Hand hygiene and water quality assessment in schools of Muthanna province, Southern Iraq

Introduction: The severe drought and prolonged heat waves in Iraq have adversely affected the water quality supplied to public facilities. Schools are among the most affected facilities by water scarcity. This work aims to evaluate the level of students' hand hygiene, and the quality of municipal (MW) and drinking water (DW) in some schools of Al-Muthanna Province, Iraq.Methodology: Between October 2021 and June 2022, a total of 324 water samples from 162 schools and 2,430 hand swabs (HSs) from 1,620 students (1,080 males and 540 females) were collected. Some physicochemical standards of water were assessed besides investigating faecal contamination in water and students' hands using Escherichia coli as an indicator.Results: All MW samples were faecally contaminated with poor standards of pH, turbidity, total dissolved solids, color, and chlorine. Despite the good physicochemical standards of all DW samples, E. coli was observed in 12% of samples. Hand hygiene levels dropped by 2.5-fold within a few hours after school entry compared to early-morning levels (before school entry). Male students were 1.5-and 1.7-fold more prone to hand contamination than female students either inside or outside school, respectively. An increasing chlorine tolerance by E. coli was observed in water samples with turbidity > 5 NTU and pH > 8.Conclusions: The students' hand hygiene level decreases within a few hours of entering school, particularly among male students. Residual -free chlorine < 0.5 mg/L with high turbidity and alkalinity in water is insufficient for 100% prevention of E. coli contamination.