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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“First, the evidence base is out of date.”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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Mohamed, N. A., Amin, N. N. Z., Ramli, S., Isahak, I., & Salleh, N. M. (2016) · Journal of Scientific and Innovative Research · doi:10.31254/jsir.2016.5101 · Cited by 21
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“Advocating for good hand hygiene practice within communities have been proven to lower the incidence of diarrhea by 23-40% and respiratory infection by about 21% (Freeman et al., 2014 and Aiello et al., 2008).”
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“Over a six-week period of study, Aiello et al. (2012) found that hand sanitizers coupled with facemask use reduced influenza-like illness between 48% and 75% per week as compared to a control group of residential-based students.”
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BackgroundPrevention and control of infections in the home
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“There appear to be no additional health benefits to using triclosan-containing consumer soap.(38,39) This is an area of controversy.”
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“, 2020), while handwashing is generally less effective for respiratory as compared to gastrointestinal illnesses (Aiello et al., 2008).”
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“The assumed reduction in disease incidence seems to be realistic, given the pooled estimates of 39% and 31% reduction in gastrointestinal illness [7,25], and a pooled estimate of 21% reduction in respiratory illness [25].”
BackgroundLoughnan, L., Ram, P. K., & Luyendijk, R. (2015) · Waterlines · doi:10.3362/1756-3488.2015.028 · Cited by 17
“Hand hygiene interventions can reduce gastrointestinal illnesses such as diarrhoea by up to 42 per cent and acute respiratory infections (ARI) by up to 34 per cent (Aiello et al., 2008).”
BackgroundIsler, M., Wissmann, R., Morach, M., Zurfluh, K., Stephan, R., & Nüesch‐Inderbinen, M. (2020) · Zoonoses and Public Health · doi:10.1111/zph.12798 · Cited by 17
“The risk of exposure of humans to zoonotic pathogens and AMR bacteria can be effectively reduced by simple hand hygiene measures (Aiello et al., 2008).”
BackgroundMatkovic, J., Clemens, K. S., Faasse, K., & Geers, A. L. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.583491 · Cited by 17
“” Items were reported on a fivepoint Likert scale ranging from (1) never to (5) always.”
BackgroundOaten, M., Stevenson, R. J., Wagland, P., Case, T. I., & Repacholi, B. M. (2014) · The Psychological Record · doi:10.1007/s40732-014-0044-9 · Cited by 17
“Effective hand hygiene is the most powerful preventative agent in the spread of infectious disease (e.g., Aiello et al. 2008; Luby et al. 2005).”
BackgroundHuberts, J. C. D. W., Greenland, K., Schmidt, W., & Curtis, V. (2016) · American Journal of Infection Control · doi:10.1016/j.ajic.2016.01.045 · Cited by 17
Inactivation of Hand Hygiene-Related Pathogens Using Engineered Water Nanostructures
Huang, R., Vaze, N., Soorneedi, A., Moore, M. D., Xue, Y., Bello, D., & Demokritou, P. (2019) · ACS Sustainable Chemistry & Engineering · doi:10.1021/acssuschemeng.9b05057 · Cited by 17
Azor-Martínez, E., Garcia-Fernandez, L., Strizzi, J. M., Cantarero-Vallejo, M. D., Jimenez-Lorente, C. P., Balaguer-Martínez, J. V., Torres‐Alegre, P., Yui-Hifume, R., Sánchez-Forte, M., & Giménez‐Sánchez, F. (2020) · American Journal of Infection Control · doi:10.1016/j.ajic.2020.03.011 · Cited by 16
Burden of infection in Australian infants
Rowland, R., Sass, Z., Ponsonby, A., Pezic, A., Tang, M. L. K., Vuillermin, P., Gray, L. E. K., Burgner, D. P., & Barwon Infant Study Investigator Group (2020) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.15174 · Cited by 16
Ali, A. S., Yohannes, M. W., & Tesfahun, T. (2023) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/00469580231218421 · Cited by 16
“6,7 Handwashing is a key practice in reducing the spread and transmission of infectious diseases such as pneumonia, influenza, HIV-related infections, and environmental enteropathies.”
