After Internet Intervention: Handwashing Up, Respiratory Infections Down

Summary and Comment |
August 12, 2015

After Internet Intervention: Handwashing Up, Respiratory Infections Down

  1. Mary E. Wilson, MD

An Internet-based program to increase handwashing among adults reduced the risk for acute respiratory infections in participants and family members.

  1. Mary E. Wilson, MD

Handwashing is recommended to prevent infection transmission, yet few rigorous studies supporting it have been published. In an open-label, randomized trial conducted over 3 years, investigators assessed whether a Web-based intervention to increase handwashing, monitor handwashing activity, and provide feedback would decrease the number of acute respiratory infections over a subsequent 16-week winter period. Participants (16,908 adults) were recruited from general practices in England. The intervention included four sessions; most participants completed at least part of all four. The intervention group received automated e-mail reminders and had access to special Web pages.

Based on participant-completed questionnaires, 51% of the intervention group and 59% of the control group reported one or more acute respiratory infections (risk ratio, 0.86). Compared with control-group participants, intervention-group participants reported fewer influenza-like illnesses, fewer total days of illness, and fewer gastrointestinal infections over the 16 weeks; such benefits extended to household members. Review of medical notes suggested that intervention-group participants had fewer consultations and fewer antibiotic prescriptions over 16 weeks and 1 year. Minor skin irritation was more common in the intervention group than the control group (4% vs. 1%).


Although the absolute decrease in respiratory infections was relatively small, the population benefit would be large. The study also found other welcome benefits: decreases in diarrhea and antibiotic use and support for the ideas that handwashing can prevent transmission to and from an individual and is effective in high-income countries. The intervention would be inexpensive to deliver and could be tailored to the needs of specific populations or settings, such as schools. Given the wide availability of Internet access, such an intervention has the potential to reach large populations. The benefit could be even greater during outbreaks. The authors and an editorialist caution that long-term effect is unclear and strategies to maintain adherence will be essential.

Editor Disclosures at Time of Publication

  • Disclosures for Mary E. Wilson, MD at time of publication Consultant / Advisory board GeoSentinel Surveillance Network (Special Advisor) Editorial boards UpToDate; Clinical Infectious Diseases; International Health; Infectious Diseases in Clinical Practice; Travel Medicine and Infectious Diseases


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