Efficacy and effectiveness of hand hygiene-related practices used community settings for removal of organisms from hands: A systematic review
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
This systematic review collected and synthesized evidence on the efficacy and effectiveness of commonly used hand hygiene 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. Eligible studies included laboratory and field studies that measured reduction in organisms on hands after washing with hand hygiene products intended for use 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 reduction in organisms on hands were calculated for categories with five or more data points from two or more studies.
Results
Of studies that met inclusion criteria, the majority focused on alcohol-based hand sanitizer (111, 63%) and handwashing with soap and water (110, 62%). Most evidence (66%) assessed bacterial reductions. Commonly used methods showed an overall >2 log reduction in bacteria after handwashing (2.12 [1.91, 2.33] log reduction for soap and water and 3.25 [3.01, 3.49] for alcohol-based sanitizers), but not for viruses (1.57 [1.23, 1.92] for soap and water and 1.72 [1.49, 1.94] for alcohol-based sanitizers).
Conclusions
The ability to draw conclusions on efficacy of types of methods was limited methods and organisms studied. Additional evidence quantifying the impact of handwashing in areas with major gaps in available data – data on viruses (especially enveloped viruses), handwashing alternatives other than alcohol-based sanitizers, drying methods and microbial water quality - would support more evidence-based recommendations.
Funding
This work was supported by the World Health Organization (PO number: 203046633).
PROSPERO registration number
CRD42023429145.
What is already known on this topic
Hand hygiene plays a critical role in preventing the spread of infectious disease, however there is a lack of data describing which methods are most efficacious for handwashing in community setting, particularly for handwashing alternatives and handwashing for viruses. Previous reviews have described the effectiveness of handwashing to prevent disease transmission, however, there has not been a thorough review describing the efficacy of handwashing for removing and inactivating organisms.
What this study adds
This study provides an overview of the current knowledge on handwashing efficacy and demonstrates that there is substantial data to suggest that both handwashing with soap and water and use of alcohol-based hand sanitizers are efficacious for removing bacteria. However, there are gaps in knowledge around the efficacy of hand hygiene practices for removal and inactivation of viruses and for a wider range of handwashing methods that are commonly practiced around the world such as use of soap alternatives like ash and sand.
How this study might affect research practice or policy
Handwashing guidelines across the globe demonstrate inconsistencies and contradictions and lack evidence to support some of the recommended practices. This study provides an overview of the current evidence to support handwashing guidelines and implementation of practices globally and indicates that handwashing with soap and water is typically an efficacious method. However, to formulate strong recommendations for handwashing practices across diverse contexts more data is needed on a wider range of conditions. This review highlights these gaps, including a lack of data on viral pathogens and elements of handwashing practices such as the use of soap alternatives, drying methods, water quality, and timing of washing.
