Cited by 805Infection Control and VentilationRespiratory viral infections researchInfection Control in Healthcare

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Physical interventions to interrupt or reduce the spread of respiratory viruses

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Jefferson, Tom, Del Mar, Chris B, Dooley, Liz, Ferroni, Eliana, Al-Ansary, Lubna A, Bawazeer, Ghada A, van Driel, Mieke L, Nair, N Sreekumaran, Jones, Mark A, Thorning, Sarah, Conly, John M·2011·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd006207.pub4PMC PMC8094623

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Abstract

BACKGROUND: Viral epidemics or pandemics of acute respiratory infections like influenza or severe acute respiratory syndrome pose a global threat. Antiviral drugs and vaccinations may be insufficient to prevent their spread. OBJECTIVES: To review the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses. SEARCH STRATEGY: We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL 2010, Issue 3), which includes the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to October 2010), OLDMEDLINE (1950 to 1965), EMBASE (1990 to October 2010), CINAHL (1982 to October 2010), LILACS (2008 to October 2010), Indian MEDLARS (2008 to October 2010) and IMSEAR (2008 to October 2010). SELECTION CRITERIA: In this update, two review authors independently applied the inclusion criteria to all identified and retrieved articles and extracted data. We scanned 3775 titles, excluded 3560 and retrieved full papers of 215 studies, to include 66 papers of 67 studies. We included physical interventions (screening at entry ports, isolation, quarantine, social distancing, barriers, personal protection, hand hygiene) to prevent respiratory virus transmission. We included randomised controlled trials (RCTs), cohorts, case-controls, before-after and time series studies. DATA COLLECTION AND ANALYSIS: We used a standardised form to assess trial eligibility. We assessed RCTs by randomisation method, allocation generation, concealment, blinding and follow up. We assessed non-RCTs for potential confounders and classified them as low, medium and high risk of bias. MAIN RESULTS: We included 67 studies including randomised controlled trials and observational studies with a mixed risk of bias. A total number of participants is not included as the total would be made up of a heterogenous set of observations (participant people, observations on participants and countries (object of some studies)). The risk of bias for five RCTs and most cluster-RCTs was high. Observational studies were of mixed quality. Only case-control data were sufficiently homogeneous to allow meta-analysis. The highest quality cluster-RCTs suggest respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children. Benefit from reduced transmission from children to household members is broadly supported also in other study designs where the potential for confounding is greater. Nine case-control studies suggested implementing transmission barriers, isolation and hygienic measures are effective at containing respiratory virus epidemics. Surgical masks or N95 respirators were the most consistent and comprehensive supportive measures. N95 respirators were non-inferior to simple surgical masks but more expensive, uncomfortable and irritating to skin. Adding virucidals or antiseptics to normal handwashing to decrease respiratory disease transmission remains uncertain. Global measures, such as screening at entry ports, led to a non-significant marginal delay in spread. There was limited evidence that social distancing was effective, especially if related to the risk of exposure. AUTHORS' CONCLUSIONS: Simple and low-cost interventions would be useful for reducing transmission of epidemic respiratory viruses. Routine long-term implementation of some measures assessed might be difficult without the threat of an epidemic.

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Authors: Jefferson, T., Del Mar, C. B., Dooley, L., Ferroni, E., Al-Ansary, L. A., Bawazeer, G. A., van Driel, M. L., Nair, N. S., Jones, M. A., Thorning, S., & Conly, J. M.
Affiliations: University of Oxford (GB)
Bond University; Centre for Research in Evidence-Based Practice (CREBP); University Drive Gold Coast Queensland Australia 4229
Bond University (AU)
Regione del Veneto (IT)
World Health Organization; Department of Health Metrics and Measurement; Geneva Switzerland
King Saud University (SA)
The University of Queensland; Primary Care Clinical Unit, Faculty of Medicine; Brisbane Queensland Australia 4029
Government of India (IN)
Gold Coast Hospital (AU)
Foothills Medical Centre (CA)
ORCID: Jefferson, Tom
Ferroni, Eliana
Bawazeer, Ghada A
Nair, N Sreekumaran
Jones, Mark A
Thorning, Sarah
Conly, John M
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2011-07-06
Volume: 11
Issue: 7
Pages: CD006207-CD006207
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd006207.pub4
PMC: PMC8094623
OpenAlex: W1534533078
Cited by: 805
References: 292
Citations by year: 2026: 5 · 2025: 19 · 2024: 54 · 2023: 81 · 2022: 95 · 2021: 135 · 2020: 191 · 2019: 20 · 2018: 20 · 2017: 16 · 2016: 26 · 2015: 41 · 2014: 31 · 2013: 33 · 2012: 20
FWCI: 4.98
Type: journal article
Language: en
Update notices: new_version (2020-11-20)
Open access: bronze
doi.org
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Ghent University Academic Bibliography (Ghent University) (submittedVersion)
Bond University Research Portal (Bond University) (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
Keywords: physical interventions, respiratory virus transmission, acute respiratory infections, face masks, hand hygiene, social distancing, quarantine, isolation, personal protection, gargling, influenza, SARS, COVID-19 pandemic, pandemic preparedness, infection control, non-pharmaceutical interventions, harms of interventions, randomized controlled trials
MeSH terms: Humans, Influenza, Human, Respiratory Tract Infections, Virus Diseases, Case-Control Studies, Randomized Controlled Trials as Topic, Virus Shedding

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