Stephen P Hilton, Nick H An, Lilly A O'Brien, Jedidiah S Snyder, Hannah K Rogers, Oliver Cumming, Joanna Esteves Mills, Bruce Gordon, Matthew C Freeman, Bethany A Caruso, Marlene K Wolfe
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引用次数: 0
Abstract
Background: 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 log10 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 log10 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 log10 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.
背景：本系统综述收集和综合了社区环境中常用的手卫生材料和去除或灭活手部病原体的方法的功效和有效性的证据。产生这些证据是为了支持世卫组织《社区环境中手部卫生指南》的制定。方法：我们检索PubMed、Web of Science、EMBASE、CINAHL、Global Health、Cochrane Library、Global Index Medicus、Scopus、PAIS Index、WHO IRIS、UN Digital Library和World Bank Library，并于2023年3月咨询专家，检索1980年1月1日至2023年3月29日发表的研究。符合条件的研究包括实验室和实地研究，测量在社区环境中洗手后手上微生物的减少；排除了医疗保健设置。两名审稿人独立地从每项研究中提取数据；使用混合方法评估工具和基于实验室的质量评估工具评估偏倚风险。从两个或两个以上的研究中获得5个或更多数据点的分类，计算出手上的生物减少log10的总结结果。结果：在符合纳入标准的177项研究中，大多数集中在含酒精的洗手液（111,63%）和用肥皂和水洗手（110,62%）。大多数证据（119.67%）评估了细菌的减少，只有7项（4%）研究涉及包膜病毒。在所有研究中，用肥皂和水洗手后，细菌减少了2.19 (95% CI 1.5至2.87)，或用含酒精的洗手液洗手后，细菌减少了3.13 (95% CI 2.7至3.56)，用肥皂和水洗手后，病毒减少了2.03 （95% CI 1.45至2.62）。然而，使用含酒精的消毒液的病毒感染率降低了10% （1.86 (95% CI 1.37至2.35)）。结论：由于对细菌、肥皂、水和酒精类消毒液的关注，比较不同材料和方法的功效的能力受到限制。量化洗手对病毒（特别是包膜病毒）的影响、除含酒精消毒剂以外的洗手替代品、干燥方法和微生物水质，以及许多此类产品在现场的有效性的更多证据，将支持更多以证据为基础的建议。普洛斯彼罗注册号：CRD42023429145。
期刊介绍：
BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.
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