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Rapid response to:


Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review

BMJ 2009; 339 doi: (Published 22 September 2009) Cite this as: BMJ 2009;339:b3675

Rapid Response:

Evidence for handwashing for the GPs

Dear Editor,

Jefferson and colleagues concluded from their systematic review that
handwashing and other simple physical interventions could reduce the
transmission of epidemic respiratory viruses.1 Both the previous2 and
current reviews included studies conducted in the community and hospital
settings but none at the primary care level. During the epidemic of severe
acute respiratory syndrome (SARS), eight primary care doctors (including
one dentist) and at least one family member of these doctors contracted
SARS with two subsequent deaths in Hong Kong.3 Another review which
focussed on evidence related to hand hygiene for general practitioners
identified four randomised control trials using gastrointestinal outcomes
such as diarrhoea as outcome measures and none on respiratory illness or
symptoms.4 Given the epidemiology, pathogens, length of contact and
severity of respiratory infections are different in a primary care context
than in the hospital and community setting, further evidence is urgently
required if the frontline practising doctors are to be convinced.


1. Jefferson, T, Der Mar C, Dooley L, Ferroni E et al. Physical
intervention to interrupt or educe the spread of respiratory virus:
systemic review. BMJ 2009;792.

2. Jefferson T, Foxlee R, Del Mar C, Dooley E, Ferroni E, Hewak W, et al.
Physical interventions to interrupt or reduce the spread of respiratory
viruses: systematic review. BMJ 2008;336:77-80.

3. Hong Kong Government Health, Welfare and food Bureau SARS Bulletin. (Accessed on

4. Leung JWK, Tam WWS, Wong TW. A review of the evidcne for hand hygiene
in different clinical and community settings for family physicians. HK
Prac 2007;29:157-163.

Competing interests:
None declared

Competing interests: No competing interests

08 October 2009
William CW Wong
Associate Professor; Director of GP and Primary Care Education
Department of General Practice, University of Melbourne, 200 Berkeley Street, Vic 3052 Australia