Hand Hygiene Compliance and Effectiveness Against Respiratory Infections Among Hajj Pilgrims: A Systematic Review

Abstract

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.

Hand Hygiene Knowledge and Practices among Domestic Hajj Pilgrims: Implications for Future Mass Gatherings Amidst COVID-19

“…Hand washing with soap and water was the most common type of hand cleaning reportedly used by the study respondents in almost all the situations followed by alcohol hand rubbing. The results of this study are consistent with, and corroborate, the findings of other studies, including a systematic review, which found among Hajj pilgrims hand washing with soap was more popular than hand gel or sanitizers [18,21]. In contrast, a study explored domestic pilgrims' uptake of health preventive measures during the peak Hajj days found the proportion of respondents washing their hands with soap and cleaning hands with hand sanitizers was same (65%); however, pilgrims who were concerned about food poisoning were more likely to clean their hands with hand sanitizers (adjusted OR 2.5, 95% CI 1.1-5.4) indicating pilgrims' degree of concern may dictate the mode of hand hygiene [19].…”

Hand Hygiene Knowledge, Perception, and Practices among Domestic Visitors to the Prophet’s Mosque in Al Madinah City Amid the COVID-19 Pandemic: A Cross-Sectional Study

“…When participants were asked about their hand hygiene practices at specific high-risk situations, soap and water was the most preferred method reportedly used, followed by alcohol-based hand rubs. This finding is in parallel with the results of formerly conducted studies among attendees of Hajj and Umrah pilgrimage that found hand washing with soap and water was more prevalent than other hand hygiene methods [15,[26][27][28]. It is also noteworthy that Saudi Arabian citizens have a preference for using soap and water to ABHR as a preventive measure against COVID-19 [19].…”

Tracking Australian Hajj Pilgrims’ Health Behavior before, during and after Hajj, and the Effective Use of Preventive Measures in Reducing Hajj-Related Illness: A Cohort Study

“…Previous studies have not explored if demographic factors were associated with an intention to use non-pharmacological protective measures before travel and their actual use during Hajj. Nonetheless, earlier studies did conclude that health education prior to departure was significantly associated with greater compliance with preventative practices, particularly the use of facemasks and hand sanitizers [19][20][21][22].…”