According to this study, bacterial contamination was present in (88.29%) of hand and nasal swabs of the food handlers. In Serbia, (24.6%) and (21.6%) smear positive central and distributive kitchens from hands and work clothes, respectively . The study in Brazil found that (24.4%) of coagulase-positive staphylococci and (75.6%) coagulase-negative staphylococci in analysing nasal and hand swabs of 82 food handlers . Therefore, bacterial contamination in the present study was higher than those of other countries.
Hand contamination of the food handlers
Regarding Staphylococcus spp. contamination on hands, (47.8%) of the food handlers were contaminated with Staphylococcus spp. in which (42.4%) was S. aureus and (5.4%) was coagulase negative Staphylococcus species. The finding of the present study is consistent with the study where there was Staphylococcus spp. (56.9%) of the nail cultures, and another study where the presence of S. aureus on hands of the food handlers in schools expressed (53.3%) [3, 16]. In contrast, other studies who reported lower S. aureus prevalence are (30.1%) , (29.2%) , (23.5%) in Ethiopia , (17.5%) in Makkah, Saudi Arabia , (16.5%) from their finger-nail contents , (12.6%) isolated from hands of Iranian food handlers , (11.1%)  and (5.6%) . This difference in contamination may be due to different populations and areas of the study.
In this study, the second most prevalent contaminant isolated from the hands of the studied group was Escherichia coli (8.11%). It is considered an enteric pathogen that are supposed to be capable of being spread by the food handlers in hospital compounds. The current finding has higher prevalence than the study (3.1% and 2.5% respectively) [19, 20]. This result which reflects hand contamination with faecal matter pointed to insufficient and poor handwashing habits among the food handlers.
Nasal bacterial growth of the food handlers
When nasal swab culture was examined, S. aureus was found in (54.95%) and coagulase negative staphylococcus was in (5.41%). The prevalence of nasal staphylococci carrier in this study is higher than that in the study  in Brazil (40.8%) and in Iraq (30.1%) . In the study in Spain, 27.6% of 300 food handlers were found to be nasal coagulase positive staphylococci carriers . The study in Kuwait city  revealed that (26.6%) of 500 restaurant workers were nasal S. aureus carriers. In Brazil, (24.4%) and (75.6%) of nasal and hand swabs of 82 food handlers were positive for coagulase-positive and coagulase-negative staphylococci . There were (19.8%) and (10.4%) isolates from the nasal cavity of the food handlers respectively [22, 23]. In contrast, the result of the present study is higher than those studies.
The current results presented that (1.8%) of the nasal swabs of the food handlers were Acinetobacter spp. It is a common cause of nosocomial or hospital acquired infection in Serbia. It is becoming a problematic due to their quick progress of drug resistance and high fatality rates (20-60%). Its transmission is possible via person-to-person connection, water contamination, food borne and contaminated hospital and surgical equipment .
Pattern of antibiotic sensitivity of Staphylococcus aureus isolates from nasal carriers of the food handlers
The detection of antibiotics-resistant S. aureus in nasal specimen is a public health attention as they can serve as sources of drug resistant S. aureus transmission in the community. In the present study, (1.64%) were resistant to amikacin. The study in Brazil stated (4.0%) were resistant to amikacin and those were higher than this study . There was no resistant strain for cefoperasone-sulbactam antibiotic in the current study. Amikacin and cefoperasone-sulbactam are antibiotics most often used for intending to treat severe respiratory infections or multidrug-resistant tuberculosis in Myanmar. The reason of few percentage of drug resistant is that there are no oral form and also needs doctor prescriptions.
In the current study, (1.64%) was resistant to levofloxacin and (6.56%) was resistant to ceftriaxone. These two drugs are also used as first line drugs in respiratory tract and gastro-intestinal tract infections according to hospital infection control guideline before getting specific antibiotics sensitivity results. In other study, (97.68%) isolates were resistant to ceftriaxone . Therefore, those were so higher resistant percentage than the current study.
In the present study, (9.84%) and (18.7%) isolates were resistant to clindamycin and amoxicillin-clavulanic acid, respectively. Clindamycin and amoxicillin-clavulanic acid are antibiotics most often used for the treatment of respiratory tract infection in Myanmar. Most Myanmar people takes these two drugs to relieve signs and symptoms of upper respiratory tract infection (e.g. sneezes, cough, sputum production) without prescription of doctors. In the study of Udo in Kuwait city, only (2.0%) were resistant to clindamycin . Other study stated (27.14%) of nasal swab samples were resistant to amoxicillin-clavulanic acid and those were higher than this study .
(5.56%) isolates in the present study was resistant to vancomycin but there were no resistant to vancomycin tested in food handlers working the community study . In the study in Botswana, (6.0%) were resistant to vancomycin . In the current study, the prevalence of nasal carriers of ORSA (probably MRSA) was found to be 21 (18.92%) of total 111 food handlers and (51.22%) of S. aureus were resistant to oxacillin. But S. aureus strains were resistant to oxacillin (22.4 %)  and (0%) . The current study result was higher than the previous studies. This difference might be due to different microbiological method of confirming MRSA. In the current study, MRSA is identified only by oxacillin disc diffusion test and not confirmed by cefoxitin disc diffusion test, MRSA latex agglutination test and PCR. Foods may be contaminated by human strains of MRSA present in meat processors and other food handlers . Due to regional variation, choice of antibiotics should be guided by local susceptibility patterns.
Association of bacterial contamination among the food handlers in hospital compounds
There was an association between hand contamination and nasal contamination (p<0.001). Similar to the present study, food handlers who carry S. aureus in their noses are a likely source of hand contamination in their workplace .