Soap versus sanitiser for preventing the transmission of acute respiratory infections in the community: a systematic review with meta-analysis and dose-response analysis

Tammy Hoffmann; Mina Bakhit; Natalia Krzyzaniak; Chris Del Mar; Anna Mae Scott; Paul Glasziou

doi:10.1136/bmjopen-2020-046175

Soap versus sanitiser for preventing the transmission of acute respiratory infections in the community: a systematic review with meta-analysis and dose-response analysis

Tammy Hoffmann, Mina Bakhit, Natalia Krzyzaniak, Chris Del Mar, Anna Mae Scott, Paul Glasziou

Institute for Evidence-Based Healthcare

Research output: Contribution to journal › Review article › Research › peer-review

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Abstract

OBJECTIVE: To compare the effectiveness of hand hygiene using alcohol-based hand sanitiser to soap and water for preventing the transmission of acute respiratory infections (ARIs) and to assess the relationship between the dose of hand hygiene and the number of ARI, influenza-like illness (ILI) or influenza events.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and trial registries were searched in April 2020.

INCLUSION CRITERIA: We included randomised controlled trials that compared a community-based hand hygiene intervention (soap and water, or sanitiser) with a control, or trials that compared sanitiser with soap and water, and measured outcomes of ARI, ILI or laboratory-confirmed influenza or related consequences.

DATA EXTRACTION AND ANALYSIS: Two review authors independently screened the titles and abstracts for inclusion and extracted data.

RESULTS: Eighteen trials were included. When meta-analysed, three trials of soap and water versus control found a non-significant increase in ARI events (risk ratio (RR) 1.23, 95% CI 0.78 to 1.93); six trials of sanitiser versus control found a significant reduction in ARI events (RR 0.80, 95% CI 0.71 to 0.89). When hand hygiene dose was plotted against ARI relative risk, no clear dose-response relationship was observable. Four trials were head-to-head comparisons of sanitiser and soap and water but too heterogeneous to pool: two found a significantly greater reduction in the sanitiser group compared with the soap group and two found no significant difference between the intervention arms.

CONCLUSIONS: Adequately performed hand hygiene, with either soap or sanitiser, reduces the risk of ARI virus transmission; however, direct and indirect evidence suggest sanitiser might be more effective in practice.

Original language	English
Article number	e046175
Journal	BMJ Open
Volume	11
Issue number	8
DOIs	https://doi.org/10.1136/bmjopen-2020-046175
Publication status	Published - 18 Aug 2021

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10.1136/bmjopen-2020-046175Licence: CC BY-NC

Soap versus sanitiser for preventing the transmission of acute respiratory infections in the community: a systematic review with meta-analysis and dose–response analysis Final published version, 2.64 MBLicence: CC BY-NC

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title = "Soap versus sanitiser for preventing the transmission of acute respiratory infections in the community: a systematic review with meta-analysis and dose-response analysis",

abstract = "OBJECTIVE: To compare the effectiveness of hand hygiene using alcohol-based hand sanitiser to soap and water for preventing the transmission of acute respiratory infections (ARIs) and to assess the relationship between the dose of hand hygiene and the number of ARI, influenza-like illness (ILI) or influenza events.DESIGN: Systematic review and meta-analysis.DATA SOURCES: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and trial registries were searched in April 2020.INCLUSION CRITERIA: We included randomised controlled trials that compared a community-based hand hygiene intervention (soap and water, or sanitiser) with a control, or trials that compared sanitiser with soap and water, and measured outcomes of ARI, ILI or laboratory-confirmed influenza or related consequences.DATA EXTRACTION AND ANALYSIS: Two review authors independently screened the titles and abstracts for inclusion and extracted data.RESULTS: Eighteen trials were included. When meta-analysed, three trials of soap and water versus control found a non-significant increase in ARI events (risk ratio (RR) 1.23, 95% CI 0.78 to 1.93); six trials of sanitiser versus control found a significant reduction in ARI events (RR 0.80, 95% CI 0.71 to 0.89). When hand hygiene dose was plotted against ARI relative risk, no clear dose-response relationship was observable. Four trials were head-to-head comparisons of sanitiser and soap and water but too heterogeneous to pool: two found a significantly greater reduction in the sanitiser group compared with the soap group and two found no significant difference between the intervention arms.CONCLUSIONS: Adequately performed hand hygiene, with either soap or sanitiser, reduces the risk of ARI virus transmission; however, direct and indirect evidence suggest sanitiser might be more effective in practice.",

author = "Tammy Hoffmann and Mina Bakhit and Natalia Krzyzaniak and {Del Mar}, Chris and Scott, {Anna Mae} and Paul Glasziou",

year = "2021",

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doi = "10.1136/bmjopen-2020-046175",

language = "English",

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T1 - Soap versus sanitiser for preventing the transmission of acute respiratory infections in the community: a systematic review with meta-analysis and dose-response analysis

