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. 2023 Jan 30;1(1):CD006207.
doi: 10.1002/14651858.CD006207.pub6.

Physical interventions to interrupt or reduce the spread of respiratory viruses

Tom Jefferson  1 , Liz Dooley  2 , Eliana Ferroni  3 , Lubna A Al-Ansary  4 , Mieke L van Driel  5   6 , Ghada A Bawazeer  7 , Mark A Jones  2 , Tammy C Hoffmann  2 , Justin Clark  2 , Elaine M Beller  2 , Paul P Glasziou  2 , John M Conly  8   9   10
Affiliations

Physical interventions to interrupt or reduce the spread of respiratory viruses

Tom Jefferson et al. Cochrane Database Syst Rev. .

Abstract

Background: Viral epidemics or pandemics of acute respiratory infections (ARIs) pose a global threat. Examples are influenza (H1N1) caused by the H1N1pdm09 virus in 2009, severe acute respiratory syndrome (SARS) in 2003, and coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 in 2019. Antiviral drugs and vaccines may be insufficient to prevent their spread. This is an update of a Cochrane Review last published in 2020. We include results from studies from the current COVID-19 pandemic.

Objectives: To assess the effectiveness of physical interventions to interrupt or reduce the spread of acute respiratory viruses.

Search methods: We searched CENTRAL, PubMed, Embase, CINAHL, and two trials registers in October 2022, with backwards and forwards citation analysis on the new studies.

Selection criteria: We included randomised controlled trials (RCTs) and cluster-RCTs investigating physical interventions (screening at entry ports, isolation, quarantine, physical distancing, personal protection, hand hygiene, face masks, glasses, and gargling) to prevent respiratory virus transmission. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures.

Main results: We included 11 new RCTs and cluster-RCTs (610,872 participants) in this update, bringing the total number of RCTs to 78. Six of the new trials were conducted during the COVID-19 pandemic; two from Mexico, and one each from Denmark, Bangladesh, England, and Norway. We identified four ongoing studies, of which one is completed, but unreported, evaluating masks concurrent with the COVID-19 pandemic. Many studies were conducted during non-epidemic influenza periods. Several were conducted during the 2009 H1N1 influenza pandemic, and others in epidemic influenza seasons up to 2016. Therefore, many studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID-19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high-income countries; crowded inner city settings in low-income countries; and an immigrant neighbourhood in a high-income country. Adherence with interventions was low in many studies. The risk of bias for the RCTs and cluster-RCTs was mostly high or unclear. Medical/surgical masks compared to no masks We included 12 trials (10 cluster-RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and 10 in the community). Wearing masks in the community probably makes little or no difference to the outcome of influenza-like illness (ILI)/COVID-19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate-certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory-confirmed influenza/SARS-CoV-2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate-certainty evidence). Harms were rarely measured and poorly reported (very low-certainty evidence). N95/P2 respirators compared to medical/surgical masks We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). We are very uncertain on the effects of N95/P2 respirators compared with medical/surgical masks on the outcome of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; 3 trials, 7779 participants; very low-certainty evidence). N95/P2 respirators compared with medical/surgical masks may be effective for ILI (RR 0.82, 95% CI 0.66 to 1.03; 5 trials, 8407 participants; low-certainty evidence). Evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory-confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; 5 trials, 8407 participants; moderate-certainty evidence). Restricting pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies (very low-certainty evidence). One previously reported ongoing RCT has now been published and observed that medical/surgical masks were non-inferior to N95 respirators in a large study of 1009 healthcare workers in four countries providing direct care to COVID-19 patients. Hand hygiene compared to control Nineteen trials compared hand hygiene interventions with controls with sufficient data to include in meta-analyses. Settings included schools, childcare centres and homes. Comparing hand hygiene interventions with controls (i.e. no intervention), there was a 14% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.86, 95% CI 0.81 to 0.90; 9 trials, 52,105 participants; moderate-certainty evidence), suggesting a probable benefit. In absolute terms this benefit would result in a reduction from 380 events per 1000 people to 327 per 1000 people (95% CI 308 to 342). When considering the more strictly defined outcomes of ILI and laboratory-confirmed influenza, the estimates of effect for ILI (RR 0.94, 95% CI 0.81 to 1.09; 11 trials, 34,503 participants; low-certainty evidence), and laboratory-confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials, 8332 participants; low-certainty evidence), suggest the intervention made little or no difference. We pooled 19 trials (71, 210 participants) for the composite outcome of ARI or ILI or influenza, with each study only contributing once and the most comprehensive outcome reported. Pooled data showed that hand hygiene may be beneficial with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.83 to 0.94; low-certainty evidence), but with high heterogeneity. In absolute terms this benefit would result in a reduction from 200 events per 1000 people to 178 per 1000 people (95% CI 166 to 188). Few trials measured and reported harms (very low-certainty evidence). We found no RCTs on gowns and gloves, face shields, or screening at entry ports.

Authors' conclusions: The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. There were additional RCTs during the pandemic related to physical interventions but a relative paucity given the importance of the question of masking and its relative effectiveness and the concomitant measures of mask adherence which would be highly relevant to the measurement of effectiveness, especially in the elderly and in young children. There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory-confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under-investigated. There is a need for large, well-designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs.

