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Hand Washing Conflicts Emerge
Regarding The Prevention of Flu


There’s no evidence that good hand hygiene practices prevent influenza transmission, according to a Council of Canadian Academies report commissioned by the Public Health Agency of Canada (PHAC).

But N95 particulate respirator-type masks are a proven "final layer of protection" against even the smallest viral particles of influenza, according to Influenza Transmission and the Role of Personal Protective Respiratory Equipment: An Assessment of the Evidence, a report prepared by an expert panel on influenza and personal protective respiratory equipment chaired by Dr. Donald Low, microbiologist-in-chief at Mount Sinai Hospital in Toronto, Ontario (www.scienceadvice.ca/documents/(2007-12-19)_Influenza_PPRE_Final_Report.pdf).

Despite those 2007 findings, PHAC still recommends handwashing as the primary preventive measure against flu transmission. The agency also states on its website that there is no evidence that wearing masks "will prevent the spread of infection in the general population. Improper use of masks may in fact increase the risk of infection."

Moreover, PHAC states in an email to CMAJ that "there is substantial evidence to support hand hygiene as a basic premise of infection prevention and control measures." The agency also indicated that its hand hygiene recommendations are based on a combination of expert opinion and evidence, including a recent Cochrane Collaboration systematic review (BMJ 2009;339:b3675).

But the contradictory evidence and recommendations on preventive measures and other pandemic (H1N1) 2009 issues leaves Canadian doctors at a loss as to the best advice to provide patients, says College of Family Physicians of Canada President Dr. Sarah Kredentser.

"The average family physician is confused and that’s partly because there is a lot of conflicting evidence, and things change day by day," Kredentser says, adding that there’s a need for the experts to get the information right and then get it out quickly to family physicians. To that end, the college is now working with PHAC, the Canadian Medical Association and other bodies to craft a one-page influenza guideline for physicians to use in the community.


Reference Sources: cmaj.ca
November 11, 2009

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