Article Text

Systematic review
Simple physical interventions such as handwashing and wearing masks can reduce spread of epidemic respiratory viruses
  1. Mary Lou Manning
  1. Mary Lou Manning
    Doctor of Nursing Practice Program, Thomas Jefferson University, Jefferson School of Nursing, 130 South 9th Street, Room 1230C, Philadelphia, PA 19107, USA; Mary.manning{at}

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The nature of infection prevention and control is changing rapidly, and clinicians working in the field are expected to lead the implementation of evidence-based interventions to interrupt, reduce or eliminate the spread of infections. The novel influenza A (H1N1) pandemic and the coronavirus outbreak that caused severe acute respiratory syndrome have placed viral infection prevention and control centre stage, be it in primary care, acute care, home care, long-term care or other care facilities, the community, schools or households. No less important is prevention and control of the more common viruses that cause acute respiratory tract infections.

The systematic review by Jefferson and colleagues provides a timely and informative evidentiary update of the previous review1 of the effectiveness of non- pharmaceutical interventions to interrupt or reduce respiratory virus transmission. Fifty-eight studies were reviewed, leading the authors to conclude again that simple and low-cost interventions, including hand hygiene and the wearing of masks, gowns and gloves, either as a single intervention or combined, are highly effective in interrupting transmission of a broad range of respiratory viruses.

The authors acknowledge limitations of the evidence as a result of methodological flaws and the commonly ignored variability in incidence of viruses. The US Centers for Disease Control and Prevention advises that annual influenza vaccination is the most effective method for preventing seasonal influenza,2 as is the H1N1 vaccine for preventing novel influenza A.3 However, the achievement of substantial vaccination rates is hindered by vaccine shortages, inconsistent supply and patient refusal. Recently, the effectiveness of neuraminidase inhibitors against the symptoms of influenza in healthy adults has been called into question.4 How widespread is the use of vaccines and antiviral agents as the primary pandemic intervention is yet to be known and the availability of both agents is inconsistent. What is known is that simple physical interventions appear to prevent transmission of respiratory viruses. Starting with hand hygiene, such interventions should be a major component of all infection prevention and control plans. Resistance to the use of such measures is foolhardy.

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  • Competing interests None.

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