Trial registration: ClinicalTrials.gov NCT00490633 NCT01158560 NCT01105767 NCT01339845 NCT01249625 NCT00880659 NCT00821509 NCT00833885 NCT0099375.

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Conflict of interest statement

LAA: has declared that they have no conflict of interest. GAB: reports working at King Saud University, Medical City, Riyadh, Saudi Arabia as clinical faculty in the College of Pharmacy, collaborating with pharmacy services to provide clinical pharmacy services in primary care clinics (non‐paid). EMB: has declared that they have no conflict of interest. JC: is an Information Specialist at the Cochrane Acute Respiratory Infections Group but was not involved in the editorial process for this review. JMC: has held or holds peer reviewed grants from the Canadian Institutes for Health Research (CIHR) on acute and primary care preparedness for COVID‐19 in Alberta, Canada and has received components of funding from a CIHR funded study via McMaster University for a randomised trial of medical masks versus N95 respirators for preventing COVID‐19 amongst healthcare workers. He has also been engaged in WHO funded studies using integrated human factors and ethnography approaches to identify and scale innovative IPC guidance implementation supports in primary care with a focus on low‐resource settings and using drone aerial systems to deliver medical supplies and PPE to remote First Nations communities during the COVID‐19 pandemic and was the primary local Investigator for a Staphylococcus aureus vaccine study funded by Pfizer for which all funding was provided only to the University of Calgary. He has received travel support from the Centers for Disease Control and Prevention (CDC) to attend an Infection Control Think Tank Meeting and from bioMerieux Canada to speak at a symposium on antimicrobial resistance co‐hosted by the University of Toronto and bioMerieux Canada. He also reports being a member and Chair of the WHO Infection Prevention and Control Research and Development Expert Group for COVID‐19 and reports being a member of the WHO Health Emergencies Programme (WHE) Ad‐hoc COVID‐19 IPC Guidance Development Group, both of which provide multidisciplinary advice to the WHO, for which no funding is received and from which no funding recommendations are made for any WHO contracts or grants. He reports declaring an opinion on topics in this review in Clinical Microbiology and Infection and Antimicrobial Resistance and Infection Control; reports being engaged as a co‐author on a randomised trial of medical masks versus N95 respirators for preventing COVID‐19 amongst healthcare workers published in the Annals of Internal Medicine in 2022 and mentioned in this current Cochrane Review, but no extraction or risk of bias assessment or data pooling or other assessment was undertaken by him nor will it be in any future updates. He has also been a member of the W21C since 2004 and served as its Medical Director from 2012‐2022. W21C is a not‐for‐profit healthcare systems research and innovation initiative based in the University of Calgary’s O'Brien Institute for Public Health and the Calgary Zone of Alberta Health Services. He reports working as an Infectious Diseases Consultant at Alberta Health Services, Calgary, Canada. LD: is a Managing Editor at the Cochrane Acute Respiratory Infections Group but was not involved in the editorial process for this review. EF: has declared that they have no conflict of interest. PG: reports a grant from the National Health and Medical Research Council, Australia. TH: is a member of the Cochrane Stroke Group Editorial Board but was not involved in the editorial process for this review. TJ: reports declaring an opinion on the topic of the review in articles for popular media. TJ is an Editor at the Cochrane Acute Respiratory Infections Group but was not involved in the editorial process for this review. See full statement here: https://restoringtrials.org/competing-interests-tom-jefferson/ MAJ: reports a grant from the National Institute for Health Research, UK. MAJ is Co‐ordinating Editor at the Cochrane Acute Respiratory Infections Group but was not involved in the editorial process for this review. MLvD: reports being a primary care panel member for the National COVID‐19 Clinical Evidence Taskforce, Australia. MLvD is Deputy Co‐ordinating Editor at the Cochrane Acute Respiratory Infections Group but was not involved in the editorial process for this review.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included trials.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included trial.
4
4
1.1
1.1. Analysis
Comparison 1: Randomised trials: medical/surgical masks versus no masks, Outcome 1: Viral illness
2.1
2.1. Analysis
Comparison 2: Randomised trials: N95 respirators compared to medical/surgical masks, Outcome 1: Viral illness
2.2
2.2. Analysis
Comparison 2: Randomised trials: N95 respirators compared to medical/surgical masks, Outcome 2: Viral illness in healthcare workers
3.1
3.1. Analysis
Comparison 3: Randomised trials: hand hygiene compared to control, Outcome 1: Viral illness
3.2
3.2. Analysis
Comparison 3: Randomised trials: hand hygiene compared to control, Outcome 2: ARI or ILI or influenza (including outcome with most events from each study)
3.3
3.3. Analysis
Comparison 3: Randomised trials: hand hygiene compared to control, Outcome 3: Influenza or ILI: sensitivity analysis including outcomes with the most precise and unequivocal definitions
3.4
3.4. Analysis
Comparison 3: Randomised trials: hand hygiene compared to control, Outcome 4: ARI or ILI or influenza: subgroup analysis
3.5
3.5. Analysis
Comparison 3: Randomised trials: hand hygiene compared to control, Outcome 5: Absenteeism
4.1
4.1. Analysis
Comparison 4: Randomised trials: hand hygiene + medical/surgical masks compared to control, Outcome 1: Viral illness
5.1
5.1. Analysis
Comparison 5: Randomised trials: hand hygiene + medical/surgical masks compared to hand hygiene, Outcome 1: Viral illness
6.1
6.1. Analysis
Comparison 6: Randomised trials: gargling compared to control, Outcome 1: Viral illness
6.2
6.2. Analysis
Comparison 6: Randomised trials: gargling compared to control, Outcome 2: SARS‐CoV‐2
See this image and copyright information in PMC

