Impact of alcohol-based hand-gel sanitizer and hand hygiene advice on travellers' diarrhoea and colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae: A randomised, controlled trial

Esther Kuenzli; Veronika K Jaeger; Susan DeCrom; Véronique Sydow; Veronika Muigg; Reno Frei; Adrian Egli; Jan Fehr; Christoph Hatz

doi:10.1016/j.tmaid.2019.101475

Impact of alcohol-based hand-gel sanitizer and hand hygiene advice on travellers' diarrhoea and colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae: A randomised, controlled trial

Travel Med Infect Dis. 2019 Nov-Dec:32:101475. doi: 10.1016/j.tmaid.2019.101475. Epub 2019 Sep 6.

Authors

Esther Kuenzli¹, Veronika K Jaeger², Susan DeCrom³, Véronique Sydow⁴, Veronika Muigg⁴, Reno Frei⁵, Adrian Egli⁶, Jan Fehr⁷, Christoph Hatz⁸

Affiliations

¹ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland. Electronic address: esther.kuenzli@uzh.ch.
² Department of Rheumatology, University Hospital Basel, Basel, Switzerland; Institute for Epidemiology and Social Medicine, University of Münster, Germany.
³ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
⁴ Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
⁵ Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
⁶ Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.
⁷ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁸ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Infectious Diseases and Hospital Hygiene, Cantonal Hospital, St. Gallen, Switzerland.

PMID: 31499238
DOI: 10.1016/j.tmaid.2019.101475

Abstract

Background: Travellers' diarrhoea (TD) is the most common health problem in international travellers. Besides being bothersome for the individual and a considerable economic burden for the public, TD is also known to be associated with becoming colonized with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriacea. Despite the high frequency of TD cases, easy and effective preventive measures are lacking. The aim of this study was to assess the impact of using hand gel sanitizer on the incidence of TD and colonization with ESBL-producing Enterobacteriaceae.

Method: A multicentre randomized intervention trial studying the effect of hand gel sanitizer on the incidence of TD and colonization with ESBL-producing Enterobacteriaceae in travellers to Southeast Asia was performed.

Results: The intention to treat analysis showed a reduction in the incidence of WHO TD in the intervention group (OR 0.54 (95% CI 0.30-0.97), p = 0.04). No effect was seen or the incidence of becoming colonized with ESBL-producing Enterobacteriaceae.

Conclusion: Using hand gel sanitizer might have a protective effect on the occurrence of TD. Based on the current data, education on the proper use appears to play a key role for its effectiveness.

Keywords: ESBL-producing Escherichia coli; Gastrointestinal infection; Prevention.