Hand hygiene and risk of influenza virus infections in the community: a systematic review and meta-analysis
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SUMMARY: Community-based prevention strategies for seasonal and pandemic influenza are essential to minimize their potential threat to public health. Our aim was to evaluate the efficacy of hand hygiene interventions in reducing influenza transmission in the community and to investigate the possible modifying effects of latitude, temperature and humidity on hand hygiene efficacy. We identified 979 articles in the initial search and 10 randomized controlled trials met our inclusion criteria. The combination of hand hygiene with facemasks was found to have statistically significant efficacy against laboratory-confirmed influenza while hand hygiene alone did not. Our meta-regression model did not identify statistically significant effects of latitude, temperature or humidity on the efficacy of hand hygiene. Our findings highlight the potential importance of interventions that protect against multiple modes of influenza transmission, and the modest efficacy of hand hygiene suggests that additional measures besides hand hygiene may also be important to control influenza.
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Trials from low-income countries were not included in Wong 2014, and the significant effect was not demonstrated when all the trials identified in the review were combined.
“Moreover, trials from the low‐income countries were not included in the review, and this significant effect was not demonstrated when all the trials identified in the review were combined.”
From Physical interventions to interrupt or reduce the spread of respiratory viruses (2023) · cites this paper as Wong 2014
The Results (Efficacy of hand hygiene interventions; page unavailable) say that two studies from less developed countries were included, contrary to the claim that such trials were excluded. The Methods (Statistical analysis; page unavailable) say the authors analysed developed and developing countries separately, not as one combined set of all trials. The copy does not specify whether either country met a formal low-income classification. (LLM, conf=0.82)
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Experimental — accuracy not yet measuredWong 2014 identified 10 RCTs and reported that the combination of hand hygiene with face masks in high-income countries (five trials) significantly reduced the incidence of laboratory-confirmed influenza and influenza-like illness, whilst hand hygiene alone did not.
“A 2014 review identified 10 RCTs and reported that the combination of hand hygiene with face masks in high‐income countries (five trials) significantly reduced the incidence of laboratory‐confirmed influenza and ILI, whilst hand hygiene alone did not (Wong 2014).”
From Physical interventions to interrupt or reduce the spread of respiratory viruses (2023) · cites this paper as Wong 2014
The Results (Search results) identify ten eligible RCTs. The Results (Efficacy of hand hygiene interventions) report significant reductions in laboratory-confirmed influenza and ILI for hand hygiene combined with face masks in developed countries, but not for hand hygiene alone. The passages in our copy do not establish the claim’s count of five trials for that subgroup. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe significant reduction in laboratory-confirmed influenza and influenza-like illness for hand hygiene and face masks in Wong 2014 may have been based on the raw numbers without adjusting for any clustering effects in the included cluster trials, which produced inappropriately narrow confidence intervals and possibly biased treatment effect estimates.
“This significant reduction in laboratory‐confirmed influenza and ILI for hand hygiene and face masks may have been based on the raw numbers without adjusting for any clustering effects in the included cluster trials, which produced inappropriately narrow CIs, and possibly biased treatment effect estimates.”
From Physical interventions to interrupt or reduce the spread of respiratory viruses (2023) · cites this paper as Wong 2014
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- Authors
- WONG, V. W. Y., COWLING, B. J., & AIELLO, A. E.
- Affiliations
- University of Hong Kong (HK)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- COWLING, B. J.
- Venue
- Epidemiology and Infection
- Publisher
- Cambridge University Press (CUP)
- Published
- 2014-01-23
- Volume
- 142
- Issue
- 5
- Pages
- 922-932
- ISSN
- 0950-2688 (ISSN-L)
- 1469-4409
- PMC
- PMC4891197
- OpenAlex
- W1978449036
- Cited by
- 146
- References
- 87
- Citations by year
- 2025: 2 · 2024: 6 · 2023: 7 · 2022: 16 · 2021: 35 · 2020: 34 · 2019: 10 · 2018: 6 · 2017: 8 · 2016: 9 · 2015: 9 · 2014: 4
- FWCI
- 1.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Epidemiology and Infection (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Funders
- National Institute of General Medical Sciences (U54GM088558, AoE/M-12/06)
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Keywords
- hand hygiene, influenza transmission, community-based prevention, face masks, seasonal influenza, pandemic influenza, laboratory-confirmed influenza, latitude, temperature, humidity
- MeSH terms
- Humans, Influenza, Human, Hand Hygiene
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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