Update of

Comment in

References

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    1. McConeghy KW, Baier R, McGrath KP, Baer CJ, Mor V. Implementing a pilot trial of an infection control program in nursing homes: results of a matched cluster randomized trial. Journal of the American Medical Directors Association 2017;18(8):707-12. - PubMed
Millar 2016 {published data only}
    1. Millar EV, Schlett CD, Law NN, Chen WJ, D'Onofrio MJ, Bennett JW, et al. Reduction in acute respiratory infection among military trainees: secondary effects of a hygiene-based cluster-randomized trial for skin and soft-tissue infection prevention. Infection Control and Hospital Epidemiology 2016;37(9):1118-20. - PMC - PubMed
Miyaki 2011 {published data only}
    1. Miyaki K, Sakurazawa H, Mikurube H, Nishizaka M, Ando H, Song Y, et al. An effective quarantine measure reduced the total incidence of influenza A H1N1 in the workplace: another way to control the H1N1 flu pandemic. Journal of Occupational Health 2011;53(4):287-92. [DOI: 10.1539/joh.10-0024-fs] - DOI - PubMed
Morton 2004 {published data only}
    1. Morton JL, Schultz AA. Healthy hands: use of alcohol gel as an adjunct to handwashing in elementary school children. Journal of School Nursing 2004;20(3):161-7. - PubMed
Najnin 2019 {published data only}
    1. Najnin N, Leder K, Forbes A, Unicomb L, Winch PJ, Ram PK, et al. Impact of a large-scale handwashing intervention on reported respiratory illness: findings from a cluster-randomized controlled trial. American Journal of Tropical Medicine and Hygiene 2019;100(3):742-9. - PMC - PubMed
Nicholson 2014 {published data only}
    1. Nicholson JA, Naeeni M, Hoptroff M, Matheson JR, Roberts AJ, Taylor D, et al. An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities. Tropical Medicine and International Health 2014;19(3):284-92. [DOI: 10.1111/tmi.12254] - DOI - PubMed
Pandejpong 2012 {published data only}
    1. Pandejpong D, Danchaivijitr S, Vanprapa N, Pandejpong T, Cook EF. Appropriate time-interval application of alcohol hand gel on reducing influenza-like illness among preschool children: a randomized, controlled trial. American Journal of Infection Control 2012;40(6):507-11. [DOI: 10.1016/j.ajic.2011.08.020] - DOI - PMC - PubMed
Priest 2014 {published data only}12609000478213
    1. Priest P, McKenzie JE, Audas R, Poore M, Brunton C, Reeves L. Hand sanitiser provision for reducing illness absences in primary school children: a cluster randomised trial. PLOS Medicine 2014;11(8):e1001700. - PMC - PubMed
Radonovich 2019 {published data only}
    1. Radonovich LJ Jr, Simberkoff MS, Bessesen MT, Brown AC, Cummings DA, Gaydos CA, et al, ResPECT investigators. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. JAMA 2019;322(9):824-33. - PMC - PubMed
Ram 2015 {published data only}
    1. Ram PK, DiVita MA, Khatun-e-Jannat K, Islam M, Krytus K, Cercone E, et al. Impact of intensive handwashing promotion on secondary household influenza-like illness in rural Bangladesh: findings from a randomized controlled trial. PLOS One 2015;10(6):e0125200. [DOI: 10.1371/journal.pone.0125200] - DOI - PMC - PubMed
Roberts 2000 {published data only}
    1. Roberts L, Smith W, Jorm L, Patel M, Douglas RM, McGilchrist C. Effect of infection control measures on the frequency of upper respiratory infection in child care: a randomised controlled study. Pediatrics 2000;105:738-42. - PubMed
Sandora 2005 {published data only}
    1. Sandora TJ, Taveras EM, Shih MC, Resnick EA, Lee GM, Ross-Degnan D, et al. A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home. Pediatrics 2005;116(3):587-94. - PubMed
Sandora 2008 {published data only}
    1. Sandora TJ, Shih MC, Goldmann DA. Reducing absenteeism from gastrointestinal and respiratory illness in elementary school students: a randomized, controlled trial of an infection-control intervention. Pediatrics 2008;121(6):e1555-62. - PubMed
Satomura 2005 {published data only}
    1. Kitamura T, Satomura K, Kawamura T, Yamada S, Takashima K, Suganuma N, et al. Can we prevent influenza-like illnesses by gargling? Internal Medicine 2007;46(18):1623-4. - PubMed
    1. Satomura K, Kitamura T, Kawamura T, Shimbo T, Watanabe M, Kamei M, et al. Prevention of upper respiratory tract infections by gargling: a randomized trial. American Journal of Preventive Medicine 2005;29(4):302-7. - PubMed
Savolainen‐Kopra 2012 {published data only}
    1. Savolainen-Kopra C, Haapakoski J, Peltola PA, Ziegler T, Korpela T, Anttila P, et al. Hand washing with soap and water together with behavioural recommendations prevents infections in common work environment: an open cluster-randomized trial. Trials 2012;13:10. [DOI: 10.1186/1745-6215-13-10] - DOI - PMC - PubMed
