摘要：To quantify the effect of hand-hygiene interventions on rates of gastrointestinal and respiratory illnesses and to identify interventions that provide the greatest efficacy, we searched 4 electronic databases for hand-hygiene trials published from January 1960 through May 2007 and conducted meta-analyses to generate pooled rate ratios across interventions (N=30 studies). Improvements in hand hygiene resulted in reductions in gastrointestinal illness of 31% (95% confidence intervals [CI]=19%, 42%) and reductions in respiratory illness of 21% (95% CI=5%, 34%). The most beneficial intervention was hand-hygiene education with use of nonantibacterial soap. Use of antibacterial soap showed little added benefit compared with use of nonantibacterial soap. Hand hygiene is clearly effective against gastrointestinal and, to a lesser extent, respiratory infections. Studies examining hygiene practices during respiratory illness and interventions targeting aerosol transmission are needed. Many studies have reported an association between improvements in hand hygiene and reductions in rates of infectious illnesses in the community. 1 Nevertheless, there are still important questions that must be addressed before guidelines regarding the use of specific interventions for reducing rates of infectious illness in the community can be devised. To our knowledge, a comprehensive meta-analysis comparing the relative effectiveness of specific hand-hygiene interventions used in the community has never been conducted. This makes it difficult to make consistent recommendations to consumers regarding the merit and utility of various hand-hygiene regimens for the prevention of common infectious illnesses. Analysis of the impact of hand-hygiene interventions for reducing infectious illnesses in the community is important for several reasons. First, there has been an explosion in the options and use of hand-hygiene products in the community. 2 Second, hand hygiene is considered an important intervention measure for pandemic public health threats, such as severe acute respiratory syndrome and avian influenza. 3 – 5 Third, research has suggested that there may be risks, including the emergence of antibiotic-resistant bacteria, associated with the use of some hand-hygiene products such as antibacterial soaps. 6 – 9 In this meta-analysis, we assessed the extent to which the published literature has established a benefit of hand-hygiene interventions for the prevention of gastrointestinal and respiratory infectious illnesses. We also identified the specific interventions that provided the greatest potential for reducing these illnesses’ symptoms.
