Simple handwashing reduces rates of respiratory illness

August 01, 2001

A little soap and water go a long way toward preventing illness, a piece of common sense dramatically demonstrated by an experiment with Navy recruits who had 45 percent fewer bouts of respiratory illnesses after being ordered to wash their hands frequently.

Respiratory illnesses are the most common cause of lost time from duty among young adults in the military, and a large outbreak can compromise military readiness, according to Margaret A. K. Ryan, M.D., now with the Naval Health Research Center in San Diego.

Handwashing has been recommended for more than 150 years as a simple but effective way of thwarting the spread of illnesses, but military personnel, as well as people outside the military, often don't follow the advice.

Ryan's findings are published in the August issue of the Journal of Preventive Medicine. The study describes a program called Operation Stop Cough, implemented at the Great Lakes Recruit Training Command Center in Illinois.

Health officials devised the program as a low-tech response to the impending lack of a vaccine the military uses to reduce the incidence of respiratory illness. In the past century, the military has tried everything from dust suppression, ultraviolet radiation, disinfectant vapors and widespread antibiotics to prevent infections, according to Ryan.

As part of the handwashing program, commanding officers told recruits to wash their hands at least five times a day. Other changes were made to facilitate frequent handwashing, including allowing "wet sinks" (rather than dry) to be acceptable for inspection purposes, installation of liquid soap dispensers at all sinks in training spaces and monthly barracks inspection "to include assessment of sink and soap availability."

Ryan and her colleagues tracked illness among Navy recruits who participated in Operation Stop Cough from 1997 to 1998 by reviewing weekly illness rates, based on trips to the medical clinic that serves the training center and visits to naval hospitals. They compared this information to rates in 1996, a year before the program went into effect.

"The overall rate of illness in 1997 and 1998 was 45 percent lower than the average rate in the preceding year," says Ryan. "Although there may have been other factors that affected illness rates, this work augments the growing literature assessing handwashing outside of healthcare settings, and evaluates such an intervention in the largest population described to date."

Operation Stop Cough produced no reduction in hospitalization rates, which may indicate that handwashing works best in preventing less virulent illnesses. However, handwashing may have mitigated, but did not prevent, an outbreak of adenoviral illness in the fall of 1997, according to Ryan.

Despite the success of the program, the researchers were unable to continue collecting data after 1998 because the emphasis on the handwashing program waxed and waned with staff turnover and competing pressures inherent to a military training center. Additionally, a survey found that close to half the recruits said keeping up the five-times-a-day washing schedule was difficult, Ryan writes.

"Increasing and sustaining compliance with handwashing may be best accomplished through a multifaceted organizational commitment," she says.

A commentary appearing in the same issue of the journal notes that the growing shortage of vaccines must be addressed, both in terms of military needs and for the general public. Though not a substitute for vaccines, handwashing is especially valuable, according to Joel C. Gaydos, M.D., M.P.H., with the Defense Department's Global Emerging Infections Surveillance and Response System.

"My impression is that in settings where visible soiling of hands is unusual, such as in offices, people are not inclined to wash their hands even before eating," says Gaydos. "Re-emphasizing handwashing in our daily lives may provide significant benefits with little effort or cost, especially during the respiratory disease season."
Funding for the study was provided by the Naval Health Research Center, Global Emerging Infection Surveillance program.

The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge and wisdom in prevention science, education, practice and policy. For more information about the Journal, contact the editorial office at 619-594-7344. For copies of the article, contact the Center for the Advancement of Health at 202-387-2829 or e-mail

Posted by the Center for the Advancement of Health For more research news and information, go to our special section devoted to health and behavior in the "Peer-Reviewed Journals" area of Eurekalert!, For information about the Center, call Ira Allen, 202-387-2829.

Contact: Margaret A. K. Ryan, 619-553-8097,

Center for Advancing Health

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