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Allison E. Aiello, PhD, Rebecca M. Coulborn, BS, Vanessa Perez, MS and Elaine L. Larson, PhD, RN

Allison E. Aiello, Rebecca M. Coulborn, and Vanessa Perez are with the Department of Epidemiology and Center for Social Epidemiology & Population Health, School of Public Health, University of Michigan, Ann Arbor. Elaine L. Larson is with the School of Nursing and the Mailman School of Public Health, Columbia University, New York, NY.

Correspondence: Requests for reprints should be sent to Allison E. Aiello, Assistant Professor of Epidemiology, Department of Epidemiology, Center for Social Epidemiology & Population Health, University of Michigan–School of Public Health, 3659 SPH Tower, 109 Observatory, Ann Arbor, MI 48109-2029 (e-mail: aielloa{at}umich.edu).

To quantify the effect of hand-hygiene interventions on rates of gastrointestinal and respiratory illnesses and to identify interventions that provide the greatest efficacy, we searched 4 electronic databases for hand-hygiene trials published from January 1960 through May 2007 and conducted meta-analyses to generate pooled rate ratios across interventions (N=30 studies).

Improvements in hand hygiene resulted in reductions in gastrointestinal illness of 31% (95% confidence intervals [CI]=19%, 42%) and reductions in respiratory illness of 21% (95% CI=5%, 34%). The most beneficial intervention was hand-hygiene education with use of nonantibacterial soap. Use of antibacterial soap showed little added benefit compared with use of nonantibacterial soap.

Hand hygiene is clearly effective against gastrointestinal and, to a lesser extent, respiratory infections. Studies examining hygiene practices during respiratory illness and interventions targeting aerosol transmission are needed.

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