The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers

Abstract

Infectious diseases (ID) circulating in the home and community remain a significant concern. Several demographic, environmental, and health care trends, as reviewed in this report, are combining to make it likely that the threat of ID will increase in coming years. Two factors are largely responsible for this trend: first, the constantly changing nature and range of pathogens to which we are exposed and, secondly, the demographic changes occurring in the community, which affect our resistance to infection. This report reviews the evidence base related to the impact of hand hygiene in reducing transmission of ID in the home and community. The report focuses on developed countries, most particularly North America and Europe. It also evaluates the use of alcohol-based hygiene procedures as an alternative to, or in conjunction with, handwashing. The report compiles data from intervention studies and considers it alongside risk modeling approaches (both qualitative and quantitative) based on microbiologic data. The main conclusions are as follows: (1) Hand hygiene is a key component of good hygiene practice in the home and community and can produce significant benefits in terms of reducing the incidence of infection, most particularly gastrointestinal infections but also respiratory tract and skin infections. (2) Decontamination of hands can be carried out either by handwashing with soap or by use of waterless hand sanitizers, which reduce contamination on hands by removal or by killing the organisms in situ. The health impact of hand hygiene within a given community can be increased by using products and procedures, either alone or in sequence, that maximize the log reduction of both bacteria and viruses on hands. (3) The impact of hand hygiene in reducing ID risks could be increased by convincing people to apply hand hygiene procedures correctly (eg, wash their hands correctly) and at the correct time. (4) To optimize health benefits, promotion of hand hygiene should be accompanied by hygiene education and should also involve promotion of other aspects of hygiene.

Access to Waterless Hand Sanitizer Improves Student Hand Hygiene Behavior in Primary Schools in Nairobi, Kenya

“…5,[11][12][13] Hand sanitizer interventions conducted in elementary schools in the United States have reduced illness-related absenteeism by 14-51%. 3,[14][15][16][17] Home-based hand sanitizer interventions have also been found to reduce respiratory and gastrointestinal illness transmission among households with children enrolled in daycare.…”

A Study to Assess the Effectiveness of Hand Hygiene Technique among School Children in Maharashtra, India

“…For school children the practice is significant, who might suffer from more severe hygiene related diseases as compared to adults 1 . In the home and everyday life setting hand hygiene is central to prevent the spread of infectious diseases 2 . School going children are spending more time in school and they are close contact with each other, sharing school materials everything from chairs to the desk, to crayons, to germs, and touching their faces.…”

Contextual and Psychosocial Determinants of Effective Handwashing Technique: Recommendations for Interventions from a Case Study in Harare, Zimbabwe

“…Compliance with complex recommendations might be inconvenient or even not practicable in some contexts. 6,37 This calls for additional studies in lowincome settings of developing countries to establish which of the presently recommended handwashing steps are both practicable during the daily life of participants and relevant for removing pathogens. This should inform the content of future handwashing recommendations.…”

“…[1][2][3][4][5] By acquiring pathogens from surfaces in the environment and transferring them to the mouth or nose, hands constitute a key route for the transmission of infectious diseases. 6 Handwashing with soap has been shown to decontaminate hands [7][8][9] and reduce the risk of ingesting pathogens and acquiring diarrhea.…”