The Operating Theatre Journal - Journal - Page 4
Handwashing during ‘normal times’ can reduce
burden of respiratory disease
New research published in The Lancet reinforces the idea that handwashing outside of pandemic times is vital
in order to reduce the burden of common colds and flu in low- and middle-income countries.
Analysis of studies involving 160,000 people across three continents reinforces message that handwashing is not just for pandemics.
Handwashing with soap can reduce
cases of acute respiratory infection (ARI)
in low- and middle-income countries
(LMICs) by as much as 17%, according to a
review published in The Lancet.
These findings, from one of the largest
known meta-analyses to date on this topic,
highlighted what the research team call a
‘missed opportunity’ to reduce the burden of
respiratory disease. The research, funded in
part by the Reckitt Global Hygiene Institute
(RGHI), reinforces the idea that efforts to
encourage frequent and adequate hand
hygiene must continue outside of pandemics.
“This research is the crystallisation of a
message many in the global health space
have been trying to spread for years: hand
hygiene is not just something to be aware of
during times of outbreaks but at all times.
Without it, people get sick unnecessarily
and even die. The majority of those deaths
are taking place in the world’s poorest
countries,” said David Wheeler, Operations
and Strategy Director, RGHI.
ARIs are infections of the respiratory tract
by viruses or bacteria that affect breathing.
They can be categorised into two types,
upper (URI) or lower (LRI), depending on the
location of infection either above or below
the voice box, respectively. Examples of
ARIs include the common cold, influenza and
pneumonia.
Recently the virus SARS-CoV-2 (responsible
for COVID-19, an ARI) led governments
worldwide to recommend public health
measures including handwashing with soap to
combat infection.
Whilst COVID-19 has drawn unprecedented
attention, endemic ARIs remain a leading
cause of mortality worldwide. Globally, ARIs
are responsible for as many as 2.5 million
deaths in 2019; with over 80% of these
deaths occurring in low and middle-income
countries.
Previous meta-analyses investigated the
impact of handwashing with soap on ARIs
but analyses have been limited in scope
(including only certain study designs), have
rarely focused on LMICs where the burden is
highest or have examined only viral ARIs.
In this review, the team – drawn from
the London School of Hygiene & Tropical
Medicine (LSHTM) as well as the World
Health Organisation and other universities –
analysed 26 studies investigating the impact
of interventions promoting handwashing with
soap in domestic, school or childcare settings
in LMICs on morbidity from ARIs.
These studies included a total of 160,000
participants from across Asia, Africa and
Latin America between the early 2000s
and May 2021, with eligible interventions
ranging from providing adequate facilities
and products, to promoting their use via mass
media campaigns or door-to-door visits.
Overall, interventions promoting handwashing
with soap were responsible for reducing the
morbidity, or burden, of ARI by 17% compared
to when no handwashing intervention was
implicated. Broken down by type of ARI,
interventions reduced LRI burden by 22%
and URI by 26%, although the team found no
evidence for their effect on test-confirmed
influenza. No included studies measured a
COVID-19 outcome.
Lead author Dr Ian Ross, from LSHTM, said:
“Today, the UN estimates that 1.8
billion people lack access to a water
tap in their home or yard. Our results
show what might be achieved with
sustained government action to promote
handwashing and ensure universal access
to the underlying infrastructure of water
supply and soap.”
In 2019, 2.5 million people died from acute
respiratory infections (ARIs) – which include
the flu, pneumococcal disease, and colds –
marking them as a leading cause of morbidity
and mortality. Over 80% of those deaths took
place in LMICs – such as Afghanistan, Yemen
and Egypt – where 27% of people don’t have
a water supply in their home making hand
washing a luxury. Around the world 1 in 3
people still lack what they need to wash their
hands with soap.
The need for frequent and thorough hand
washing was a key prevention method
encouraged globally throughout the COVID-19
pandemic yet, according to the researchers,
handwashing campaigns in ‘normal times’
are “rare” despite being a critical deterrent
against a variety of other illnesses including
gastrointestinal infections and norovirus
alongside ARIs.
“Since cases of COVID-19 have decreased,
so too has the enthusiasm for hygiene yet
it is vital in fighting these more common
illnesses. The report’s findings should
serve as a catalyst for action in this regard,
reinvigorating what have become stagnant
efforts to invest in and promote hand hygiene
globally,” David Wheeler commented.
“Better hygiene will lead to fewer cases of
illness and death whilst helping to avoid
missed days of school for children and of
work for adults. All of this will bolster
countries’ economies; many of which have
been waning in the wake of COVID-19 and
other global events. This latest research is
more evidence of how something as simple
as keeping hands clean can safeguard public
health and can help decision-makers as they
think about their health budgets and the
initiatives they’re investing in.” said Dave
Wheeler.
RGHI’s focus is on generating a significant
body of science-based research pertaining
to hygiene behaviours and their impact so
that leaders can make more evidence-based
decisions around public health.
In this latest paper, researchers have called
for decision-makers to more extensively
promote handwashing measures whilst
investing in water supply and handwashing
facilities.
“Our results show what might be achieved
with sustained government action to promote
handwashing and ensure universal access to
the underlying infrastructure of water supply
and soap,” said Dr Ian Ross, lead author and
assistant professor of health economics at
LSHTM.
The paper contributes to the Lancet
Commission on Water, Sanitation and Hygiene
(WASH) and Health, involving experts from
LSHTM. Further information about the
Commission can be found here:
https://www.thelancet.com/journals/lancet/
article/PIIS0140-6736(21)02005-5/fulltext
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