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However, the efficacy of such interventions is unclear. A systematic literature review was undertaken to identify and evaluate the published literature on <jats:styled-content style=\"fixed-case\">NPI<\/jats:styled-content> efficacy to prevent human transmission of influenza virus in adults. Reviewers assessed the quality of eligible studies utilizing the <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>ritical <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ppraisal <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>kills <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>rogramme for bias and the <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>cottish <jats:styled-content style=\"fixed-case\">I<\/jats:styled-content>ntercollegiate <jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>uidelines <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>etwork for methodological quality. Studies were assessed for risk of bias domains of random sequence generation, allocation concealment, attribution bias, selective reporting and blinding. Relevant citations of 2247 were reduced to 100 for full\u2010text evaluation. Only seven met all selection criteria and pooled analysis was not feasible. Of the seven studies, two were randomized controlled trials (<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>) and five were cluster <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>. The main <jats:styled-content style=\"fixed-case\">NPI<\/jats:styled-content> studied were disinfection and hygiene; barriers; and combined <jats:styled-content style=\"fixed-case\">NPI<\/jats:styled-content>. However, these seven <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content> had significant design flaws. Only two studies used laboratory confirmed influenza and poor statistical power was a major problem. Positive significant interventions included professional oral hygiene intervention in the elderly and hand washing. Despite the potential for <jats:styled-content style=\"fixed-case\">NPI<\/jats:styled-content> in preventing influenza transmission, there is very limited data available. Hand washing and dental hygiene may be useful, but other interventions have not been fully assessed. Properly designed studies evaluating large populations including \u2018at risk\u2019 patients and in a variety of communities are needed.<\/jats:p>","DOI":"10.1111\/resp.12541","type":"journal-article","created":{"date-parts":[[2015,4,15]],"date-time":"2015-04-15T00:42:56Z","timestamp":1429058576000},"page":"896-903","source":"Crossref","is-referenced-by-count":60,"title":["Use of non\u2010pharmaceutical interventions to reduce the transmission of influenza in adults: A systematic review"],"prefix":"10.1111","volume":"20","author":[{"given":"Sheree M.S.","family":"Smith","sequence":"first","affiliation":[{"name":"School of Nursing and Midwifery University of Western Sydney  Sydney New South Wales Australia"},{"name":"Centre for Pharmacology and Therapeutics Imperial College Chelsea and Westminster Campus  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Sonego","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery University of Western Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwenyth R.","family":"Wallen","sequence":"additional","affiliation":[{"name":"National Institutes of Health Clinical Center  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Waterer","sequence":"additional","affiliation":[{"name":"School of Medicine and Pharmacology Royal Perth Unit University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen C.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit Department of Epidemiology and Preventative Medicine Faculty of Medicine Nursing and Health Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Thompson","sequence":"additional","affiliation":[{"name":"School of Medicine and Pharmacology Queen Elizabeth II Unit University of Western Australia  Perth Western Australia Australia"},{"name":"The Lung Health Clinic Hollywood Hospital  Perth Western Australia Australia"},{"name":"Department of Respiratory Medicine Sir Charles Gairdner Hospital  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,4,14]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0019467"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(07)70029-4"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq071"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0027932"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1212.060506"},{"key":"e_1_2_7_7_1","unstructured":"Centers for Disease Control.Community NPIs.2014. 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