title: Hand washing with soap and water together with behavioural recommendations prevents infections in common work environment: an open cluster-randomized trial.
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.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT00981877
  
  
  BACKGROUND
  The Finnish Work Environment Fund and the National Institute for Health and Welfare.
authors.affiliation: National Institute for Health and Welfare (THL), Department of Infectious Disease Surveillance and Control, Intestinal Viruses Unit, PO Box 30, FIN-00271 Helsinki, Finland. carita.savolainen-kopra@thl.fi
authors.forename: Carita
authors.initials: C
authors.lastname: Savolainen-Kopra
authors.forename: Jaason
authors.initials: J
authors.lastname: Haapakoski
authors.forename: Piia A
authors.initials: PA
authors.lastname: Peltola
authors.forename: Thedi
authors.initials: T
authors.lastname: Ziegler
authors.forename: Terttu
authors.initials: T
authors.lastname: Korpela
authors.forename: Pirjo
authors.initials: P
authors.lastname: Anttila
authors.forename: Ali
authors.initials: A
authors.lastname: Amiryousefi
authors.forename: Pentti
authors.initials: P
authors.lastname: Huovinen
authors.forename: Markku
authors.initials: M
authors.lastname: Huvinen
authors.forename: Heikki
authors.initials: H
authors.lastname: Noronen
authors.forename: Pia
authors.initials: P
authors.lastname: Riikkala
authors.forename: Merja
authors.initials: M
authors.lastname: Roivainen
authors.forename: Petri
authors.initials: P
authors.lastname: Ruutu
authors.forename: Juha
authors.initials: J
authors.lastname: Teirilä
authors.forename: Erkki
authors.initials: E
authors.lastname: Vartiainen
authors.forename: Tapani
authors.initials: T
authors.lastname: Hovi
mesh_terms: D000041:Absenteeism; D000328:Adult; D000438:Alcohols; D003140:Communicable Disease Control / Q000379:methods*; D017281:Cost of Illness; D004202:Disinfectants; D005387:Finland; D005782:Gels; D006235:Hand Disinfection; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D008875:Middle Aged; D016272:Occupational Health; D018582:Sick Leave; D012915:Soaps; D013997:Time Factors; D016896:Treatment Outcome; D014777:Virus Diseases / Q000517:prevention & control* / Q000635:transmission; D014867:Water; D017132:Workplace; D055815:Young Adult
chemical_list: D000438:Alcohols; D004202:Disinfectants; D005782:Gels; D012915:Soaps; D014867:Water