Abstract
BackgroundHand hygiene is considered as an important means of infection control. We explored whether guided hand hygiene together with transmission-limiting behaviour reduces infection episodes and lost days of work in a common work environment in an open cluster-randomized 3-arm intervention trial.MethodsA total of 21 clusters (683 persons) were randomized to implement hand hygiene with soap and water (257 persons), with alcohol-based hand rub (202 persons), or to serve as a control (224 persons). Participants in both intervention arms also received standardized instructions on how to limit the transmission of infections. The intervention period (16 months) included the emergence of the 2009 influenza pandemic and the subsequent national hand hygiene campaign influencing also the control arm.ResultsIn the total follow-up period there was a 6.7% reduction of infection episodes in the soap-and water arm (p = 0.04). Before the onset of the anti-pandemic campaign, a statistically significant (p = 0.002) difference in the mean occurrence of infection episodes was observed between the control (6.0 per year) and the soap-and-water arm (5.0 per year) but not between the control and the alcohol-rub arm (5.6 per year). Neither intervention had a decreasing effect on absence from work.ConclusionsWe conclude that intensified hand hygiene using water and soap together with behavioural recommendations can reduce the occurrence of self-reported acute illnesses in common work environment. Surprisingly, the occurrence of reported sick leaves also increased in the soap-and water-arm.Trial RegistrationClinicalTrials.gov: NCT00981877Source of fundingThe Finnish Work Environment Fund and the National Institute for Health and Welfare.
Highlights
Hand hygiene is considered as an important means of infection control
Enhanced hand hygiene is a well established means to prevent the transmission of infections in hospital settings [1] as well as in other semi-closed environments with high infection pressure, such as day care centers [2,3,4,5], schools [6,7] and military service [8]
We studied whether enhanced hand hygiene together with behavioural recommendations aimed at reducing transmission by droplets during coughing or sneezing could reduce infection episodes and absence from work in a common office work environment
Summary
Hand hygiene is considered as an important means of infection control. Enhanced hand hygiene is a well established means to prevent the transmission of infections in hospital settings [1] as well as in other semi-closed environments with high infection pressure, such as day care centers [2,3,4,5], schools [6,7] and military service [8]. Enhanced hand hygiene has been studied as a means to prevent the transmission of respiratory and diarrheal infections in community settings. In a recent study, enhanced hand hygiene together with the use of a surgical face mask prevented influenza virus transmission within households when implemented within 36 hours of the onset of symptoms in the index patient [12]. Influenza transmission was not reduced by interventions to promote hand washing and face mask use in another study [13]
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