March 31, 2023

Mar 4, 2023
Hand hygiene is likely to modestly reduce the burden of respiratory illness,

Harms associated with physical interventions were under‐investigated

There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations,

as well as the impact of adherence on effectiveness,

especially in those most at risk of ARIs.
Physical measures, prevent respiratory viruses spreading between people

Washing hands often

RCTs on hand washing
= 19

N = 71,210

Wearing masks, eye protection, gloves, and protective gowns

RCTs on masks = 78

No RCTs on gowns and gloves

Wiping surfaces with disinfectant

6 trials

Avoiding contact with other people (isolation or quarantine)

3 RCTs

Not touching your eyes, nose, or mouth


Sneezing or coughing into your elbow


Keeping a certain distance away from other people (distancing)

Examining people entering a country for signs of infection (screening)

No RCTs on examining people on entry

Hand hygiene interventions versus controls (i.e. no intervention)

Pooling for the broad outcome of ARI

14% relative reduction in the number of people with ARIs in the hand hygiene group

RR 0.86, (0.81 to 0.90)

9 trials, n = 52,105

moderate‐certainty evidence,

suggesting a probable benefit.

In absolute terms

A reduction from 380 events per 1000 people,

to 327 per 1000 people.

Using more strictly defined outcomes of ILI

Estimates of effect for ILI

RR 0.94

11 trials, n = 34,503

low‐certainty evidence

Beneficial effect was not statistically significant if ILI,

and laboratory-confirmed ILI were analysed separately

Laboratory‐confirmed influenza

RR 0.91

8 trials, n = 8,332

low‐certainty evidence,

suggest the intervention made little or no difference.

Composite (pooled) outcome ARI or ILI or influenza

Hand hygiene may be beneficial with an 11% relative reduction of respiratory illness

RR 0.89

low‐certainty evidence

In absolute terms

This benefit would result in a reduction from 200 events per 1000 people,

to 178 per 1000 people

Few trials measured and reported harms

very low‐certainty evidence.

Surface/object disinfection compared to control

Numbers of cases of viral respiratory illness (ARIs, ILI, confirmed influenza)

Six trials

A significant reduction in ARI in the intervention group

OR 0.47 (53% benefit)

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