Simmerman 2011 {published data only}
    1. Simmerman JM, Suntarattiwong P, Levy J, Jarman RG, Kaewchana S, Gibbons RV, et al. Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand. Influenza and Other Respiratory Viruses 2011;5(4):256-67. [DOI: 10.1111/j.1750-2659.2011.00205.x] - DOI - PMC - PubMed
Stebbins 2011 {published data only}
    1. Stebbins S, Cummings DA, Stark JH, Vukotich C, Mitruka K, Thompson W, et al. Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: a randomized controlled trial. Pediatric Infectious Disease Journal 2011;30(11):921-6. [DOI: 10.1097/INF.0b013e3182218656] - DOI - PMC - PubMed
Suess 2012 {published data only}
    1. Suess T, Remschmidt C, Schink SB, Schweiger B, Nitsche A, Schroeder K, et al. The role of facemasks and hand hygiene in the prevention of influenza transmission in households: results from a cluster randomised trial; Berlin, Germany, 2009-2011. BMC Infectious Disease 2012;12:26. [DOI: 10.1186/1471-2334-12-26] - DOI - PMC - PubMed
Swarthout 2020 {published data only}
    1. Swarthout J, Ram PK, Arnold CD, Dentz HN, Arnold BF, Kalungu S, et al. Effects of individual and combined water, sanitation, handwashing, and nutritional interventions on child respiratory infections in rural Kenya: a cluster-randomized controlled trial. American Journal of Tropical Medicine and Hygiene 2020;102(6):1286-95. [DOI: 10.4269/ajtmh.19-0779] - DOI - PMC - PubMed
Talaat 2011 {published data only}
    1. Talaat M, Afifi S, Dueger E, El-Ashry N, Marfin A, Kandeel A, et al. Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt. Emerging Infectious Diseases 2011;17(4):619-25. [DOI: 10.3201/eid1704.101353] - DOI - PMC - PubMed
Teesing 2021 {published data only}
    1. Teesing GR, Richardus JH, Nieboer D, Petrignani M, Erasmus V, Verduijn-Leenman A, et al. The effect of a hand hygiene intervention on infections in residents of nursing homes: a cluster randomized controlled trial. Antimicrobial Resistance & Infection Control 2021;10(1):80. [DOI: 10.1186/s13756-021-00946-3.] - DOI - PMC - PubMed
Temime 2018 {published data only}16474757
    1. Temime L, Cohen N, Ait-Bouziad K, Denormandie P, Dab W, Hocine MN. Impact of a multicomponent hand hygiene-related intervention on the infectious risk in nursing homes: a cluster randomized trial. American Journal of Infection Control 2018;46(2):173-9. [DOI: 10.1016/j.ajic.2017.08.030] - DOI - PubMed
Turner 2004a {published data only}
    1. Turner RB, Biedermann KA, Morgan JM, Keswick B, Ertel KD, Barker MF. Efficacy of organic acids in hand cleansers for prevention of rhinovirus infections. Antimicrobial Agents and Chemotherapy 2004;48(7):2595-8. - PMC - PubMed
Turner 2004b {published data only}
    1. Turner RB, Biedermann KA, Morgan JM, Keswick B, Ertel KD, Barker MF. Efficacy of organic acids in hand cleansers for prevention of rhinovirus infections. Antimicrobial Agents and Chemotherapy 2004;48(7):2595-8. - PMC - PubMed
Turner 2012 {published data only}
    1. Turner RB, Fuls JL, Rodgers ND, Goldfarb HB, Lockhart LK, Aust LB. A randomized trial of the efficacy of hand disinfection for prevention of rhinovirus infection. Clinical Infectious Diseases 2012;54(10):1422-6. [DOI: 10.1093/cid/cis201] - DOI - PubMed
White 2001 {published data only}
    1. White CG, Shinder FS, Shinder AL, Dyer DL. Reduction of illness absenteeism in elementary schools using an alcohol-free instant hand sanitizer. Journal of School Nursing 2001;17(5):258-65. - PubMed
Yeung 2011 {published data only}
    1. Yeung WK, Tam WS, Wong TW. Cluster randomized controlled trial of a hand hygiene intervention involving pocket-sized containers of alcohol-based hand rub for the control of infections in long-term care facilities. Infection Control and Hospital Epidemiology 2011;32:67-76. - PubMed
Young 2021 {published data only}
    1. Young BC, Eyre DW, Kendrick S, White C, Smith S, Beveridge G, et al. Daily testing for contacts of individuals with SARS-CoV-2 infection and attendance and SARS-CoV-2 transmission in English secondary schools and colleges: an open-label, cluster-randomised trial. Lancet 2021;398:1217-29. [DOI: .1016/S0140 - 6736(21)01908 - 5] - PMC - PubMed
Zomer 2015 {published data only}NTR3000
    1. Zomer TP, Erasmus V, Looman CW, Tjon-A-Tsien A, Van Beeck EF, De Graaf JM, et al. A hand hygiene intervention to reduce infections in child daycare: a randomized controlled trial. Epidemiology and Infection 2015;143(12):2494-502. [DOI: 10.1017/S095026881400329X] - DOI - PMC - PubMed

