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Effect of Hand Hygiene on Infectious Disease Risk in the Community Setting: A Meta-Analysis
Open accessAbstract
To quantify the effect of hand-hygiene interventions on rates of gastrointestinal and respiratory illnesses and to identify interventions that provide the greatest efficacy, we searched 4 electronic databases for hand-hygiene trials published from January 1960 through May 2007 and conducted meta-analyses to generate pooled rate ratios across interventions (N=30 studies). Improvements in hand hygiene resulted in reductions in gastrointestinal illness of 31% (95% confidence intervals [CI]=19%, 42%) and reductions in respiratory illness of 21% (95% CI=5%, 34%). The most beneficial intervention was hand-hygiene education with use of nonantibacterial soap. Use of antibacterial soap showed little added benefit compared with use of nonantibacterial soap. Hand hygiene is clearly effective against gastrointestinal and, to a lesser extent, respiratory infections. Studies examining hygiene practices during respiratory illness and interventions targeting aerosol transmission are needed.
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“the latest published meta-analysis to include any ARI as an outcome was reported in 2008 by Aiello and colleagues”
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“who estimated that hand hygiene improvements reduced ARIs by 21% (95% CI 5-34)”
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“First, the evidence base is out of date.”
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“To our knowledge, this study is the first meta-analysis of the effect of handwashing with soap interventions on any ARI since the 2008 study by Aiello and colleagues.14”
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Diarrhea at the Hajj and Umrah
Gautret, P., Benkouiten, S., Sridhar, S., Al‐Tawfiq, J. A., & Memish, Z. A. (2015) · Travel Medicine and Infectious Disease · doi:10.1016/j.tmaid.2015.02.005 · Cited by 72
“Sanitation and good hygiene behavior are fundamental for the prevention of diarrheal diseases, especially hand hygiene [49].”
BackgroundZapka, C. A., Leff, J. W., Henley, J. B., Tittl, J., Nardo, E. D., Butler, M. S., Griggs, R. K., Fierer, N., & Edmonds-Wilson, S. L. (2017) · mBio · doi:10.1128/mbio.00093-17 · Cited by 74
Gizaw, Z., Birhan, T. A., Azanaw, J., Addisu, A., & Chercos, D. H. (2018) · Environmental Health and Preventive Medicine · doi:10.1186/s12199-018-0714-3 · Cited by 71
Cleanliness in context: reconciling hygiene with a modern microbial perspective
Vandegrift, R., Bateman, A. C., Siemens, K. N., Nguyen, M., Wilson, H. E., Green, J. L., Wymelenberg, K. G. V. D., & Hickey, R. J. (2017) · Microbiome · doi:10.1186/s40168-017-0294-2 · Cited by 77
“Studies linking hygiene intervention to health demonstrate the effectiveness of handwashing at reducing the risk of diarrhetic disease [20, 21] and upper respiratory infection [21, 22].”
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“While no specific protection exists against these diseases, personal hygiene, especially hand hygiene, has been acknowledged as a key element to prevent the spread in the community [16].”
BackgroundQutob, N., Awartani, F., Asia, M., & Khader, I. A. (2021) · PLoS ONE · doi:10.1371/journal.pone.0244925 · Cited by 69
Prevention and Control of Childhood Pneumonia and Diarrhea
Leung, D. T., Chisti, M. J., & Pavia, A. T. (2015) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2015.08.003 · Cited by 73
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Herd Protection from Drinking Water, Sanitation, and Hygiene Interventions
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Nerby, J. M., Gorwitz, R. J., Lesher, L. J., Juni, B. A., Jawahir, S., Lynfield, R., & Harriman, K. H. (2011) · The Pediatric Infectious Disease Journal · doi:10.1097/inf.0b013e31822256c3 · Cited by 64
“Refused 147 (19) Healthcare risk factors identified on interview 40 (5) Unable to contact 223 (28) Deadline passed 138 (18) Total enrolled 236 (30) Total eligible cases 784 (100%)”
BackgroundSavolainen-Kopra, C., Haapakoski, J., Peltola, P. A., Ziegler, T., Korpela, T., Anttila, P., Amiryousefi, A., Huovinen, P., Huvinen, M., Noronen, H., et al. (2012) · Trials · doi:10.1186/1745-6215-13-10 · Cited by 64
“In recent meta-analyses, however, the overall evidence has been considered inconclusive due to differences in study designs and difficulty in adjusting for confounding factors [9,10].”
