Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis

Abstract

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.

Dave Morrison stands in front of one of his trailers outfitted with rows of sinks that are used by firefighters to wash their hands at fire camps in Dorris, California. Photograph by Lee Juillerat. Used with permission of AP Wide World.

FIGURE 1—

Rate ratios for the effect of hand-hygiene interventions on gastrointestinal illness (a), respiratory illness (b), and combined illnesses (c). Note. RR = rate ratio; CI = confidence interval; LL = lower confidence limit; UL = upper confidence limit. Bars with RRs indicate 95% CIs. In studies of antibacterial soap, nonantibacterial soap was provided to the control groups. ^aOverall weighted summary rate ratio across all studies in the forest plot.