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Is Hand Hygiene Linked to Health Benefits in the Community in Developed Countries? pp. 181-213 $0.00
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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Is Hand Hygiene Linked to Health Benefits in the Community in Developed Countries? pp. 181-213