Nonpharmacological interventions to reduce respiratory viral transmission: an evidence-based review with recommendations

Abstract

BACKGROUND: Viral respiratory infections are a leading cause of worldwide mortality and exert the potential to cause global socioeconomic crises. However, inexpensive, efficacious, and rapidly deployable strategies to reduce viral transmission are increasingly important in the setting of an ongoing pandemic, though not entirely understood. This article provides a comprehensive review of commonly employed nonpharmacological interventions to interrupt viral spread and provides evidence-based recommendations for their use. METHODOLOGY: A systematic review of three databases was performed. Studies with defined endpoints of subjects receiving one of five interventions (nasal washing, gargling, personal protective equipment (PPE), social distancing, and hand hygiene) were included. An evidence-based review of the highest level of evidence, with recommendations, was created in accordance with a previously described, rigorous, iterative process. RESULTS: Fifty-four primary studies were included. The most commonly studied intervention was hand hygiene, followed by PPE, gargling, saline nasal washing, and social distancing. CONCLUSIONS: Mask use and hand hygiene are strong recommendations for prevention of viral transmission. Donning gloves, gowns, and eye protection are a recommendation in healthcare settings. Saline nasal washing and gargling are options in selected populations. Although an aggregate level of evidence is not provided, the authors recommend social distancing.

Impacts of public health and social measures on COVID-19 in Europe: a review and modified Delphi technique

“…Some studies considered physical distancing, quarantine and contact tracing as part of the results analysis of social distancing ( 24 , 26 ). For hygiene measures , the interventions studied fell into three broad categories: the main use of hand sanitizers, the use of soap, and those that provided education on hygiene practices only ( 24 , 31 ). Further recommendations to be applied in specific contexts such as using gloves, gowns, and eye protection, saline nasal washing and gargling were also identified.…”

“…In addition, one study evaluated surface disinfection with chlorine or ethanol-based disinfectant, concluding its effectiveness in reducing SARS-CoV-2 transmission ( 24 ). There was consensus among 10 studies that using face covering reduces the risk of transmission, incidence, mortality, and hospitalization for COVID-19 ( 22 , 24 , 26 , 31–34 ). The impact of not using a mask, using a face mask, surgical or medical masks, and N95 masks were analyzed.…”

Infection prevention measures in acute care settings based on severe acute respiratory syndrome coronavirus 2 transmission patterns and risk: a review

“…Eye protection continues to be recommended to prevent transmission via conjunctival inoculation. Studies evaluating SARS-CoV-2, in addition to other respiratory viruses such as SARS-CoV and MERS-CoV, have found evidence supporting reduced transmission with the use of eye protection such as in Chu et al 's meta-analysis [OR 0.22, (0.12–0.39) 95% CI] [24 ▪ ,99,100].…”