AU - Hoffmann, Tammy

AU - Bakhit, Mina

AU - Krzyzaniak, Natalia

AU - Del Mar, Chris

AU - Scott, Anna Mae

AU - Glasziou, Paul

PY - 2021/8/18

Y1 - 2021/8/18

N2 - OBJECTIVE: To compare the effectiveness of hand hygiene using alcohol-based hand sanitiser to soap and water for preventing the transmission of acute respiratory infections (ARIs) and to assess the relationship between the dose of hand hygiene and the number of ARI, influenza-like illness (ILI) or influenza events.DESIGN: Systematic review and meta-analysis.DATA SOURCES: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and trial registries were searched in April 2020.INCLUSION CRITERIA: We included randomised controlled trials that compared a community-based hand hygiene intervention (soap and water, or sanitiser) with a control, or trials that compared sanitiser with soap and water, and measured outcomes of ARI, ILI or laboratory-confirmed influenza or related consequences.DATA EXTRACTION AND ANALYSIS: Two review authors independently screened the titles and abstracts for inclusion and extracted data.RESULTS: Eighteen trials were included. When meta-analysed, three trials of soap and water versus control found a non-significant increase in ARI events (risk ratio (RR) 1.23, 95% CI 0.78 to 1.93); six trials of sanitiser versus control found a significant reduction in ARI events (RR 0.80, 95% CI 0.71 to 0.89). When hand hygiene dose was plotted against ARI relative risk, no clear dose-response relationship was observable. Four trials were head-to-head comparisons of sanitiser and soap and water but too heterogeneous to pool: two found a significantly greater reduction in the sanitiser group compared with the soap group and two found no significant difference between the intervention arms.CONCLUSIONS: Adequately performed hand hygiene, with either soap or sanitiser, reduces the risk of ARI virus transmission; however, direct and indirect evidence suggest sanitiser might be more effective in practice.

AB - OBJECTIVE: To compare the effectiveness of hand hygiene using alcohol-based hand sanitiser to soap and water for preventing the transmission of acute respiratory infections (ARIs) and to assess the relationship between the dose of hand hygiene and the number of ARI, influenza-like illness (ILI) or influenza events.DESIGN: Systematic review and meta-analysis.DATA SOURCES: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and trial registries were searched in April 2020.INCLUSION CRITERIA: We included randomised controlled trials that compared a community-based hand hygiene intervention (soap and water, or sanitiser) with a control, or trials that compared sanitiser with soap and water, and measured outcomes of ARI, ILI or laboratory-confirmed influenza or related consequences.DATA EXTRACTION AND ANALYSIS: Two review authors independently screened the titles and abstracts for inclusion and extracted data.RESULTS: Eighteen trials were included. When meta-analysed, three trials of soap and water versus control found a non-significant increase in ARI events (risk ratio (RR) 1.23, 95% CI 0.78 to 1.93); six trials of sanitiser versus control found a significant reduction in ARI events (RR 0.80, 95% CI 0.71 to 0.89). When hand hygiene dose was plotted against ARI relative risk, no clear dose-response relationship was observable. Four trials were head-to-head comparisons of sanitiser and soap and water but too heterogeneous to pool: two found a significantly greater reduction in the sanitiser group compared with the soap group and two found no significant difference between the intervention arms.CONCLUSIONS: Adequately performed hand hygiene, with either soap or sanitiser, reduces the risk of ARI virus transmission; however, direct and indirect evidence suggest sanitiser might be more effective in practice.

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U2 - 10.1136/bmjopen-2020-046175

DO - 10.1136/bmjopen-2020-046175

M3 - Review article

C2 - 34408031

SN - 2044-6055

VL - 11

JO - BMJ Open

JF - BMJ Open

IS - 8

M1 - e046175

ER -

Soap versus sanitiser for preventing the transmission of acute respiratory infections in the community: a systematic review with meta-analysis and dose-response analysis

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