Hand sanitisers in public won't wipe out the flu but they might help reduce its spread

(MENAFN- The Conversation) This year's flu season is off to an early start, with 144,000 confirmed cases so far in 2019. That'smore than twice as many confirmed casesof the flu than for all of 2018 (58,000), and almost as many as the 2017 horror flu season (251,000).

The number of cases so far this year, includingmore than 231 deathsnationwide, led the NSW oppositionhealth spokesperson to callfor hand sanitisers in public spaces to help slow the spread.

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Influenza spreads via droplets from coughing and sneezing, which is why it's a good idea to catch your cough. But coughing into your hand can leave flu virus on your hands, which is whywe recommendcoughing into yourelbow or sleeveand washing your hands afterwards.

Along withgetting vaccinatedand staying home if you're sick, washing your hands is the best defence against getting the flu.

If the government can make this easier by providing hand sanitisers in public places, it may be worth the investment. It won't solve our flu problem but it might be an important tool in the toolbox of measures to reduce its spread.

The scientific literature on hand sanitisers isn't so clear-cut.

A 2019 study inuniversity collegesshowed the use of hand hygiene and face masks didn't protect against flu any better than mask use alone. But unlike some other countries, Australia doesn't have a strong habit of mask use when people are unwell, so this may not be very helpful to us.

A2014 study in New Zealand schoolsshowed that providing sanitiser didn't reduce the rate of absenteeism from school either.

While these studies make it sound like hand sanitiser is not very effective, that's not the end of the story.

Other studies show a positive effect – a16% reductionin respiratory illness in one and a21% reductionin another. For some infections, theevidenceis even stronger – for example, gastroenteritis, most of which is also viral.

However,few of these studiesshowing the benefits of hand sanitisers were done during a large disease outbreak, which means the potential benefit may be even greater.

Not all influenza-like illness is caused by the flu – it can be other viruses as well, so the estimates are a bit rubbery at best. Hand sanitiser trials which look at influenza-like illness or respiratory infections generally are more likely to show benefits than those that just look for influenza – meaning good hand hygiene prevents other infections as well.

Although preventing infection in hospitals is not the same as doing it in the community, there are two important lessons from hospital infection control.

First, in hospital hand-hygiene programs, hand sanitiser ismore effectivethan soap-and-water hand-washing, provided your hands aren't visibly dirty.

This is partly because of the rapid effect of the alcohol, but mostly because it's much quicker and thereforemore likelythat staff will use it.

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The second important point fromhand hygieneandother areasof hospital infection control is that introducing a 'bundle' of strategies usually reduces healthcare-associated infection rates – even when the individual parts of these bundles don't show benefits alone.

This could be because the individual effect sizes are too small, or that change in practice highlights a 'safety culture'.

Installing hand rub in public areas won't solve this year's flu outbreak by itself. But it can be part of a bundle of strategies – as long as the dispensers are kept topped up.

And it's certainly a safe intervention – despite somedesperate hysteriaabout the safety of hand gels, or the risk of people drinking them, there is little evidence this actually occurs in reality.

Hand sanitiser is also likely to be easier to implement than fixing the much larger social problem of Australiansgoing to workwhen they're sick. This may be because of inadequate sick leave, concerns about 'letting the team down', or other logistical problems such as child-care.

Get your flu vaccine – even now it's still not too late – and get it for your kids as well, fortheir sakeas well asyour own .

Remember to stay home if you're unwell, and always to cough into your sleeve. And don't forget to clean your hands – even if the government doesn't end up making it easier for you.

Read more:
The 2019 flu shot isn't perfect – but it's still our best defence against influenza

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