Physical interventions to interrupt or reduce the spread of respiratory viruses: Systematic review

Tom Jefferson, Ruth Foxlee, Chris B Del Mar, Elizabeth Dooley, Eliana Ferroni, Bill Hewak, Adi Prabhala, Sreekumaran Nair, A. Rivetti

Research output: Contribution to journalReview articleResearchpeer-review

125 Citations (Scopus)

Abstract

Objective To systematically review evidence for the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses.

Data extraction Search strategy of the Cochrane Library, Medline, OldMedline, Embase, and CINAHL, without language restriction, for any intervention to prevent transmission of respiratory viruses (isolation, quarantine, social distancing, barriers, personal protection, and hygiene). Study designs were randomised trials, cohort studies, case-control studies, and controlled before and after studies.

Data synthesis Of 2300 titles scanned 138 full papers were retrieved, including 49 papers of 51 studies. Study quality was poor for the three randomised controlled trials and most of the cluster randomised controlled trials; the observational studies were of mixed quality. Heterogeneity precluded meta-analysis of most data except that from six case-control studies. The highest quality cluster randomised trials suggest that the spread of respiratory viruses into the community can be prevented by intervening with hygienic measures aimed at younger children. Meta-analysis of six case-control studies suggests that physical measures are highly effective in preventing the spread of SARS: handwashing more than 10 times daily (odds ratio 0.45, 95% confidence interval 0.36 to 0.57; number needed to treat=4, 95% confidence interval 3.65 to 5.52); wearing masks (0.32, 0.25 to 0.40; NNT=6, 4.54 to 8.03); wearing N95 masks (0.09, 0.03 to 0.30; NNT=3, 2.37 to 4.06); wearing gloves (0.43, 0.29 to 0.65; NNT=5, 4.15 to 15.41); wearing gowns (0.23, 0.14 to 0.37; NNT=5, 3.37 to 7.12); and handwashing, masks, gloves, and gowns combined (0.09, 0.02 to 0.35; NNT=3, 2.66 to 4.97). The incremental effect of adding virucidals or antiseptics to normal handwashing to decrease the spread of respiratory disease remains uncertain. The lack of proper evaluation of global measures such as screening at entry ports and social distancing prevent firm conclusions being drawn.

Conclusion Routine long term implementation of some physical measures to interrupt or reduce the spread of respiratory viruses might be difficult but many simple and low cost interventions could be useful in reducing the spread.
Original languageEnglish
Article number77
Number of pages9
JournalBritish Medical Journal
Volume336
Issue number7635
DOIs
Publication statusE-pub ahead of print - 10 Jan 2008

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Hand Disinfection
Masks
Viruses
Case-Control Studies
Meta-Analysis
Randomized Controlled Trials
Confidence Intervals
Quarantine
Numbers Needed To Treat
Social Isolation
Local Anti-Infective Agents
Hygiene
Libraries
Observational Studies
Cohort Studies
Language
Odds Ratio
Costs and Cost Analysis
5-nicotinooxymethyl-alpha-tocopherylnicotinate

Cite this

Jefferson, Tom ; Foxlee, Ruth ; Del Mar, Chris B ; Dooley, Elizabeth ; Ferroni, Eliana ; Hewak, Bill ; Prabhala, Adi ; Nair, Sreekumaran ; Rivetti, A. / Physical interventions to interrupt or reduce the spread of respiratory viruses: Systematic review. In: British Medical Journal. 2008 ; Vol. 336, No. 7635.
@article{038fcc3e97c546bbaf54f56e6cec180a,
title = "Physical interventions to interrupt or reduce the spread of respiratory viruses: Systematic review",
abstract = "Objective To systematically review evidence for the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses.Data extraction Search strategy of the Cochrane Library, Medline, OldMedline, Embase, and CINAHL, without language restriction, for any intervention to prevent transmission of respiratory viruses (isolation, quarantine, social distancing, barriers, personal protection, and hygiene). Study designs were randomised trials, cohort studies, case-control studies, and controlled before and after studies.Data synthesis Of 2300 titles scanned 138 full papers were retrieved, including 49 papers of 51 studies. Study quality was poor for the three randomised controlled trials and most of the cluster randomised controlled trials; the observational studies were of mixed quality. Heterogeneity precluded meta-analysis of most data except that from six case-control studies. The highest quality cluster randomised trials suggest that the spread of respiratory viruses into the community can be prevented by intervening with hygienic measures aimed at younger children. Meta-analysis of six case-control studies suggests that physical measures are highly effective in preventing the spread of SARS: handwashing more than 10 times daily (odds ratio 0.45, 95{\%} confidence interval 0.36 to 0.57; number needed to treat=4, 95{\%} confidence interval 3.65 to 5.52); wearing masks (0.32, 0.25 to 0.40; NNT=6, 4.54 to 8.03); wearing N95 masks (0.09, 0.03 to 0.30; NNT=3, 2.37 to 4.06); wearing gloves (0.43, 0.29 to 0.65; NNT=5, 4.15 to 15.41); wearing gowns (0.23, 0.14 to 0.37; NNT=5, 3.37 to 7.12); and handwashing, masks, gloves, and gowns combined (0.09, 0.02 to 0.35; NNT=3, 2.66 to 4.97). The incremental effect of adding virucidals or antiseptics to normal handwashing to decrease the spread of respiratory disease remains uncertain. The lack of proper evaluation of global measures such as screening at entry ports and social distancing prevent firm conclusions being drawn.Conclusion Routine long term implementation of some physical measures to interrupt or reduce the spread of respiratory viruses might be difficult but many simple and low cost interventions could be useful in reducing the spread.",
author = "Tom Jefferson and Ruth Foxlee and {Del Mar}, {Chris B} and Elizabeth Dooley and Eliana Ferroni and Bill Hewak and Adi Prabhala and Sreekumaran Nair and A. Rivetti",
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Jefferson, T, Foxlee, R, Del Mar, CB, Dooley, E, Ferroni, E, Hewak, B, Prabhala, A, Nair, S & Rivetti, A 2008, 'Physical interventions to interrupt or reduce the spread of respiratory viruses: Systematic review' British Medical Journal, vol. 336, no. 7635, 77. https://doi.org/10.1136/bmj.39393.510347.BE

