Kent State researchers recently completed a pioneering office-based hand-hygiene improvement intervention which reduced common communicable illness by close to a third. This was the first U.S. pilot randomized cluster trial of its kind, and findings were published in the prominent Journal of Occupational and Environmental Medicine.
“The workplace is considered a key location to reach the public in slowing the spread of disease, since employees spend more than half their waking hours at work, in close proximity and sharing equipment,” explains Maggie Stedman-Smith, assistant professor, Environmental Health Sciences, and principal investigator. “With the aim of reducing self-reported acute respiratory infection/influenza-like illness and gastrointestinal infection, we followed diverse employees at a Midwestern government center for 90 days during the 2012-13 influenza season. Self-report of infectious disease has shown validity among the public in past studies. Our research found a 31-percent relative reduction in combined self-reported infections,” she says.
The impact is potentially far-reaching. “The cost of communicable disease is estimated in the tens of billions of dollars annually. Further, hand hygiene has been identified by the World Health Organization as an important strategy early in a pandemic before a suitable vaccine can be developed,” says Stedman-Smith.
“A large portion of the burden of illness from communicable infections falls on employers,” observes Stedman-Smith’s chief collaborator, Cathy L.Z. DuBois, PhD, associate dean for administration, College of Business Administration. “There are the costs of medical intervention for self-insured organizations, as well as rising health insurance premiums,” DuBois says. “In addition, there are costs associated with absenteeism, employee replacement, presenteeism (reduced productivity due to working while ill), increased overtime from healthy workers picking up the slack and reduced morale.”
Hands are an important pathway for the transfer of pathogens associated with the spread of communicable disease. “Contaminated hands frequently come in contact with the nose, mouth and eyes, which are portals of entry for infectious agents,” says Stedman-Smith, who is also a registered nurse with a MS degree in nursing, in addition to holding an MPH and PhD in Environmental Health Sciences. “For example, one office-based study showed that employees contacted their eyes, nostrils and mouth more than 15 times in an hour.”
The study’s intervention group viewed a five-minute hand-hygiene training video, which discussed the U.S. Centers for Disease Control and Prevention three-tiered recommendations for reducing influenza in the workplace: vaccination; the practice of proactive hand-hygiene and respiratory etiquette behaviors; and staying home when ill. The video covered the role of hand hygiene in reducing the spread of pathogens associated with infectious disease, recommended when to perform hand hygiene in the workplace and demonstrated effective technique for cleaning hands with soap and water and alcohol-based hand sanitizer. Free-standing canisters of hand sanitizer and hand-hygiene motivational posters were installed in participating departments near time clocks and in break rooms, kitchens, copy machine areas and conference rooms. Employees received two-ounce bottles of hand sanitizer for personal use, and employees with extensive public contact received 12-ounce bottles. Control-group employees received non-hand-hygiene training regarding effectiveness in communication with healthcare providers. In total, 18 departments with some 1700 employees were involved.
“Our findings demonstrate that a relatively simple multimodal hand-hygiene improvement campaign can result in a significant reduction in self-reported communicable infections,” Stedman-Smith says. “Given the annual burden employers bear, the findings, while modest, may be clinically important,” she observes. “The next step is to seek funding to support a larger office-based hand-hygiene improvement trial that analyzes single health conditions as outcomes and includes cost-benefit evaluations,” she says.
In addition to DuBois, Stedman-Smith’s research team colleagues included biostatistician Scott Grey, PhD, now with the Department of Cardiology at the University of Michigan; doctoral students Diana M. Kingsbury and Sunita Shakya, MPH ’13; Jennifer Scofield, intervention site liaison; and Ken Slenkovich, the college’s assistant dean for operations and community relations.
The college acknowledges GOJO Industries for use of the hand-hygiene training video, for providing hand-sanitization products at cost and for advice on product placement.
