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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“First, the evidence base is out of date.”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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InfluentialFomite Transmission in Airports Based on Real Human Touch Behaviors
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“(3) Assure the quality of PPE in healthcare settings to avoid cross-transmission.”
BackgroundDifferences in Hygiene Habits among Children Aged 8 to 11 Years by Type of Schooling
Pico, A. M. P., Álvarez, E. M., Rodríguez, J. V., & Mayordomo, R. (2022) · Children · doi:10.3390/children9020129 · Cited by 9
Enkhbat, M., Ganchimeg, T., Erdenee, O., & Katsumata, A. T. (2022) · Journal of Environmental and Public Health · doi:10.1155/2022/3103241 · Cited by 9
Gaffan, N., Dégbey, C., Kpozéhouen, A., Ahanhanzo, Y. G., & Paraïso, M. N. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-074332 · Cited by 9
Prince-Guerra, J. L., Nace, M. E., Lyles, R. H., de Aceituno, A. M. F., Bartz, F. E., Arbogast, J. W., Gentry-Shields, J., Jaykus, L., Heredia, N. L., García, S., et al. (2020) · Applied and Environmental Microbiology · doi:10.1128/aem.00780-20 · Cited by 9
“Most of these studies have been conducted in health care or community settings (8, 9, 13, 14), which may not accurately reflect”
BackgroundMardiko, A. A., & von Lengerke, T. (2020) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2020.113590 · Cited by 11
“, infections of the respiratory tract (Aiello et al., 2008; Rabie and Curtis, 2006), gastrointestinal tract (e.”
BackgroundJetha, Q., Bisserbe, C., McManus, J., Waldroop, D., Naliponguit, E. C., Villaseñor, J. M., Maule, L., & Lehmann, L. (2020) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.20-0174 · Cited by 9
“sitic infections as well as respiratory infections, and skin infections.(4,7,8) Despite the proven health benefits, it is estimated that less than 20%of the world’s population wash their hands with soap after defecating.”
BackgroundThe impact of television on-air time on hand hygiene compliance behaviors during COVID-19 outbreak
Morii, D., Miura, A., & Komori, M. (2023) · American Journal of Infection Control · doi:10.1016/j.ajic.2023.03.001 · Cited by 9
“century, hand hygiene has been repeatedly demonstrated to reduce healthcare-associated infections, as well as community-acquired infections (5),(6),(7),(8),(9),(10).”
BackgroundPersonal hygiene among military personnel: developing and testing a self-administered scale
Saffari, M., Koenig, H. G., Pakpour, A. H., Sanaeinasab, H., Jahan, H. R., & Sehlo, M. G. (2013) · Environmental Health and Preventive Medicine · doi:10.1007/s12199-013-0366-2 · Cited by 9
“Some studies indicate that the hygienic behaviors of hand-washing can on its own result in a decrease the incidence of respiratory infections and gastrointestinal disease by 21 and 31 %, respectively [12, 13].”
BackgroundDavis, N. L., Wiener, J. B., Juliano, J. J., Adair, L. S., Chasela, C., Kayira, D., Hudgens, M. G., van der Horst, C., Jamieson, D. J., Kourtis, A. P., et al. (2017) · Clinical Infectious Diseases · doi:10.1093/cid/cix367 · Cited by 9
Bonnesen, C. T., Plauborg, R., Denbæk, A. M., Due, P., & Johansen, A. (2015) · Health Education Research · doi:10.1093/her/cyv019 · Cited by 9
“A recent meta-analysis of hand hygiene interventions showed that hand sanitizer reduced the rate of gastrointestinal illness and of combined illness [26] and alternatively, implementation of hand disinfection could be considered.”
MethodMacLeod, C., Mills, J. E., Caruso, B. A., Chase, C., Chidziwisano, K., Chipungu, J., Dreibelbis, R., Ejemot-Nwadiaro, R. I., Gordon, B. A., Thomas, A. M., et al. (2025) · PLOS Water · doi:10.1371/journal.pwat.0000344 · Cited by 7
Public health and social benefits of at-house water supplies. Final Report
Evans, B., Bartram, J., Hunter, P. R., Williams, A. R., Geere, J. A., Majuru, B., Bates, L., Fisher, M. B., Overbo, A., & Schmidt, W. P. (2013) · Cited by 8
Germ Destroyer - A Gamified System to Increase the Hand Washing Duration in Shared Bathrooms
Altmeyer, M., Lessel, P., Schubhan, M., Hnatovskiy, V., & Krüger, A. (2019) · Annual Symposium on Computer-Human Interaction in Play · doi:10.1145/3311350.3347157 · Cited by 8
“Similarly, hand disinfection is considered to encourage bacteria developing antibiotic resistances [1], which is why usual hand washing should be performed in everyday life.”
