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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“First, the evidence base is out of date.”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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“…is an essential behaviour that significantly enhances public health (UNICEF 2021)The benefits of hand hygiene have long been established, including a reduction of up to 40% of diarrhoeal diseases (Freeman et al. 2014) and 21% of respiratory diseases in the general population (Aiello et al. 2008).”
Manuelpillai, B., Lopman, B. A., Doran, C. R., & Porter, C. K. (2025) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiaf153 · Cited by 1
“One potential explanation is that, early in the pandemic, limited understanding of SARS-CoV-2 transmission led to broad NPI recommendations such as handwashing that are more effective for AGE than ARI [13].”
The role and prospects of skin microbiota in dermatosis
Chen, Y., Yao, Z., Ruan, Z., Gao, W., Zheng, W., & Li, X. (2025) · Therapeutic Advances in Infectious Disease · doi:10.1177/20499361251333562 · Cited by 1
“74,75 In addition, exogenous factors, including the application of cosmetic products, occlusive dressings, and detergents, can significantly impact the skin’s microbial community.”
Awareness Regarding Hand Hygiene: A Survey Based Study
Sarfaraz, S. A., Rizwan, H., Siddique, S., Firdous, K., & Khan, S. (2015) · American Journal of Pharmacology and Pharmacotherapeutics · doi:10.21767/2393-8862.100021 · Cited by 1
“There are variable routes of transmission of infectious diseases such as through saliva, through blood and body secretions(5), skin and mucous membrane(6), through air(7), through direct or indirect contact with infected person(8) or through contaminated food and water.(9) Infections can also be spread when infected p…”
BackgroundDetermination and comparison of the antimicrobial efficacy of alcohol based hand hygiene products
Birteksöz, A. S., Döşler, S., & Ötük, G. (2015) · Istanbul Journal of Pharmacy · doi:10.16883/jfpiu.90661 · Cited by 1
“In addition, a meta-analysis that was performed to assess the effect of hand hygiene on the risk of infectious diseases in community settings confirmed that hand hygiene interventions prevent gastrointestinal diseases in developed and developing countries (Aiello et al., 2008; Alp et al., 2011).”
BackgroundMoncion, K., Young, K., Tunis, M. C., Rempel, S., Stirling, R., & Zhao, L. (2019) · Relevé des maladies transmissibles au Canada · doi:10.14745/ccdr.v45i01a02f · Cited by 1
“Am J Infect Control 2018 Apr;46(4):448–55.”
BackgroundSari, R. E., & Daswito, R. (2018) · Jurnal Kesehatan Terpadu (Integrated Health Journal) · doi:10.32695/jkt.v1i9.5 · Cited by 1
Ahmed, T. (2019) · Stamford Journal of Microbiology · doi:10.3329/sjm.v8i1.42431 · Cited by 1
“Making the body parts clean and germ free (pathogenic or spoilage causing bacteria) especially those parts which come into direct contact with other people as well as things used in life is the first way of the sanitation or good hygienic life (1).”
BackgroundRahman, M. N., Abdullah-Al-Shoeb, M., Huq, S., & Azad, M. A. K. (2019) · Journal of World s Poultry Research · doi:10.36380/scil.2019.jlsb21 · Cited by 1
“In a health care setting hand washing is mandatory procedure according to Centers for Disease Control and Prevention (CDCP) and it may protect us from thousands of microbes [6].”
BackgroundMethodFlu and Flu Vaccination in Comparison, in the Evaluation of the Health Status of Children
Bottaro, G., Bottaro, G., & Palermo, F. (2020) · American Journal of Pediatrics · doi:10.11648/j.ajp.20200603.23 · Cited by 1
“It can also be transmitted through contacts between hands which were previously contaminated with respiratory secretions, and therefore a careful hand hygiene is essential to limit the spread of the disease [3].”
BackgroundEducators Teach Effective Hand Washing with a Simplified Method
Buck, J. H., Greenway, S., Hoffman, K., & Wittman, G. (2018) · Journal of Extension · doi:10.34068/joe.56.06.23 · Cited by 1
Oladeji, O., Farah, A. E., Hassan, A., Ayanle, M., Ali, Y. M., & Ali, Y. M. (2020) · Journal of Advances in Medicine and Medical Research · doi:10.9734/jammr/2020/v32i1930663 · Cited by 1
“17 mean reduction in respiratory illness of 21% [20] However a randomized controlled trial in Bangladesh that placed and maintained a handwashing station with soap and water in homes to promote hand washing and a community based studies in Kenya did not find a reduction in the cases of respiratory infection among chil…”
Background
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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