Efficacy and effectiveness of hand hygiene-related practices used in community settings for removal of organisms from hands: a systematic review
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This systematic review collected and synthesised evidence on the efficacy and effectiveness of commonly used hand hygiene materials and methods for removing or inactivating pathogens on hands in community settings. The evidence was generated to support the development of the WHO Guidelines for Hand Hygiene in Community Settings.
Methods
We searched PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, PAIS Index, WHO IRIS, UN Digital Library and World Bank eLibrary, and consulted experts in March 2023 for studies published between 1 January 1980 and 29 March 2023. Eligible studies included laboratory and field studies measuring reduction in organisms on hands after washing as intended in community settings; healthcare settings were excluded. Two reviewers independently extracted data from each study; risk of bias was assessed using the Mixed Method Appraisal Tool and a laboratory-based quality assessment tool. Summary results in terms of log 10 reduction in organisms on hands were calculated for categories with five or more data points from two or more studies.
Results
Of 177 studies that met inclusion criteria, the majority focused on alcohol-based hand sanitiser (111, 63%) and handwashing with soap and water (110, 62%). Most evidence (119, 67%) assessed bacterial reductions and only 7 (4%) studies addressed enveloped viruses. Across studies, there was a >2 log 10 reduction in bacteria after handwashing with soap and water (2.19 (95% CI 1.5 to 2.87)) or alcohol-based sanitisers (3.13 (95% CI 2.7 to 3.56)), and for viruses after handwashing with soap and water (2.03 (95% CI 1.45 to 2.62)). However, there was a <2 log 10 reduction for viruses with alcohol-based sanitisers (1.86 (95% CI 1.37 to 2.35)).
Conclusions
The ability to compare efficacy across materials and methods was limited due to the focus on bacteria and soap and water and alcohol-based sanitisers. Additional evidence quantifying the impact of handwashing on viruses (especially enveloped viruses), handwashing alternatives other than alcohol-based sanitisers, drying methods and microbial water quality, as well as the effectiveness of many of these products in the field would support more evidence-based recommendations.
PROSPERO registration number
CRD42023429145.
