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Hand washing reduces infections
Authors' conclusions
Hand hygiene is likely to modestly reduce the burden of respiratory illness,
Harms associated with physical interventions were under‐investigated
There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations,
as well as the impact of adherence on effectiveness,
especially in those most at risk of ARIs.
Physical measures, prevent respiratory viruses spreading between people
Washing hands often
RCTs on hand washing
= 19
N = 71,210
Wearing masks, eye protection, gloves, and protective gowns
RCTs on masks = 78
No RCTs on gowns and gloves
Wiping surfaces with disinfectant
6 trials
Avoiding contact with other people (isolation or quarantine)
3 RCTs
Not touching your eyes, nose, or mouth
No RCTs
Sneezing or coughing into your elbow
No RCTs
Keeping a certain distance away from other people (distancing)
Examining people entering a country for signs of infection (screening)
No RCTs on examining people on entry
Hand hygiene interventions versus controls (i.e. no intervention)
Pooling for the broad outcome of ARI
14% relative reduction in the number of people with ARIs in the hand hygiene group
RR 0.86, (0.81 to 0.90)
9 trials, n = 52,105
moderate‐certainty evidence,
suggesting a probable benefit.
In absolute terms
A reduction from 380 events per 1000 people,
to 327 per 1000 people.
Using more strictly defined outcomes of ILI
Estimates of effect for ILI
RR 0.94
11 trials, n = 34,503
low‐certainty evidence
Beneficial effect was not statistically significant if ILI,
and laboratory-confirmed ILI were analysed separately
Laboratory‐confirmed influenza
RR 0.91
8 trials, n = 8,332
low‐certainty evidence,
suggest the intervention made little or no difference.
Composite (pooled) outcome ARI or ILI or influenza
Hand hygiene may be beneficial with an 11% relative reduction of respiratory illness
RR 0.89
low‐certainty evidence
In absolute terms
This benefit would result in a reduction from 200 events per 1000 people,
to 178 per 1000 people
Few trials measured and reported harms
very low‐certainty evidence.
Surface/object disinfection compared to control
Numbers of cases of viral respiratory illness (ARIs, ILI, confirmed influenza)
Six trials
A significant reduction in ARI in the intervention group
OR 0.47 (53% benefit)
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