References to studies excluded from this review

Abou El Hassan 2004 {published data only}
    1. Abou El Hassan MA, Meulen-Muileman I, Abbas S, Kruyt FA. Conditionally replicating adenoviruses kill tumor cells via a basic apoptotic machinery-independent mechanism that resembles necrosis-like programmed cell death. Journal of Virology 2004;78(22):12243-51. - PMC - PubMed
Ahmadian 2022 {published data only}
    1. Ahmadian M, Ghasemi M, Nasrollahi Borujeni N, Afshan S, Fallah M, Ayaseh H, et al. Does wearing a mask while exercising amid COVID-19 pandemic affect hemodynamic and hematologic function among healthy individuals? Implications of mask modality, sex, and exercise intensity. Physician and Sportsmedicine 2022;50(3):257-68. - PubMed
Amirav 2005 {published data only}
    1. Amirav I, Oron A, Tal G, Cesar K, Ballin A, Houri S, et al. Aerosol delivery in respiratory syncytial virus bronchiolitis: hood or face mask? Journal of Pediatrics 2005;147(5):627-31. - PubMed
Anderson 2004 {published data only}
    1. Anderson RM, Fraser C, Ghani AC, Donnelly CA, Riley S, Ferguson NM, et al. Epidemiology, transmission dynamics and control of SARS: the 2002-2003 epidemic. Philosophical Transactions of the Royal Society of London - Series B: Biological Sciences 2004;359(1447):1091-105. - PMC - PubMed
Anonymous 2002 {published data only}
    1. Anon. Antiseptic skin cleansers may prevent rhinovirus transmission. Clinical Infectious Diseases 2002;34(3):ii.
Anonymous 2004 {published data only}
    1. Anon. Can antiviral tissues prevent the spread of colds? Consumer Reports 2004;69(12):56. - PubMed
Anonymous 2005a {published data only}
    1. Anon. Antiviral Kleenex. Medical Letter on Drugs & Therapeutics 2005;47(1199):3-4. - PubMed
Anonymous 2005b {published data only}
    1. Anon. Focusing on this year's flu...use healthy handwashing...and when soap and water aren't handy, hand gels work well, too. Child Health Alert 2005;23:1-2. - PubMed
Anonymous 2005c {published data only}
    1. How long is a cold contagious? Is there any way to prevent transmitting a cold? Johns Hopkins Medical Letter, Health After 50 2005;17(10):8. - PubMed
Apisarnthanarak 2009 {published data only}
    1. Apisarnthanarak A, Apisarnthanarak P, Cheevakumjorn B, Mundy LM. Intervention with an infection control bundle to reduce transmission of influenza-like illnesses in a Thai preschool. Infection Control and Hospital Epidemiology 2009;30(9):817-22. - PubMed
Apisarnthanarak 2010 {published data only}
    1. Apisarnthanarak A, Uyeki TM, Puthavathana P, Kitphati R, Mundy LM. Reduction of seasonal influenza transmission among healthcare workers in an intensive care unit: a 4-year intervention study in Thailand. Infection Control and Hospital Epidemiology 2010;31(10):996-1003. - PubMed
Aragon 2005 {published data only}
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Azor‐Martinez 2014 {published data only}
    1. Azor-Martinez E, Gonzalez-Jimenez Y, Seijas-Vazquez ML, Cobos-Carrascosa E, Santisteban-Martinez J, Martinez-Lopez JM, et al. The impact of common infections on school absenteeism during an academic year. American Journal of Infection Control 2014;42(6):632-7. - PubMed
Barros 1999 {published data only}
    1. Barros AJ, Ross DA, Fonseca WV, Williams LA, Moreira-Filho DC. Preventing acute respiratory infections and diarrhoea in child care centres. Acta Paediatrica 1999;88(10):1113-8. - PubMed
Bauer 2009 {published data only}
    1. Bauer G, Bossi L, Santoalla M, Rodríguez S, Fariña D, Speranza AM. Impacto de un programa de prevención de infecciones respiratorias en lactantes prematuros de alto riesgo: estudio prospectivo y multicéntrico. Archivos Argentinos de Pediatria 2009;107(2):111-8. - PubMed
Bell 2004 {published data only}
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Bellissimo‐Rodrigues 2009 {published data only}
    1. Bellissimo-Rodrigues F, Bellissimo-Rodrigues WT, Viana JM, Teixeira GC, Nicolini E, Auxiliadora-Martins M, et al. Effectiveness of oral rinse with chlorhexidine in preventing nosocomial respiratory tract infections among intensive care unit patients. Infection Control and Hospital Epidemiology 2009;30(10):952-8. - PubMed
Ben‐Abraham 2002 {published data only}
    1. Ben-Abraham R, Keller N, Szold O, Vardi A, Weinberg M, Barzilay Z, et al. Do isolation rooms reduce the rate of nosocomial infections in the pediatric intensive care unit? Journal of Critical Care 2002;17(3):176-80. - PubMed