BackgroundMethodUniversal WASH coverage; what it takes for fragile states. Case of Jariban district in Somalia
Mafuta, W., Zuwarimwe, J., & Mwale, M. (2021) · PLoS ONE · doi:10.1371/journal.pone.0247417 · Cited by 8
“Poor access also contributes to childhood undernutrition [8], maternal mortality [9] neglected tropical diseases [10], [11] and respiratory infections [12].”
BackgroundMasai, A. N., & Akın, L. (2021) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2021.10.017 · Cited by 8
COVID-19 and organisational resilience in Brazil's water sector
Zambrano, K. T., Imani, M., & Cunha, D. G. F. (2022) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2022.157637 · Cited by 9
“…of the simplest and most effective ways to prevent infections and further evidence suggests that improvements in hand hygiene may reduce spread of respiratory viruses and other infectious diseases (Aiello et al., 2008; Haque, 2020; Hirose et al., 2021; Islam et al., 2022; Warren-Gash et al., 2013).”
White, S., Heath, T., Mutula, A. C., Dreibelbis, R., & Palmer, J. J. (2022) · Conflict and Health · doi:10.1186/s13031-022-00476-8 · Cited by 8
“Handwashing behaviour has the potential to curb the spread of diarrhoeal [3] and respiratory diseases [4–6] which are among the leading causes of mortality in the wake of crises [7].”
BackgroundChatterjee, S., Roy, M. N., Banerjee, K., Mojumdar, S., & Osbert, N. (2022) · Journal of Water and Health · doi:10.2166/wh.2022.129 · Cited by 8
Alwan, N. H., Safwan, J., Kerek, R., & Ghach, W. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1256433 · Cited by 8
“Despite that, it was found that university students improperly wash their hands thus increasing their chances of contracting and spreading infectious diseases and having high absenteeism (6, 12, 17).”
BackgroundSpreading the handwashing message: An alternative to traditional media campaigns
Rosen, L., Brody, D. L., Zucker, D. M., Manor, O., Meier, M., Rosen, B., Lev, E., & Engelhard, D. (2010) · American Journal of Infection Control · doi:10.1016/j.ajic.2009.12.013 · Cited by 8
“Simple handwashing with soap, known to reduce transmission of gastrointestinal and upper respiratory illness, is being widely recommended.(2,3) The school is a natural field of operation, given its key role in both education and the spread of disease.”
BackgroundGizaw, Z., Addisu, A., & Kassie, D. G. (2020) · Environmental Health Insights · doi:10.1177/1178630220927361 · Cited by 8
“Other studies also reported the association of hand hygiene and GI symptoms among children (7, 29, 30).”
BackgroundHüttel, F. B., Iversen, A.-M., Hansen, M. B., Ersbøll, B. K., Ellermann‐Eriksen, S., & Olsen, N. L. (2021) · PLoS ONE · doi:10.1371/journal.pone.0257684 · Cited by 8
A One Health evaluation of water, sanitation, and hygiene (WASH) services in Butaro Sector, Rwanda
Coughlin, L. L., Schurer, J. M., Umubyeyi, C., Sijenyi, S., Arif, K., Niyonkuru, V. U., Byiringiro, E., Lutz, N., Korukire, N., Murcott, S. E., et al. (2022) · Journal of Water Sanitation and Hygiene for Development · doi:10.2166/washdev.2022.204 · Cited by 11
“Improved access to handwashing has been associated with a 31% reduction in gastrointestinal illness and a 21% reduction in respiratory illness (Aiello et al. 2008).”
BackgroundDallagiacoma, G., Rhedin, S., Odone, A., & Alfvén, T. (2024) · Acta Paediatrica · doi:10.1111/apa.17199 · Cited by 8
Alum, A., Rubino, J. R., & Ijaz, M. (2010) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2010.11.005 · Cited by 8
Interaction design of automatic faucet for standard hand-wash
Fitriyah, H., Widasari, E. R., Setiawan, E., & Kusuma, B. A. (2018) · MATEC Web of Conferences · doi:10.1051/matecconf/201815403003 · Cited by 8
Viral Upper Respiratory Infection
Barrett, B. P. (2007) · Elsevier eBooks · doi:10.1016/b978-1-4160-2954-0.50024-7 · Cited by 8
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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