Hand disinfectant or soap What better prevents transmission in the outpatient setting? Hand hygiene is considered an effective intervention in the fight against the transmission of viruses and bacteria that cause respiratory infections. But what helps better to prevent their spread - hand disinfectants or washing hands with soap and water? An Australian research team recently investigated this question in a systematic review with meta-analysis [1]. For this purpose, they included 18 randomised controlled trials: four of themcompared hand disinfectants and soap directly with each other, and 14 assessed both in comparison to a control group. In addition, a doseresponse analysis was conducted to determine the risk of respiratory infection in relation to the frequency of the intervention [1]. Properly applied, both methods contribute to fewer respiratory illnesses Overall, the research team concluded that hand hygiene has a moderate but important role in reducing respiratory disease transmission. Provided interventions are carried out appropriately, both hand disinfection and hand washing with soap can reduce the risk of transmission. However, some evidence from the studies suggested that hand sanitizers may be more effective in practice [1]. While the use of hand disinfectants according to the “5 moments of hand hygiene” has a firm place in health care anyway [2], hand washing with soap and water is usually sufficient in the private sphere. If available, however, hand disinfectants should be used if communicable diseases are known in the environment. This also applies to possible contact with pathogens, when dealing with immunocompromised people and when there is no possibility to wash hands. Direct comparison of hand disinfectant and soap does not yield a clear result The four head-to-head studies that directly compared hand sanitizers with hand washing differed greatly in design. Two two-arm studies found an advantage of hand sanitizers over water andsoap, amounting to a 12% lower rate of absenteeism and a 13% lower risk of respiratory infection in daycare children, respectively [1]. In contrast, two three-arm studies (one in primary schools, one in companies) found no or no significant difference between disinfectant vs. water plus soap [1]. Differences cannot be explained by frequency of intervention BIn the meta-analysis, three studies found a non-significant result with soap and water compared to the control, while disinfectants significantly reduced respiratory infections by 20% (pooled) compared to the control in six studies [1]. However, no clear relationship between dose and effect could be derived from the 11 studies with sufficient information on the frequency of hand hygiene events [1]. Different efficacies of hand disinfectant or soap and water cannot be explained by this. You too can help prevent infections by practising proper hand hygiene. For more information on when to wash your hands and when to disinfect, visit: https://www.sterillium.info/en/stories-hub/hand-hygieneday-2021 https://www.bode-science-center.com/fileadmin/user_ upload/download-en/2022-WHHD-Washing-vs-DisinfectionEN.pdf Sources: 1. Hoffmann T et al. (2021) Soap versus sanitiser for preventing the transmission of acute respiratory infections in the community: a systematic review with meta-analysis and dose-response analysis. BMJ Open;11: e046175. https://doi.org/10.1136/bmjopen-2020-046175 2. WHO (2009) WHO Guidelines on Hand Hygiene in Health Care. 10 9 8 7 6 5 4 3 2 1 0 Sources considered in the review [1] Number of studies SSoap vs. control Hand disinfectant vs. control Head-to-head comparisons soap vs. hand disinfectant (vs. control) 5 9 4 KNOWLEDGE 8
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