Black 1981 {published data only}
    1. Black RE, Dykes AC, Anderson KE, Wells JG, Sinclair SP, Gary GW, et al. Handwashing to prevent diarrhea in day-care centers. American Journal of Epidemiology 1981;113(4):445-51. - PubMed
Borkow 2010 {published data only}
    1. Borkow G, Zhou SS, Page T, Gabbay J. A novel anti-influenza copper oxide containing respiratory face mask. PLOS One 2010;5(6):1-8. - PMC - PubMed
Bouadma 2010 {published data only}
    1. Bouadma L, Mourvillier B, Deiler V, Le Corre B, Lolom I, Régnier B, et al. A multifaceted program to prevent ventilator-associated pneumonia: impact on compliance with preventive measures. Critical Care Medicine 2010;38(3):789-96. - PubMed
Bowen 2007 {published data only}
    1. Bowen A, Ma H, Ou J, Billhimer W, Long T, Mintz E, et al. A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools. American Journal of Tropical Medicine and Hygiene 2007;76(6):1166-73. - PubMed
Breugelmans 2004 {published data only}
    1. Breugelmans JG, Zucs P, Porten K, Broll S, Niedrig M, Ammon A, et al. SARS transmission and commercial aircraft. Emerging Infectious Diseases 2004;10(8):1502-3. - PMC - PubMed
Cai 2009 {published data only}
    1. Cai W, Schweiger B, Buchholz U, Buda S, Littmann M, Heusler J, et al. Protective measures and H5N1-seroprevalence among personnel tasked with bird collection during an outbreak of avian influenza A/H5N1 in wild birds, Ruegen, Germany, 2006. BMC Infectious Diseases 2009;9:170. - PMC - PubMed
Cantagalli 2010 {published data only}
    1. Cantagalli MR, Alvim VF, Andrade EC, Leite IC. Associação entre desnutrição energético-protéica e infecção respiratória aguda em crianças na atenção primária à saúde. Revista de APS 2010;13(1):26-33.
Carbonell‐Estrany 2008 {published data only}
    1. Carbonell-Estrany X, Bont L, Doering G, Gouyon JB, Lanari M. Clinical relevance of prevention of respiratory syncytial virus lower respiratory tract infection in preterm infants born between 33 and 35 weeks gestational age. European Journal of Clinical Microbiology and Infectious Diseases 2008;27(10):891-9. - PubMed
Carter 2002 {published data only}
    1. Carter JM. Hand washing decreases risk of colds and flu. Journal of the National Medical Association 2002;94(2):A11. - PMC - PubMed
Castillo‐Chavez 2003 {published data only}
    1. Castillo-Chavez C, Castillo-Garsow CW, Yakubu AA. Mathematical models of isolation and quarantine. JAMA 2003;290(21):2876-7. - PubMed
Cava 2005a {published data only}
    1. Cava MA, Fay KE, Beanlands HJ, McCay EA, Wignall R. Risk perception and compliance with quarantine during the SARS outbreak. Journal of Nursing Scholarship 2005;37(4):343-7. - PubMed
Cava 2005b {published data only}
    1. Cava MA, Fay KE, Beanlands HJ, McCay EA, Wignall R. The experience of quarantine for individuals affected by SARS in Toronto. Public Health Nursing 2005;22(5):398-406. - PubMed
CDC 2003a {published data only}
    1. Centers for Disease Control and Prevention. Cluster of severe acute respiratory syndrome cases among protected health-care workers - Toronto, Canada, April 2003. Morbidity & Mortality Weekly Report 2003;52(19):433-6. - PubMed
CDC 2003b {published data only}
    1. Centers for Disease Control and Prevention. Use of quarantine to prevent transmission of severe acute respiratory syndrome - Taiwan, 2003. Morbidity & Mortality Weekly Report 2003;52(29):680-3. - PubMed
Chai 2005 {published data only}
    1. Chai LY, Ng TM, Habib AG, Singh K, Kumarasinghe G, Tambyah PA. Paradoxical increase in methicillin-resistant Staphylococcus aureus acquisition rates despite barrier precautions and increased hand washing compliance during an outbreak of severe acute respiratory syndrome. Clinical Infectious Diseases 2005;40(4):623-3. - PMC - PubMed
Chami 2012 {published data only}
    1. Chami K, Gavazzi G, Bar-Hen A, Carrat F, Wazières B, Lejeune B, et al. A short-term, multicomponent infection control program in nursing homes: a cluster randomized controlled trial. Journal of the American Medical Directors Association 2012;13(6):569.e9-569.e17. - PubMed
Chaovavanich 2004 {published data only}
    1. Chaovavanich A, Wongsawat J, Dowell SF, Inthong Y, Sangsajja C, Sanguanwongse N, et al. Early containment of severe acute respiratory syndrome (SARS); experience from Bamrasnaradura Institute, Thailand. Journal of the Medical Association of Thailand 2004;87(10):1182-7. - PubMed
