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Last updated April 14, 2020. 3 minute read

How effective is hand washing in reducing flu transmission?

The exact effect size of handwashing specifically for preventing flu transmission in the community is not currently known. However, because of its proven effectiveness in other settings (and lack of evidence showing that it doesn’t work), hand washing remains an important strong recommendation in preventing the spread of the flu.

rachel-kwon-md Written by Dr. Rachel Kwon, MD
Reviewed by Dr. Mike Bohl, MD, MPH

Influenza (the flu) is a contagious illness that affects the respiratory (breathing) system. The most common symptoms include fever, sore throat, runny nose, general aches and pains, cough, and fatigue. It can range from a mild illness that goes away on its own with rest and fluids to a severe illness requiring the person to be hospitalized. In certain cases, it can lead to death. 

There are two main types of influenza viruses (type A and type B). Death is an extreme outcome of flu, but there are other, more common outcomes that have an important impact each season. These include missed days of work, school, and increased burden on the healthcare system.

How many people get the flu each year?

In the United States, flu season (the time when most people get the flu) is in the fall and winter (CDC, 2020). The number of people affected is different each year, depending on infection control practices, how many people get the flu vaccine, how effective that year’s flu vaccine is, and other factors. In the 2018–2019 flu season, the CDC estimates that 35.5 million people in the US had the flu and that 16.5 million (about half—46%) of them had to see a doctor for the flu (CDC, 2020).

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How many people die from the flu each year

While overall mortality rate (how many people die from the disease as a percentage of how many that got the disease) is a rough indicator of how deadly the flu is, it is important to remember that the risk of severe illness depends on many factors, like age and how sick the person is at baseline (i.e. if they have any chronic illnesses).

In the 2018–2019 flu season, an estimated 34,000 people died from the flu or complications (of the 35.5 million who had the flu), making the overall death rate about 1 in every 1,000.

How effective is handwashing in preventing the flu?

According to the CDC, the single best way to prevent flu is to get a flu vaccine every year. Good health and hygiene, such as washing hands and covering a cough or sneeze, can also help prevent germs, including viruses like influenza, from spreading. The exact effect size of handwashing specifically for preventing flu transmission in the community is not currently known. However, because of its proven effectiveness in other settings (and lack of evidence showing that it doesn’t work), hand washing remains an important strong recommendation in preventing the spread of the flu (Moncion, 2019). In a study of 1,201 people (407 with influenza and 794 of their household contacts), hand hygiene helped reduce transmission of influenza among household contacts but only when implemented within 36 hours of the person showing symptoms (Cowling, 2009).

The best practices for washing hands are (CDC, 2020):

  • Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap
  • Scrub your hands for at least 20 seconds
  • Rinse hands well under clean, running water

You may also consider using a paper towel to open the door afterward.

Is washing your hands more effective than using hand sanitizer?

The CDC says that washing hands with soap and water as above is the best way to reduce the spread of infection in most situations, but an alcohol-based sanitizer with at least 60% alcohol can also be used as long as hands are not visibly dirty or greasy (in which case you should wash with soap and water).