Physical interventions to interrupt or reduce the spread of respiratory viruses: Systematic review. / Jefferson, Tom; Foxlee, Ruth; Del Mar, Chris B; Dooley, Elizabeth; Ferroni, Eliana; Hewak, Bill; Prabhala, Adi; Nair, Sreekumaran; Rivetti, A.

In: British Medical Journal, Vol. 336, No. 7635, 77, 10.01.2008.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Physical interventions to interrupt or reduce the spread of respiratory viruses: Systematic review

AU - Jefferson, Tom

AU - Foxlee, Ruth

AU - Del Mar, Chris B

AU - Dooley, Elizabeth

AU - Ferroni, Eliana

AU - Hewak, Bill

AU - Prabhala, Adi

AU - Nair, Sreekumaran

AU - Rivetti, A.

PY - 2008/1/10

Y1 - 2008/1/10

N2 - Objective To systematically review evidence for the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses.Data extraction Search strategy of the Cochrane Library, Medline, OldMedline, Embase, and CINAHL, without language restriction, for any intervention to prevent transmission of respiratory viruses (isolation, quarantine, social distancing, barriers, personal protection, and hygiene). Study designs were randomised trials, cohort studies, case-control studies, and controlled before and after studies.Data synthesis Of 2300 titles scanned 138 full papers were retrieved, including 49 papers of 51 studies. Study quality was poor for the three randomised controlled trials and most of the cluster randomised controlled trials; the observational studies were of mixed quality. Heterogeneity precluded meta-analysis of most data except that from six case-control studies. The highest quality cluster randomised trials suggest that the spread of respiratory viruses into the community can be prevented by intervening with hygienic measures aimed at younger children. Meta-analysis of six case-control studies suggests that physical measures are highly effective in preventing the spread of SARS: handwashing more than 10 times daily (odds ratio 0.45, 95% confidence interval 0.36 to 0.57; number needed to treat=4, 95% confidence interval 3.65 to 5.52); wearing masks (0.32, 0.25 to 0.40; NNT=6, 4.54 to 8.03); wearing N95 masks (0.09, 0.03 to 0.30; NNT=3, 2.37 to 4.06); wearing gloves (0.43, 0.29 to 0.65; NNT=5, 4.15 to 15.41); wearing gowns (0.23, 0.14 to 0.37; NNT=5, 3.37 to 7.12); and handwashing, masks, gloves, and gowns combined (0.09, 0.02 to 0.35; NNT=3, 2.66 to 4.97). The incremental effect of adding virucidals or antiseptics to normal handwashing to decrease the spread of respiratory disease remains uncertain. The lack of proper evaluation of global measures such as screening at entry ports and social distancing prevent firm conclusions being drawn.Conclusion Routine long term implementation of some physical measures to interrupt or reduce the spread of respiratory viruses might be difficult but many simple and low cost interventions could be useful in reducing the spread.

AB - Objective To systematically review evidence for the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses.Data extraction Search strategy of the Cochrane Library, Medline, OldMedline, Embase, and CINAHL, without language restriction, for any intervention to prevent transmission of respiratory viruses (isolation, quarantine, social distancing, barriers, personal protection, and hygiene). Study designs were randomised trials, cohort studies, case-control studies, and controlled before and after studies.Data synthesis Of 2300 titles scanned 138 full papers were retrieved, including 49 papers of 51 studies. Study quality was poor for the three randomised controlled trials and most of the cluster randomised controlled trials; the observational studies were of mixed quality. Heterogeneity precluded meta-analysis of most data except that from six case-control studies. The highest quality cluster randomised trials suggest that the spread of respiratory viruses into the community can be prevented by intervening with hygienic measures aimed at younger children. Meta-analysis of six case-control studies suggests that physical measures are highly effective in preventing the spread of SARS: handwashing more than 10 times daily (odds ratio 0.45, 95% confidence interval 0.36 to 0.57; number needed to treat=4, 95% confidence interval 3.65 to 5.52); wearing masks (0.32, 0.25 to 0.40; NNT=6, 4.54 to 8.03); wearing N95 masks (0.09, 0.03 to 0.30; NNT=3, 2.37 to 4.06); wearing gloves (0.43, 0.29 to 0.65; NNT=5, 4.15 to 15.41); wearing gowns (0.23, 0.14 to 0.37; NNT=5, 3.37 to 7.12); and handwashing, masks, gloves, and gowns combined (0.09, 0.02 to 0.35; NNT=3, 2.66 to 4.97). The incremental effect of adding virucidals or antiseptics to normal handwashing to decrease the spread of respiratory disease remains uncertain. The lack of proper evaluation of global measures such as screening at entry ports and social distancing prevent firm conclusions being drawn.Conclusion Routine long term implementation of some physical measures to interrupt or reduce the spread of respiratory viruses might be difficult but many simple and low cost interventions could be useful in reducing the spread.

U2 - 10.1136/bmj.39393.510347.BE

DO - 10.1136/bmj.39393.510347.BE

M3 - Review article

VL - 336

JO - BMJ (Clinical research ed.)

JF - BMJ (Clinical research ed.)

SN - 0959-535X

IS - 7635

M1 - 77

ER -