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Open Access Highly Accessed Research

Hand washing with soap and water together with behavioural recommendations prevents infections in common work environment: an open cluster-randomized trial

Carita Savolainen-Kopra1*, Jaason Haapakoski2, Piia A Peltola3, Thedi Ziegler4, Terttu Korpela4, Pirjo Anttila5, Ali Amiryousefi6, Pentti Huovinen7, Markku Huvinen8, Heikki Noronen9, Pia Riikkala9, Merja Roivainen1, Petri Ruutu10, Juha Teirilä11, Erkki Vartiainen12 and Tapani Hovi14

Author Affiliations

1 National Institute for Health and Welfare (THL), Department of Infectious Disease Surveillance and Control, Intestinal Viruses Unit, P.O. Box 30, FIN-00271 Helsinki, Finland

2 National Institute for Health and Welfare (THL), Information Department, Information Systems Development and Support Unit, Helsinki, Finland

3 National Institute for Health and Welfare (THL), Department of Vaccination and Immune Protection, Vaccine Research Unit, Helsinki, Finland

4 National Institute for Health and Welfare (THL), Department of Vaccination and Immune Protection, Viral Infections Unit, Helsinki, Finland

5 Kesko Oyj, Helsinki, Finland

6 University of Helsinki, Department of Mathematics and Statistics

7 National Institute for Health and Welfare (THL), Division of Health Protection and Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland

8 Outokumpu Oyj and Outotec Oyj, Espoo, Finland

9 Nordea Bank Finland Plc, Helsinki, Finland

10 National Institute for Health and Welfare (THL), Department of Infectious Disease Surveillance and Control

11 SOK, Helsinki, Finland

12 National Institute for Health and Welfare (THL), Division of Welfare and Health Promotion

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Trials 2012, 13:10  doi:10.1186/1745-6215-13-10

Published: 16 January 2012

Abstract

Background

Hand hygiene is considered as an important means of infection control. We explored whether guided hand hygiene together with transmission-limiting behaviour reduces infection episodes and lost days of work in a common work environment in an open cluster-randomized 3-arm intervention trial.

Methods

A total of 21 clusters (683 persons) were randomized to implement hand hygiene with soap and water (257 persons), with alcohol-based hand rub (202 persons), or to serve as a control (224 persons). Participants in both intervention arms also received standardized instructions on how to limit the transmission of infections. The intervention period (16 months) included the emergence of the 2009 influenza pandemic and the subsequent national hand hygiene campaign influencing also the control arm.

Results

In the total follow-up period there was a 6.7% reduction of infection episodes in the soap-and water arm (p = 0.04). Before the onset of the anti-pandemic campaign, a statistically significant (p = 0.002) difference in the mean occurrence of infection episodes was observed between the control (6.0 per year) and the soap-and-water arm (5.0 per year) but not between the control and the alcohol-rub arm (5.6 per year). Neither intervention had a decreasing effect on absence from work.

Conclusions

We conclude that intensified hand hygiene using water and soap together with behavioural recommendations can reduce the occurrence of self-reported acute illnesses in common work environment. Surprisingly, the occurrence of reported sick leaves also increased in the soap-and water-arm.

Trial Registration

ClinicalTrials.gov: NCT00981877

Source of funding

The Finnish Work Environment Fund and the National Institute for Health and Welfare.