risk.

## Contribution

The study introduces flow cytometry as a method to monitor hand hygiene effectiveness in preschool children.

## Key findings

- The intervention group showed a significant reduction in live cells post-intervention.
- Turbidity decreased in both groups after handwashing.
- No significant differences were found between left and right hands or genders.

## Abstract

Hand hygiene (HH)-related illnesses, such as diarrhea, are one of the leading causes of death in children under five, whereas handwashing with soap can reduce infection rates in this age group. This study monitored whether a simple intervention in the form of a handwashing exercise could reduce the pathogens on preschool children’s hands, potentially reducing HH-related diseases. Hand bag-wash samples were collected from preschool children (N = 160) participating in an intervention study. The samples were collected pre- and post-intervention from the intervention group (IG) and control group (CG). The samples were analyzed using flow cytometry, where the microbiological counts and turbidity were compared between the left and right hands, genders, and pre- and post-intervention groups. The results indicated no significant difference in the microbiological counts of the left and right hands or between the genders of participants, with a significant reduction in intact live cells on the IG children’s hands post-intervention (p = 0.000). There was a significant positive correlation (p = 0.000) between the turbidity pre- and post-handwashing, with a decreased mean in terms of the turbidity recorded for both groups. Handwashing either with or without soap reduced the microbiological counts on preschoolers’ hands. Reinforcing handwashing at critical times and promoting correct handwashing procedures can assist in reducing hand-hygiene-related diseases in preschool children.