Enteric pathogen infections are a leading cause of morbidity
and
mortality globally, with the highest disease burden in low-income
countries. Hands act as intermediaries in enteric pathogen transmission,
transferring enteric pathogens between people and the environment
through contact with fomites, food, water, and soil. In this study,
we conducted a systematic review of prevalence and concentrations
of fecal indicator microorganisms (i.e., E. coli,
fecal coliform) and enteric pathogens on hands. We identified 84 studies,
reporting 35,440 observations of hand contamination of people in community
or household settings. The studies investigated 44 unique microorganisms,
of which the most commonly reported indicators were E. coli and fecal coliforms. Hand contamination with 12 unique enteric pathogens
was reported, with adenovirus and norovirus as the most frequent.
Mean E. coli prevalence on hands was 62% [95% CI
40%–82%] and mean fecal coliform prevalence was 66% [95% CI
22%–100%]. Hands were more likely to be contaminated with E. coli in low/lower-middle-income countries (prevalence:
69% [95% CI 48%–88%]) than in upper-middle/high-income countries
(6% [95% CI 2%–12%]). The Review also highlights the importance
of standardizing hand sampling methods, as hand rinsing was associated
with greater fecal contamination compared to other sampling methods.