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Table 1 Intervention studies’ characteristics

From: The effectiveness of hand hygiene interventions for preventing community transmission or acquisition of novel coronavirus or influenza infections: a systematic review

Study ID Country Aim of the study Study design Population Sample size Intervention Comparator Type of respiratory infection Relevant outcomes Findings Protection effect of HH (effect estimates)
Biswas et al. [24] Bangladesh To evaluate the effectiveness of a behaviour change intervention with ABHR and respiratory hygiene messages in school settings to reduce the incidence of influenza virus infections among schoolchildren cRCT School children N = 10,855 school children Provision of ABHR, HH education & respiratory hygiene education No ABHR provided and no HH & respiratory education provided Influenza Influenza acquisition The incidence of laboratory-confirmed influenza per 1000 student-weeks among children in the intervention schools was 53% lower than in the control schools (IRR: 0.5; 95% CI: 0.3, 0.8; p = 0.01). Significant protective effect (OR: 0.40; 95% CI: 0.22, 0.71)
Cowling et al. [19] China To investigate whether HH and use of face masks prevents household transmission of influenza cRCT General public N = 259 households (1) Provision of soap, ABHR & HH education vs. (2) face masks education, provision of surgical masks, soap, ABHR & HH education Healthy diet and lifestyle education Influenza Influenza transmission (secondary attack rates) Secondary attack ratios (percentage of household members that became infected) did not significantly differ at the household level (24% in the education group, 14% in the HH group, and 18% in the face mask & HH group; p = 0.37).
However, when intervention was implemented within 36 hours of symptom onset in the index patient, there was a significant difference in the secondary attack ratios between groups (4% in face masks & HH group, 5% in HH group and 12% in education group; p = 0.04).
No significant effect (OR: 0.52; 95% CI: 0.27, 1.00)
Larson et al. [20] USA To test the effectiveness of three household interventions on incidence & transmission of URI & influenza, knowledge of transmission of URIs, & vaccination rates cRCT General public N = 509 primarily Hispanic households (1) educational materials & ABHR vs. (2) educational materials & ABHR & masks Educational materials only Influenza Influenza acquisition & secondary transmission No significant difference in influenza cases between the education group and ABHR group (p = 0.2) or ABHR & face masks group (p = 0.9). No significant effect (OR: 1.16; 95% CI: 0.67, 2.01)
Ram et al. [21] Bangladesh To test the impact of intensive hand washing promotion on household transmission of influenza-like illness and influenza in rural Bangladesh RCT General public N = 384 household compounds Provision of education and skills training, set up of hand washing station and provision of soap & water, provision of reminders (cue cards) No education or training, no soap or water provided, no hand washing stations, no cue cards Influenza Influenza transmission (secondary attack rate ratio) No significant difference in secondary attack ratio between the intervention arm households (9.6%) and the control arm households (4.0%) of patients with laboratory-confirmed influenza (secondary attack ratio: 2.40; 95% CI: 0.68, 8.47; p = 0.17). No significant effect (OR: 2.52; 95% CI: 1.12, 5.64)
Stebbins et al. [22] USA To assess the impact of non-pharmacological interventions on the incidence of laboratory-confirmed influenza infections among elementary school children cRCT School children N = 3360 pupils HH & respiratory hygiene training & ABHR No ABHR provided and no HH & respiratory training provided Influenza Influenza acquisition No significant effect of the intervention on the number of laboratory-confirmed influenza cases (IRR: 0.81; 95% CI: 0.54, 1.23; p = 0.33), but children in intervention schools had significantly fewer influenza A infections in comparison with control schools (IRR: 0.48; 95% CI: 0.26, 0.87; p < 0.02). No significant effect (OR: 0.94; 95% CI: 0.64, 1.39)
Talaat et al. [23] Egypt To evaluate the effectiveness of an intensive HH campaign on reducing the incidence of laboratory-confirmed influenza cRCT School children N = 44,451 pupils HH education messages & activities and hand washing twice a day No HH education provided & no instruction to hand wash twice a day Influenza Influenza acquisition The rate of laboratory-confirmed influenza was higher among pupils who reported their illness in the control schools (35%) than in the intervention schools (18%) (p < 0.01). Significant protective effect (OR: 0.64; 95% CI: 0.51, 0.80)
  1. ABHR alcohol-based hand rub, CI confidence interval, cRCT cluster randomised trial, HH hand hygiene, IRR incidence rate ratio, OR Odds ratio, p p-value, RCT randomised controlled trial, URI upper respiratory infection