BackgroundLi, K., Rui, J., Song, W., Luo, L., Zhao, Y., Qu, H., Liu, H., Wei, H., Zhang, R., Abudunaibi, B., et al. (2024) · Nature Communications · doi:10.1038/s41467-024-48201-8 · Cited by 63
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“Examples of such interventions that have been found to have an impact on water-borne and water-related diseases include hand washing with soap [8, 9], integrated water supply and sanitation [10], household and village level treatment, water storage and hygiene education [11–13], and face washing [14–16].”
BackgroundEisenberg, J. N. S., Trostle, J., Sorensen, R. J. D., & Shields, K. F. (2012) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031811-124530 · Cited by 62
Kumar, S., Loughnan, L., Luyendijk, R., Hernández, O., Weinger, M., Arnold, F., & Ram, P. K. (2017) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.16-0445 · Cited by 61
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“The primary outcomes of interest were the following: [1] handwashing behaviours (cleansing hands with water, with soap and water, or with hand sanitiser, at any key moment as listed above); [2] diarrhoea morbidity [prevalence or incidence] or mortality [regardless of aetiology and case confirmation]; and [3] one or mo…”
BackgroundEffect of hand hygiene on infectious diseases in the office workplace: a systematic review
Zivich, P. N., Gancz, A. S., & Aiello, A. E. (2018) · American Journal of Infection Control · doi:10.1016/j.ajic.2017.10.006 · Cited by 58
Self-citationWatson, J., Dreibelbis, R., Aunger, R. V., Deola, C., King, K., Long, S., Chase, R. P., & Cumming, O. (2018) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2018.09.002 · Cited by 60
“Handwashing with soap (HWWS) is one of the most cost-effective public health interventions (Jamieson et al., 2006) and reduces the risk of both diarrhoeal and respiratory disease by over 20% (Aiello et al., 2008; Freeman et al., 2014).”
BackgroundWang, Z., Lapinski, M. K., Quilliam, E. T., Jaykus, L., & Fraser, A. M. (2017) · American Journal of Infection Control · doi:10.1016/j.ajic.2017.01.018 · Cited by 66
Handwashing before Food Preparation and Child Feeding: A Missed Opportunity for Hygiene Promotion
Nizame, F. A., UNICOMB, L. E., Sanghvi, T. G., Roy, S., Nuruzzaman, M., Ghosh, P. K., WINCH, P. J., & Luby, S. P. (2013) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.13-0434 · Cited by 58
“Child caregivers Mother of child 69 (99) 134 (96) 138 (99) 341 (97) Monthly household income* < US $100 (8,000 Taka) 26 (37) 111 (80) 79 (56) 216 (62) 3 US $100 (8,000 Taka) 44 (63) 29 (20) 61 (44) 134 (38) Education of mother of child* No formal education 5 (7) 23 (16) 39 (28) 67 (19) Primary level 31 (44) 42 (30) 43…”
Hashim, S., Salmuna, Z. N., Mohamed, Z., Hasan, H. B., Harun, A. B., Ismail, N., Rahman, Z. A., Suraiya, S., Naing, N. N., & Aziz, A. A. (2016) · Journal of Travel Medicine · doi:10.1093/jtm/tav019 · Cited by 59
“A systematic review on hand-hygiene interventions, including education and the use of alcohol-based hand sanitizers towards respiratory illness indicated that some of the interventions were not efficacious against respiratory illnesses.(30) The consistent application of hand hygiene during critical points in the chain…”
BackgroundTodd, E. C. D., Greig, J. D., Michaels, B., Bartleson, C. A., Smith, D., & Holah, J. T. (2010) · Journal of Food Protection · doi:10.4315/0362-028x-73.12.2306 · Cited by 58
“(1) conducted meta-analyses to generate pooled rate ratios across interventions for 30 hand hygiene trials published from January 1960 through May 2007.”
