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A Little Hand Hygiene Goes a Long Way

Meta-analysis results of community-based intervention studies indicate that use of nonantibacterial soap and hand-hygiene education significantly reduce respiratory and GI illnesses.

Does hand washing really reduce the incidence of gastrointestinal (GI) and respiratory illnesses in the community, and, if so, by how much? Which is better: alcohol-based hand sanitizers, nonantibacterial (plain) soap, or antibacterial soap? To answer these questions, investigators from the University of Michigan and Columbia University identified more than 5000 relevant studies published from 1960 to 2007 and pooled results from 30 community-based intervention studies (conducted in developed and developing countries) that met criteria for review (19 of the 30 studies focused on children aged 5 years and younger).

Compared with no education, hand-hygiene education alone (7 studies) significantly reduced the risk for GI illness by 31% and for respiratory illness (4 studies) by 14%. Education plus use of nonantibacterial soap (6 studies) significantly reduced the risk for GI illness by 39% and for respiratory illness (1 study) by 51%, compared with control conditions, but had no significant effect in the two studies that combined the two outcomes. In two studies, use of antibacterial soaps did not offer an advantage over plain soap for either illness. Although alcohol-based hand sanitizer plus education did not reduce the risk for either illness alone, this strategy showed a protective effect in the three studies that combined the two outcomes (21% reduction). In two studies, benzalkonium chloride–based hand sanitizer significantly reduced the risk for GI and respiratory illnesses alone and the two outcomes combined by about 40%.

Comment: This meta-analysis provides us with solid community-based (vs. hospital-based) research to use when educating patients about the virtues of hand washing. Education is essential: The authors cite results from a U.S. study of 7800 participants indicating that only 67% (75% of women and 58% of men) washed their hands after using a public restroom. The finding that plain soap works as well as antibacterial soaps is reassuring, given concerns that use of antibacterial soaps might actually promote emergence of antibiotic-resistant bacteria. When I extolled the virtues of hand washing in my annual flu-prevention message to students, one responded that my advice seemed mundane. If parents and children discount this simple but effective prevention technique because it is not high-tech, that would be unfortunate. I’m going to keep washing my hands and telling students to do the same.

— Alain Joffe, MD, MPH, FAAP

Published in Journal Watch Pediatrics and Adolescent Medicine September 10, 2008

Citation(s):

Aiello AE et al. Effect of hand hygiene on infectious disease risk in the community setting: A meta-analysis. Am J Public Health 2008 Aug; 98:1372.

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