Hand hygiene to reduce community transmission of influenza and acute respiratory tract infection: a systematic review

Abstract

Hand hygiene may be associated with modest protection against some acute respiratory tract infections, but its specific role in influenza transmission in different settings is unclear. We aimed to review evidence that improving hand hygiene reduces primary and secondary transmission of (i) influenza and (ii) acute respiratory tract infections in community settings. We searched Medline, Embase, Global Health and Cochrane databases up to 13 February 2012 for reports in any language of original research investigating the effect of hand hygiene on influenza or acute respiratory tract infection where aetiology was unspecified in community settings including institutions such as schools, and domestic residences. Data were presented and quality rated across outcomes according to the Grading of Recommendations Assessment, Development and Evaluation system. Sixteen articles met inclusion criteria. There was moderate to low-quality evidence of a reduction in both influenza and respiratory tract infection with hand hygiene interventions in schools, greatest in a lower-middle-income setting. There was high-quality evidence of a small reduction in respiratory infection in childcare settings. There was high-quality evidence for a large reduction in respiratory infection with a hand hygiene intervention in squatter settlements in a low-income setting. There was moderate-to highquality evidence of no effect on secondary transmission of influenza in households that had already experienced an index case. While hand hygiene interventions have potential to reduce transmission of influenza and acute respiratory tract infections, their effectiveness varies depending on setting, context and compliance.

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

“…Hand hygiene in nonhealthcare settings has reduced respiratory and gastrointestinal tract infections. 395,396 Hand hygiene opportunities for healthcare personnel, people with CF, and families are summarized in Table 7.…”

Using a novel rapid viral test to improve triage of emergency department patients with acute respiratory illness during flu season

“…Every year, influenza is estimated to cause 200,000 hospitalizations and 20,000 deaths in the United States, and 250,000-500,000 deaths globally [3][4][5]. In addition to immunization, early treatment, social distancing, and good hygiene reduce the incidence and severity of disease [6][7][8].…”

Hand Hygiene Program Decreases School Absenteeism Due to Upper Respiratory Infections

“…Future studies could include observational measures to measure correct handwashing techniques. Whereas hand hygiene interventions have the potential to reduce transmission of influenza and acute respiratory tract infections, their effectiveness varies depending on the setting, context, and compliance . The higher reduction in respiratory infections found in our study was possibly due to that it coincided with influenza pandemic, an important educational support and we provided hand sanitizer in the schools of EG.…”

“…The study did not separately measure the individual impact of handwashing with soap, rubbing hands with hand sanitizer, and educational intervention. However, previous and late studies have proven that each measure is effective individually and better results are obtained when multifactorial programs are used . One other potential limitation in our study is that it was carried out during the influenza pandemic and both the CG and the EG used hand sanitizer before this study started.…”