BackgroundTemitayo, I. O. (2016) · Texila international journal of public health · doi:10.21522/tijph.2013.04.04.art055 · Cited by 16
“A recent meta-analysis of 30 hand hygiene studies found that improvements in hand washing reduced the incidence of upper respiratory tract infections by 21% and gastrointestinal illnesses by 31% (Aiello et al, 2008).”
MethodNutrition-Sensitive Irrigation and Water Management
Bryan, E., Chase, C., & Schulte, M. (2019) · World Bank, Washington, DC eBooks · doi:10.1596/32309 · Cited by 16
“In addition, reducing the time that caregivers spend fetching water lowers diarrhea and improves nutritional outcomes in children under age 5 (Pickering and Davis 2012) through improved hygiene practices (Aiello et al. 2008; Motarjemi et al. 1993), more time available for child care (Burger and Esrey 1995; Cairncross…”
BackgroundGeometric Model of a Coastal Aquifer to Promote the Sustainable Use of Water. Manglaralto, Ecuador
Carrión-Mero, P., Quiñonez-Barzola, X., Morante-Carballo, F., Montalván, F. J., Herrera-Franco, G., & Plaza‐Úbeda, J. A. (2021) · Water · doi:10.3390/w13070923 · Cited by 16
“1% of the population of the Manglaralto parish (40,000 people including locals and tourists) [72,73].”
BackgroundSuccess of a Multimodal Program to Improve Hand Hygiene Compliance
Rees, S., Houlahan, B., Safdar, N., Sanford-Ring, S., Shore, T., & Schmitz, M. M. (2013) · Journal of Nursing Care Quality · doi:10.1097/ncq.0b013e3182902404 · Cited by 16
Does Genetic Diversity Predict Health in Humans?
Lie, H. C., Simmons, L. W., & Rhodes, G. (2009) · PLoS ONE · doi:10.1371/journal.pone.0006391 · Cited by 16
Alzaher, A. A., Almudarra, S. S., Mustafa, M. H., & Gosadi, I. M. (2018) · Saudi Medical Journal · doi:10.15537/smj.2018.10.23344 · Cited by 15
White, S., Heath, T., Ibrahim, W. K., Ihsan, D., Blanchet, K., Curtis, V., & Dreibelbis, R. (2022) · PLoS ONE · doi:10.1371/journal.pone.0264434 · Cited by 15
Pérez, V., Uddin, M., Galea, S., Monto, A. S., & Aiello, A. E. (2011) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2010.117002 · Cited by 15
Diarrhoeal diseases in Soweto, South Africa, 2020: a cross-sectional community survey
Johnstone, S., Page, N. A., Thomas, J., Madhi, S. A., Mutevedzi, P. C., Myburgh, N., Herrera, C., & Groome, M. J. (2021) · BMC Public Health · doi:10.1186/s12889-021-11470-9 · Cited by 15
Natnael, T., Adane, M., Alemnew, Y., Andualem, A., & Hailu, F. (2021) · PLoS ONE · doi:10.1371/journal.pone.0253452 · Cited by 18
“It can play a role in reduction of respiratory illness by 21% and gastrointestinal illness by 31% [72].”
BackgroundRetractedMarín-Gabriel, J. C., & de Santiago, E. R. (2020) · Gastroenterología y Hepatología (English Edition) · doi:10.1016/j.gastre.2020.05.001 · Cited by 15
Persistence of viral RNA in stool samples from patients recovering from covid-19
Barth, R. E., & de Regt, M. J. A. (2020) · BMJ · doi:10.1136/bmj.m1724 · Cited by 15
Gizaw, Z., Worku, A., Bitew, B. D., Lee, J., & Bisesi, M. S. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-056411 · Cited by 14
Caruso, B. A., Snyder, J. S., Cumming, O., Mills, J. E., Gordon, B. A., Rogers, H., Freeman, M. C., & Wolfe, M. K. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-077677 · Cited by 14
“…reviews have synthesised evidence of health outcomes linked with hand hygiene in community settings, including infectious disease outcomes, 10 22–24 infectious disease outcomes in the workplace, 25 diarrhoeal disease outcomes, 26–28 respiratory infection outcomes 29–31 and cases of influenza.”
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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