Chau 2003 {published data only}
    1. Chau PH, Yip PS. Monitoring the severe acute respiratory syndrome epidemic and assessing effectiveness of interventions in Hong Kong Special Administrative Region. Journal of Epidemiology and Community Health 2003;57(10):766-9. - PMC - PubMed
Chau 2008 {published data only}
    1. Chau JP, Thompson DR, Twinn S, Lee DT, Lopez V, Ho LS. An evaluation of SARS and droplet infection control practices in acute and rehabilitation hospitals in Hong Kong. Hong Kong Medical Journal 2008;14(Suppl 4):44-7. - PubMed
Chen 2007 {published data only}
    1. Chen YC, Chiang LC. Effectiveness of hand-washing teaching programs for families of children in paediatric intensive care units. Journal of Clinical Nursing 2007;16(6):1173-9. - PubMed
Chen 2022 {published data only}
    1. Chen MH, Chang PC. The effectiveness of mouthwash against SARS-CoV-2 infection: A review of scientific and clinical evidence. Journal of the Formosan Medical Association 2022;121(5):879-85. [10.1016/j.jfma.2021.10.001] - PMC - PubMed
Cheng 2010 {published data only}
    1. Cheng VC, Tai JW, Wong LM, Chan JF, Li IW, To KK, et al. Prevention of nosocomial transmission of swine-origin pandemic influenza virus A/H1N1 by infection control bundle. Journal of Hospital Infection 2010;74(3):271-7. - PMC - PubMed
Chia 2005 {published data only}
    1. Chia SE, Koh D, Fones C, Qian F, Ng V, Tan BH, et al. Appropriate use of personal protective equipment among healthcare workers in public sector hospitals and primary healthcare polyclinics during the SARS outbreak in Singapore. Occupational and Environmental Medicine 2005;62(7):473-7. - PMC - PubMed
Clynes 2010 {published data only}
    1. Clynes N. Surgical masks vs N95 respirators for preventing influenza. JAMA 2010;303(10):937-9. - PubMed
Costa 2021 {published data only}
    1. Costa DD, Brites C, Nunes Vaz S, Souzade Santana D, Nunesdos Santos J, Ramos Cury P. Chlorhexidine mouthwash reduces the salivary viral load of SARS-CoV-2: a randomized clinical trial. Oral Diseases 2021;00:1-9. [DOI: 10.1111/odi.14086] - DOI - PubMed
Cowling 2007 {published data only}
    1. Cowling BJ, Muller MP, Wong IO, Ho LM, Louie M, McGeer A, et al. Alternative methods of estimating an incubation distribution: examples from severe acute respiratory syndrome. Epidemiology 2007;18(2):253-9. - PubMed
Cyril Vitug 2021 {published data only}
    1. Cyril Vitug L, Santiaguel J, Exconde MA, Bautista MA. Oral gargle of ethanol-based mouthwash solution and its effects on adult patients with mild COVID-19 infection: an open-label randomized controlled trial. Chest 2021;160(4):A2504. [DOI: 10.1016/j.chest.2021.08.014] - DOI
Dalakoti 2022 {published data only}
    1. Dalakoti M, Long C, Bains A, Djohan A, Ahmad I, Chan SP, et al. Effect of surgical mask use on peak physical performance during exercise treadmill testing - a real world, crossover study. Frontiers in Physiology 2022;13:913974. [DOI: 10.3389/fphys.2022.913974] - DOI - PMC - PubMed
Daniels 2010 {published data only}
    1. Daniels TL, Talbot TR. Unmasking the confusion of respiratory protection to prevent influenza-like illness in crowded community settings. Journal of Infectious Diseases 2010;201(4):483-5. - PubMed
Daugherty 2008 {published data only}
    1. Daugherty EL. Health care worker protection in mass casualty respiratory failure: infection control, decontamination, and personal protective equipment. Respiratory Care 2008;53(2):201-12; discussion 212-4. - PubMed
Davies 1994 {published data only}
    1. Davies KJ, Herbert AM, Westmoreland D, Bagg J. Seroepidemiological study of respiratory virus infections among dental surgeons. British Dental Journal 1994;176(7):262-5. - PubMed
Day 1993 {published data only}
    1. Day RA, St Arnaud S, Monsma M. Effectiveness of a handwashing program. Clinical Nursing Research 1993;2(1):24-40. - PubMed
Day 2006 {published data only}
    1. Day T, Park A, Madras N, Gumel A, Wu J. When is quarantine a useful control strategy for emerging infectious diseases? American Journal of Epidemiology 2006;163(5):479-85. - PMC - PubMed
Dell'Omodarme 2005 {published data only}
    1. Dell'Omodarme M, Prati MC. The probability of failing in detecting an infectious disease at entry points into a country. Statistics in Medicine 2005;24(17):2669-79. - PMC - PubMed
Denbak 2018 {published data only}
