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Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households
Annals of Internal Medicine, 10/07/09

Cowling BJ et al. – Hand hygiene and facemasks seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset. These findings suggest that nonpharmaceutical interventions are important for mitigation of pandemic and interpandemic influenza.

Methods

Cluster randomized, controlled trial.
Randomization was computer generated; allocation was concealed from treating physicians and clinics and implemented by study nurses at the time of the initial household visit.
Patients: 407 people presenting to outpatient clinics with influenza–like illness who were positive for influenza A or B virus by rapid testing (index patients) and 794 household members (contacts) in 259 households.
Intervention: Lifestyle education (control) (134 households), hand hygiene (136 households), or surgical facemasks plus hand hygiene (137 households) for all household members.

Results

Sixty (8%) contacts in the 259 households had RT–PCR–confirmed influenza virus infection in the 7 days after intervention.
Hand hygiene with or without facemasks seemed to reduce influenza transmission, but the differences compared with the control group were not significant.
In 154 households in which interventions were implemented within 36 hours of symptom onset in the index patient, transmission of RT–PCR–confirmed infection seemed reduced, an effect attributable to fewer infections among participants using facemasks plus hand hygiene.
Adherence to interventions varied.

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