Scolaris Content Display Scolaris Content Display

Intervensi fizikal untuk mengawal dan mengurangkan penyebaran virus sistem pernafasan (respiratori)

This is not the most recent version

Collapse all Expand all

Background

Viral epidemics or pandemics of acute respiratory infections like influenza or severe acute respiratory syndrome pose a global threat. Antiviral drugs and vaccinations may be insufficient to prevent their spread.

Objectives

To review the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses.

Search methods

We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL 2010, Issue 3), which includes the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to October 2010), OLDMEDLINE (1950 to 1965), EMBASE (1990 to October 2010), CINAHL (1982 to October 2010), LILACS (2008 to October 2010), Indian MEDLARS (2008 to October 2010) and IMSEAR (2008 to October 2010).

Selection criteria

In this update, two review authors independently applied the inclusion criteria to all identified and retrieved articles and extracted data. We scanned 3775 titles, excluded 3560 and retrieved full papers of 215 studies, to include 66 papers of 67 studies. We included physical interventions (screening at entry ports, isolation, quarantine, social distancing, barriers, personal protection, hand hygiene) to prevent respiratory virus transmission. We included randomised controlled trials (RCTs), cohorts, case‐controls, before‐after and time series studies.

Data collection and analysis

We used a standardised form to assess trial eligibility. We assessed RCTs by randomisation method, allocation generation, concealment, blinding and follow up. We assessed non‐RCTs for potential confounders and classified them as low, medium and high risk of bias.

Main results

We included 67 studies including randomised controlled trials and observational studies with a mixed risk of bias. A total number of participants is not included as the total would be made up of a heterogenous set of observations (participant people, observations on participants and countries (object of some studies)). The risk of bias for five RCTs and most cluster‐RCTs was high. Observational studies were of mixed quality. Only case‐control data were sufficiently homogeneous to allow meta‐analysis. The highest quality cluster‐RCTs suggest respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children. Benefit from reduced transmission from children to household members is broadly supported also in other study designs where the potential for confounding is greater. Nine case‐control studies suggested implementing transmission barriers, isolation and hygienic measures are effective at containing respiratory virus epidemics. Surgical masks or N95 respirators were the most consistent and comprehensive supportive measures. N95 respirators were non‐inferior to simple surgical masks but more expensive, uncomfortable and irritating to skin. Adding virucidals or antiseptics to normal handwashing to decrease respiratory disease transmission remains uncertain. Global measures, such as screening at entry ports, led to a non‐significant marginal delay in spread. There was limited evidence that social distancing was effective, especially if related to the risk of exposure.

Authors' conclusions

Simple and low‐cost interventions would be useful for reducing transmission of epidemic respiratory viruses. Routine long‐term implementation of some measures assessed might be difficult without the threat of an epidemic.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Intervensi fizikal untuk mengawal dan mengurangkan penyebaran virus sistem pernafasan (respiratori)

Walaupun virus respiratori pada kebiasanya hanya membawa kepada penyakit yang kurang serius tapi ianya mampu menyebabkan wabak yang besar. Kira‐kira 10% hingga 15% daripada penduduk sedunia menghidapi influenza setiap tahun, dengan kadar jangkitan setinggi 50% semasa wabak besar. Pandemik global yang melibatkan jangkitan virus telah berlaku dengan dahsyat. Pada 2003, sekitar 8000 orang telah menghidapi wabak Sindrom Pernafasan Akut Teruk (SARS) dan seramai 780 orang telah terbunuh. Wabak ini telah menyebabkan krisis sosial dan ekonomi yang besar. Pada tahun 2006, virus burung yang baru H5N1, dan pada tahun 2009 ancaman influenza ‘babi’ pandemik baru H1N1 telah menyebabkan kebimbangan global pada masa itu. Langkah tunggal dan yang mungkin agak mahal (terutamanya penggunaan vaksin atau ubat antivirus) mungkin tidak mampu untuk mengawal penyebarannya. Oleh itu, kami telah mencari bukti tentang keberkesanan halangan fizikal mudah (seperti membasuh tangan atau memakai topeng muka) untuk mengurangkan jangkitan virus respiratori.

Kami menyertakan 67 kajian termasuk kajian kawalan rawak dan kajian pemerhatian yang mempunyai pelbagai risiko berat sebelah. Jumlah peserta tidak disertakan oleh kerana jumlah tersebut diambil daripada pelbagai jenis pemerhatian: Ini termasuk peserta yang terlibat dan pemerhatian terhadap peserta dan negara‐negara terlibat (menjadi tujuan/objek dalam beberapa kajian). Oleh itu, jumlah angka sebenar agak mengelirukan. Penyebaran virus respiratori boleh dikurangkan melalui langkah‐langkah penjagaan kebersihan (seperti mencuci tangan), terutamanya ketika mendekati kanak‐kanak yang lebih muda. Membasuh tangan dengan kerap juga boleh mengurangkan penyebaran jangkitan virus daripada kanak‐kanak kepada ahli isi rumah yang lain. Pelaksanaan halangan kepada penyebaran virus seperti pengasingan dan pengambilan langkah‐langkah kebershian (seperti memakai topeng muka, sarung tangan dan gaun) mungkin berkesan dalam pengawal penularan virus respiratori ketika wabak ataupun di hospital. Kami mendapati tiada bukti yang kukuh yang mendapati bahawa alat pernafasan N95 yang lebih mahal dan yang kurang selesa adalah lebih berkesan daripada topeng pembedahan biasa. Tambahan lagi, tiada bukti yang jelas jika penambahan pembunuh kuman atau antiseptik dalam sabun pencuci tangan mampu menambahkan keberkesanannya. Terdapat kekurangan bukti untuk menyokong saringan di pintu masuk dan perenggangan sosial (memisahkan sekurang‐kurangnya satu meter antara yang orang yang dijangkiti dengan yang tidak dijangkiti) sebagai kaedah‐kaedah yang dapat mengurangkan penyebaran semasa wabak.