The role of hand hygiene in the prevention of respiratory tract infections in Hajj pilgrims
has not been assessed through a focussed systematic review of the literature. Considering
this, a systematic review was undertaken to synthesize the up-to-date literature on the compliance
and effectiveness of hand hygiene among Hajj attendees. Major databases, including OVID Medline,
were searched by using a combination of MeSH terms and text words for potentially relevant
articles. Data from identified articles were abstracted, quality assessed and combined into a summary
effect. Twelve observational studies containing data of 6,320 pilgrims were included. The
compliance of hand washing with non-alcoholic surfactants was 77.7% (ranged from 31.5% to
90.3% in individual studies) and the compliance of hand cleaning with alcoholic products was
44.9% (ranged from 30.7% to 67.4%). Education was a key influencer of hand hygiene practice.
Only three of the six studies that assessed the effectiveness of hand hygiene against clinical disease
found the practice to be effective, and only one of the two studies that evaluated its effectiveness
against a laboratory-confirmed infection found it to be effective. This systematic review suggests
that hand hygiene using non-alcoholic products is generally acceptable among Hajj pilgrims
but there is no conclusive evidence on its effectiveness.
Keywords: Hajj, hand hygiene, respiratory infections, compliance, pilgrims, non-alcoholic.
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