UCL Centre for Infectious Disease Epidemiology, Research Department of Infection & Population Health, Royal Free Hospital, London, UK.
Influenza Other Respir Viruses. 2013 Sep;7(5):738-49. doi: 10.1111/irv.12015. Epub 2012 Oct 8.
Hand hygiene may be associated with modest protection against some acute respiratory tract infections, but its specific role in influenza transmission in different settings is unclear. We aimed to review evidence that improving hand hygiene reduces primary and secondary transmission of (i) influenza and (ii) acute respiratory tract infections in community settings. We searched Medline, Embase, Global Health and Cochrane databases up to 13 February 2012 for reports in any language of original research investigating the effect of hand hygiene on influenza or acute respiratory tract infection where aetiology was unspecified in community settings including institutions such as schools, and domestic residences. Data were presented and quality rated across outcomes according to the Grading of Recommendations Assessment, Development and Evaluation system. Sixteen articles met inclusion criteria. There was moderate to low-quality evidence of a reduction in both influenza and respiratory tract infection with hand hygiene interventions in schools, greatest in a lower-middle-income setting. There was high-quality evidence of a small reduction in respiratory infection in childcare settings. There was high-quality evidence for a large reduction in respiratory infection with a hand hygiene intervention in squatter settlements in a low-income setting. There was moderate- to high-quality evidence of no effect on secondary transmission of influenza in households that had already experienced an index case. While hand hygiene interventions have potential to reduce transmission of influenza and acute respiratory tract infections, their effectiveness varies depending on setting, context and compliance.
手卫生可能与一些急性呼吸道感染的适度保护有关，但在不同环境中其对手流感传播的具体作用尚不清楚。我们旨在回顾证据，即改善手卫生可减少（i）流感和（ii）社区环境中急性呼吸道感染的原发和继发传播。我们检索了 Medline、Embase、全球卫生和 Cochrane 数据库，截至 2012 年 2 月 13 日，以获取任何语言的报告，这些报告调查了手卫生对流感或急性呼吸道感染的影响，病因在社区环境（包括学校和家庭住所等机构）中未明确。根据推荐评估、制定和评估系统（Grading of Recommendations Assessment, Development and Evaluation system），按结局呈现和评价质量。16 篇文章符合纳入标准。在学校中，手卫生干预措施可减少流感和呼吸道感染，证据质量为中等到低等；在中低收入环境中，效果最大。在儿童保育环境中，呼吸道感染的减少具有高质量证据。在低收入环境中的棚户区，手卫生干预措施可大幅减少呼吸道感染，具有高质量证据。在已经发生过流感病例的家庭中，手卫生干预对流感的继发传播无影响，具有中等到高等质量证据。虽然手卫生干预措施有可能减少流感和急性呼吸道感染的传播，但它们的有效性因环境、背景和依从性而异。
