The potential impact of intensified community hand hygiene interventions on respiratory tract infections: a modelling study
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Abstract
Hand hygiene is among the most fundamental and widely used behavioural measures to reduce the person-to-person spread of human pathogens and its effectiveness as a community intervention is supported by evidence from randomized trials. However, a theoretical understanding of the relationship between hand hygiene frequency and change in risk of infection is lacking. Using a simple model-based framework for understanding the determinants of hand hygiene effectiveness in preventing viral respiratory tract infections, we show that a crucial, but overlooked, determinant of the relationship between hand hygiene frequency and risk of infection via indirect transmission is persistence of viable virus on hands. If persistence is short, as has been reported for influenza, hand-washing needs to be performed very frequently or immediately after hand contamination to substantially reduce the probability of infection. When viable virus survival is longer (e.g. in the presence of mucus or for some enveloped viruses) less frequent hand washing can substantially reduce the infection probability. Immediate hand washing after contamination is consistently more effective than at fixed-time intervals. Our study highlights that recommendations on hand hygiene should be tailored to persistence of viable virus on hands and that more detailed empirical investigations are needed to help optimize this key intervention.
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SciScore for 10.1101/2020.05.26.20113464: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our model has several limitations. Firstly, we specifically modelled indirect transmission routes via hands and did not consider direct droplet and aerosol transmission. To date, there is little known about the relative importance of the various transmission routes of respiratory pathogens [30]. When other routes are considered, the effect of hand hygiene will be reduced. Secondly, there is limited literature on many parameters used in the …
SciScore for 10.1101/2020.05.26.20113464: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our model has several limitations. Firstly, we specifically modelled indirect transmission routes via hands and did not consider direct droplet and aerosol transmission. To date, there is little known about the relative importance of the various transmission routes of respiratory pathogens [30]. When other routes are considered, the effect of hand hygiene will be reduced. Secondly, there is limited literature on many parameters used in the model, which prevents us from making more precise quantitative conclusions. These include the probability of infection with contaminated hands, the survival of pathogens on contaminated hands and infective dose. Furthermore, we modelled all infection events with the same rate of decay, i.e., the same probability of pathogen persistence on the hands. In reality, hand contamination events are likely to be heterogeneous with small droplets persisting only a short amount of time and heavy contamination with mucus decaying at a slower rate. We performed sensitivity analyses with varying parameter values and distributions to ensure our conclusions are robust on a qualitative level.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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