Is Hand Hygiene Linked to Health Benefits in the Community in Developed Countries? pp. 181-213
Authors: (Thea F. van de Mortel, School of Health and Human Sciences, Southern Cross University, Australia)
Abstract: Mortality rates from infectious diseases have declined dramatically in developed countries over the last century, largely due to improvements in nutrition, sanitation, and vaccination, and to the development of effective antimicrobials. Research has demonstrated that hands can be contaminated by pathogens, and that washing hands or using a waterless hand sanitizer can reduce that microbial contamination. Increased frequency of hand hygiene in homes, child care facilities, schools, and workplaces is therefore hypothesized to reduce infectious illness in the community, thus reducing morbidity and mortality and improving productivity as well as providing both a health and a cost benefit to the community. There is some evidence to support this hypothesis in the developing world, where infectious illnesses are very common and a major source of morbidity and mortality for the population, particularly for children. However, in a modern society that has proper sanitation, clean water, plentiful food and access to good health care, does increased hand hygiene frequency or the use of antimicrobial hand hygiene solutions significantly improve health and reduce costs in the community outside of the hospital setting? Various studies have examined infectious illness and/or illness absenteeism outcomes in response to hand hygiene programs in first world homes, child care facilities, elementary schools, colleges and some workplaces, with effects ranging from a lack of significant improvement to reductions in illness and illness absenteeism of up to 50%. However, the studies are often confounded by poor research design, including lack of randomisation and blinding, failure to calculate sample sizes and power, failure to analyse on the basis of intention to treat, and failure to take clustering into account when calculating sample sizes and analysing data, most of which have a tendency to increase the chance of spurious positive findings. Reductions in mild infectious illnesses, such as colds, must also be offset against possible adverse effects of frequent hand hygiene such as skin damage and the increased risk of atopy in children exposed to a very hygienic environment in early life. This chapter will discuss the relative benefits and costs of hand hygiene programs in developed countries in the community setting and make some suggestions on the design and analysis of future programs.
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