Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort [version 1; peer review 1 approved, 1 approved with reservations]

Sarah Beale; Anne M. Johnson; Maria Zambon; Flu Watch Group; Andrew C. Hayward; Ellen B. Fragaszy

doi:10.12688/WELLCOMEOPENRES.15796.1

Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort [version 1; peer review 1 approved, 1 approved with reservations]

Sarah Beale, Anne M. Johnson, Maria Zambon, Flu Watch Group, Andrew C. Hayward^*, Ellen B. Fragaszy

^*Corresponding author for this work

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Abstract

Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections.
Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study. Participants (n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status.
Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42).
Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.

Original language	English
Pages (from-to)	1-10
Number of pages	10
Journal	Wellcome Open Research
Volume	5
DOIs	https://doi.org/10.12688/WELLCOMEOPENRES.15796.1
Publication status	Published - 20 May 2020

Bibliographical note

Note: There is a newer version of this article: Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort [version 2; peer review: 2 approved]

Funding Information: The Flu Watch study received funding from the Medical Research Council (MRC) and the Wellcome Trust (G0600511, G0800767 and MC_U122785833). S.B. is supported by an MRC doctoral studentship (MR/N013867/1). The funders were not actively involved in the design, delivery, or analysis of this research. The views expressed in this publication are those of the authors and not necessarily of the MRC or the Wellcome Trust. AH is an NIHR Senior Investigator. The views expressed in this Article are those of the authors and not necessarily those of the NIHR, or the Department of Health and Social Care.
AH and MZ serve on UK New and Emerging Respiratory Virus Threats Advisory Group. AMJ was a Governor of Wellcome Trust from 2011-18 and is Chair of the Committee for Strategic Coordination for Health of the Public Research. The other
authors declare no competing interests.

Open Access: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Publisher Copyright: © 2020. Beale S et al.

Citation: Beale S, Johnson AM, Zambon M et al. Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort [version 1; peer review: 1 approved, 1 approved with reservations] Wellcome Open Research
2020, 5:98 https://doi.org/10.12688/wellcomeopenres.15796.1

DOI: https://doi.org/10.12688/wellcomeopenres.15796.1

Keywords

COVID-19
coronavirus
hand washing
pandemic
respiratory hygiene
respiratory infection

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

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Beale2020HandHygienePracticesAndTheRiskOfHumanCoronavirusInfectionsVersion1WellcomeOpenResFinal published version, 810 KBLicence: CC BY

Cite this

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title = "Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort [version 1; peer review 1 approved, 1 approved with reservations]",

abstract = "Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections.Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study. Participants (n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status.Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42).Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.",

keywords = "COVID-19, coronavirus, hand washing, pandemic, respiratory hygiene, respiratory infection",

author = "Sarah Beale and Johnson, {Anne M.} and Maria Zambon and Group, {Flu Watch} and Hayward, {Andrew C.} and Fragaszy, {Ellen B.}",

note = "Note: There is a newer version of this article: Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort [version 2; peer review: 2 approved] Funding Information: The Flu Watch study received funding from the Medical Research Council (MRC) and the Wellcome Trust (G0600511, G0800767 and MC_U122785833). S.B. is supported by an MRC doctoral studentship (MR/N013867/1). The funders were not actively involved in the design, delivery, or analysis of this research. The views expressed in this publication are those of the authors and not necessarily of the MRC or the Wellcome Trust. AH is an NIHR Senior Investigator. The views expressed in this Article are those of the authors and not necessarily those of the NIHR, or the Department of Health and Social Care. AH and MZ serve on UK New and Emerging Respiratory Virus Threats Advisory Group. AMJ was a Governor of Wellcome Trust from 2011-18 and is Chair of the Committee for Strategic Coordination for Health of the Public Research. The other authors declare no competing interests. Open Access: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Publisher Copyright: {\textcopyright} 2020. Beale S et al. Citation: Beale S, Johnson AM, Zambon M et al. Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort [version 1; peer review: 1 approved, 1 approved with reservations] Wellcome Open Research 2020, 5:98 https://doi.org/10.12688/wellcomeopenres.15796.1 DOI: https://doi.org/10.12688/wellcomeopenres.15796.1",

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AU - Johnson, Anne M.

AU - Zambon, Maria

AU - Group, Flu Watch

AU - Hayward, Andrew C.

AU - Fragaszy, Ellen B.

N1 - Note: There is a newer version of this article: Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort [version 2; peer review: 2 approved] Funding Information: The Flu Watch study received funding from the Medical Research Council (MRC) and the Wellcome Trust (G0600511, G0800767 and MC_U122785833). S.B. is supported by an MRC doctoral studentship (MR/N013867/1). The funders were not actively involved in the design, delivery, or analysis of this research. The views expressed in this publication are those of the authors and not necessarily of the MRC or the Wellcome Trust. AH is an NIHR Senior Investigator. The views expressed in this Article are those of the authors and not necessarily those of the NIHR, or the Department of Health and Social Care. AH and MZ serve on UK New and Emerging Respiratory Virus Threats Advisory Group. AMJ was a Governor of Wellcome Trust from 2011-18 and is Chair of the Committee for Strategic Coordination for Health of the Public Research. The other authors declare no competing interests. Open Access: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Publisher Copyright: © 2020. Beale S et al. Citation: Beale S, Johnson AM, Zambon M et al. Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort [version 1; peer review: 1 approved, 1 approved with reservations] Wellcome Open Research 2020, 5:98 https://doi.org/10.12688/wellcomeopenres.15796.1 DOI: https://doi.org/10.12688/wellcomeopenres.15796.1

PY - 2020/5/20

Y1 - 2020/5/20

N2 - Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections.Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study. Participants (n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status.Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42).Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.

AB - Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections.Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study. Participants (n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status.Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42).Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.

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KW - coronavirus

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KW - respiratory infection

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ER -

Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort [version 1; peer review 1 approved, 1 approved with reservations]

Abstract

Bibliographical note

Keywords

UN SDGs

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