    1. Denbak AM, Andersen A, Bonnesen CT, Laursen B, Ersbøll AK, Due P, et al. Effect evaluation of a randomized trial to reduce infectious illness and illness-related absenteeism among schoolchildren: The Hi Five Study. Pediatric Infectious Disease Journal 2018;37(1):16-21. - PubMed
Desenclos 2004 {published data only}
    1. Desenclos JC, Werf S, Bonmarin I, Levy-Bruhl D, Yazdanpanah Y, Hoen B, et al. Introduction of SARS in France, March-April, 2003. Emerging Infectious Diseases 2004;10(2):195-200. - PMC - PubMed
DiGiovanni 2004 {published data only}
    1. DiGiovanni C, Conley J, Chiu D, Zaborski J. Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak. Biosecurity and Bioterrorism 2004;2(4):265-72. - PubMed
Doebbeling 1992 {published data only}
    1. Doebbeling BN, Stanley GL, Sheetz CT. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. New England Journal of Medicine 1992;327(2):88-92. - PubMed
Dwosh 2003 {published data only}
    1. Dwosh HA, Hong HH, Austgarden D, Herman S, Schabas R. Identification and containment of an outbreak of SARS in a community hospital. Canadian Medical Association Journal 2003;168(11):1415-20. - PMC - PubMed
Edmonds 2010 {published data only}
    1. Edmonds S, Dzyakanava V, Macinga D. Efficacy of hand hygiene products against pandemic H1N1 influenza. American Journal of Infection Control 2010;38(5):E132-3.
Egger 2022 {published data only}
    1. Egger F, Blumenauer D, Fischer P, Venhorst A, Kulenthiran S, Bewarder Y, et al. Effects of face masks on performance and cardiorespiratory response in well-trained athletes. Clinical Infectious Diseases 2022;111(3):264-71. [DOI: 10.1007/s00392-021-01877-0] - DOI - PMC - PubMed
Fendler 2002 {published data only}
    1. Fendler EJ, Ali Y, Hammond BS, Lyons MK, Kelley MB, Vowell NA. The impact of alcohol hand sanitizer use on infection rates in an extended care facility. American Journal of Infection Control 2002;30(4):226-33. - PubMed
Ferrer 2021 {published data only}
    1. Ferrer MD, Sánchez Barrueco A, Martinez‑Beneyto Y, Mateos-Moreno MV, Ausina-Márquez V, García-Vázquez E, et al. Clinical evaluation of antiseptic mouth rinses to reduce salivary load of SARS-CoV-2. Scientific Reports 2021;11:24392. [DOI: ] - PMC - PubMed
Flint 2003 {published data only}
    1. Flint J, Burton S, Macey JF, Deeks SL, Tam TW, King A, et al. Assessment of in-flight transmission of SARS - results of contact tracing. Canadian Communicable Disease Report 2003;29(12):105-10. - PubMed
Fung 2004 {published data only}
    1. Fung CP, Hsieh TL, Tan KH, Loh CH, Wu JS, Li C, et al. Rapid creation of a temporary isolation ward for patients with severe acute respiratory syndrome in Taiwan. Infection Control and Hospital Epidemiology 2004;25(12):1026-32. - PubMed
Garcia 2010 {published data only}
    1. Garcia MC. The protection against influenza provided by surgical masks is not inferior to what the FFP2 (N95) respiratory protector can give. FMC Formacion Medica Continuada en Atencion Primaria 2010;17(5):365.
Gaydos 2001 {published data only}
    1. Gaydos JC. Returning to the past: respiratory illness, vaccines, and handwashing. American Journal of Preventive Medicine 2001;21(2):150-1. - PubMed
Gensini 2004 {published data only}
    1. Gensini GF, Yacoub MH, Conti AA. The concept of quarantine in history: from plague to SARS. Journal of Infection 2004;49(4):257-61. - PMC - PubMed
Gharebaghi 2020 {published data only}
    1. Gharebaghi N, Valizade Hasanloei MA, Mosarrezaii Agdam A, Mohsenirad S. The effect of combined mouth wash gentamycine, colistin and vancomycine in prevention of ventilator associated pneumonia in mechanical ventilatory patients admitted to intensive care unit: a randomized clinical trial. Scientific Journal of Kurdistan University of Medical Sciences 2020;104:105-16. [DOI: 10.52547/sjku.25.1.105] - DOI
Girou 2002 {published data only}
    1. Girou E, Loyeau S, Legrand P, Oppein F, Brun-Buisson C. Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. BMJ 2002;325:362. - PMC - PubMed
Giuliano 2021 {published data only}
    1. Giuliano KK, Penoyer D, Middleton A. Oral care as prevention for nonventilator hospital-acquired pneumonia: a four-unit cluster randomized study. American Journal of Nursing 2021;121(6):24-33. - PubMed
Glass 2006 {published data only}
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Goel 2007 {published data only}
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