BackgroundHandwashing in averting infectious diseases: Relevance to COVID-19
Haque, M. (2020) · Journal of Population Therapeutics and Clinical Pharmacology · doi:10.15586/jptcp.v27sp1.711 · Cited by 62
Effectiveness of a hand hygiene program at child care centers: a cluster randomized trial
Azor-Martinez, E., Yui-Hifume, R., Muñoz-Vico, F. J., Jimenez-Noguera, E., Strizzi, J. M., Martinez-Martinez, I., Garcia-Fernandez, L., Seijas-Vazquez, M. L., Torres-Alegre, P., Fernández-Campos, M. A., et al. (2018) · Pediatrics · doi:10.1542/peds.2018-1245 · Cited by 51
Coliform Sources and Mechanisms for Regrowth in Household Drinking Water in Limpopo, South Africa
Mellor, J., Smith, J. A., Samie, A., & Dillingham, R. A. (2013) · Journal of Environmental Engineering · doi:10.1061/(asce)ee.1943-7870.0000722 · Cited by 61
“2010b), which might lead to diarrhea (Aiello et al. 2008).”
BackgroundSharma, M., Batra, K., Davis, R. E., & Wilkerson, A. H. (2021) · Healthcare · doi:10.3390/healthcare9010055 · Cited by 55
“the spread of gastrointestinal and respiratory infections by 31% and 21%, respectively [6,7].”
BackgroundUddin, M., Cherkowski, G., Liu, G., Zhang, J., Monto, A. S., & Aiello, A. E. (2009) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2009.090852 · Cited by 53
“Reported soap and water hand-washing time was divided between those reporting times between 0 and <20 s and those reporting times of 20 s or greater, based on recommendations for the community setting.(18) Average daily use of hand sanitiser was categorised into greater than three times per day versus less than three…”
BackgroundA scale for measuring hygiene behavior: Development, reliability and validity
Stevenson, R. J., Case, T. I., Hodgson, D. M., Porzig-Drummond, R., Barouei, J., & Oaten, M. (2009) · American Journal of Infection Control · doi:10.1016/j.ajic.2009.01.003 · Cited by 53
“Questions 2 to 9 and 15 to 20 had common response options: ‘‘always’’ (scored as 4), ‘‘usually’’ (3), ‘‘occasionally’’ (2), and ‘‘never’’ ( 1 ).”
Influential
Metadata
- Authors
- Aiello, A. E., Coulborn, R. M., Perez, V., & Larson, E. L.
- Affiliations
- University of Michigan (US)
- Allison E. Aiello, Rebecca M. Coulborn, and Vanessa Perez are with the Department of Epidemiology and Center for Social Epidemiology & Population Health, School of Public Health, University of Michigan, Ann Arbor. Elaine L. Larson is with the School of Nursing and the Mailman School of Public Health, Columbia University, New York, NY.
- Venue
- American Journal of Public Health
- Publisher
- American Public Health Association
- Published
- 2008-08
- Volume
- 98
- Issue
- 8
- Pages
- 1372-1381
- ISSN
- 0090-0036 (ISSN-L)
- 1541-0048
- PMC
- PMC2446461
- OpenAlex
- W2109881331
- Cited by
- 796
- References
- 75
- Citations by year
- 2026: 21 · 2025: 44 · 2024: 49 · 2023: 57 · 2022: 78 · 2021: 91 · 2020: 83 · 2019: 40 · 2018: 39 · 2017: 40 · 2016: 31 · 2015: 48 · 2014: 36 · 2013: 39 · 2012: 31
- FWCI
- 2.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Public Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Michigan
- Topics
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric health and respiratory diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Keywords
- hand hygiene, gastrointestinal diseases, respiratory diseases, infectious disease prevention, community settings, hand hygiene education, antibacterial soap, infection transmission
- MeSH terms
- Communicable Disease Control, Communicable Diseases, Gastrointestinal Diseases, Hand Disinfection, Humans, Respiratory Tract Infections, Surface-Active Agents, Databases, Bibliographic, Skin Care, Community-Acquired Infections, Risk Assessment
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