STOPFLU: Is it Possible to Reduce the Number of Days Off in Office Work by Improved Hand-hygiene?
Condition: Respiratory Infection; Gastroenteritis
MeSH terms: Respiratory Tract Infections; Gastroenteritis
Study type: Interventional

Summary: 
      Improved hand hygiene is known to reduce transmission of both respiratory (RTI) and
      gastrointestinal infections (GTI) under "semi-closed" conditions such as hospitals, day-care
      centres and schools. It is not known if similar interventions would have the desired effect
      in a regular office work. This study is aiming to investigate this possibility by recruiting
      volunteers from several companies in the Helsinki Region. The two intervention groups will
      receive detailed instructions e.g. for proper coughing and sneezing, and for regular cleaning
      of hands with either standard liquid soap or with alcohol-based gel rubbing. Third group will
      serve as the control and is advised not to change their previous behaviour in this respect.
      The participants will report weekly possible RTI or GTI symptoms and related days off through
      internet. The study is planned to run about 18 months to cover the seasonal variation of the
      epidemics of the causative different viruses.
    

Detailed description: 
      It is common knowledge that both respiratory tract infections (RTI) and gastrointestinal
      infections (GTI) cause a large part of short periods of days off from work, day care and
      school. In addition, because of the generally mild nature of the diseases, especially adults
      often come to work in spite of symptoms, and may therefore initiate transmission of infection
      among their colleagues. The chain of events from exposure to a pathogenic virus to subsequent
      infection and staying home because of infectious disease is a very complicated one, and is
      affected by many factors potentially causing variation, such as the multitude of causative
      agents, different individual histories of infections, variability of inter-personal contacts
      in work and various working- team feelings -influenced thresholds for staying home etc.
      Therefore, we aim to recruit at least 24 operationally distinct volunteer groups, each
      including at least 50 persons, and to continue the intervention about 18 months.

      A virus transmission "risk-index" will be calculated for each group based on potential
      participant questionnaires enquiring, among other things, about numbers and ages of children,
      their possible out-of-home day care, personal properties such as smoking, chronic diseases,
      and potential differences in contacts during daily work. The 24 groups will be divided in
      groups of three most similar ones, and members each triplet then randomised in one the
      intervention groups or the control (see brief summary).

      Data collection is based on self-reporting through Monday-morning electronic reports using a
      standard form. The from is enquiring about possible exposure to persons suffering from RTI or
      GTI, and possible own symptoms of the same diseases during the preceding 7 day period
      (including weekends and other holidays). The form will require daily records offering all
      possible combinations of the following categories: healthy-with symptoms, working
      normally-day off, own disease-child ill-other reason for day off.

      Etiology of the symptoms will not be searched for on individual basis in this study but a
      connection to RTI virus epidemiology is built by a sentinel surveillance, where occupational
      health clinics located in the premises of the participating companies send a standard number
      of weekly specimens collected from employees visiting the clinic. For possible GTI outbreaks
      a standard outbreak investigation principle will be followed, including 3-5 specimens. from
      typical patients will be collected. Common causative agents of the diseases will be searched
      for using real-time PCR techniques.
    

Intervention name(s): Hand washing; Disinfectant rubbing
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Instructions for proper coughing and sneezing, and for reduced hand shaking, frequent hand washing in office and at home; Instructions for proper coughing and sneezing, and for reduced hand shaking; frequent rubbing of hands with alcohol containing disinfectant in office and at home
Intervention MeSH terms: Disinfectants
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: virus infection; hygiene; transmission; intervention