Hand-hygiene mitigation strategies against global disease spreading through the air transportation network

Christos Nicolaides; Demetris Avraam; Luis Cueto-Felgueroso; Marta C. González; Ruben Juanes

The effectiveness of mitigation strategies against global pandemics is evaluated through the total expected cost versus the total public health benefit 45 . The target of each strategy is to maximise the social welfare by incurring in the minimum economic cost. For interventions where travel restrictions are implemented 46 , the cost increases with the number of closed airports and the number of individuals that get stranded in those airports. The reward is related to the relative decrease in the global footprint of the disease, compared with the null case of non-interventions. In contrast to the mobility-driven strategies that change the population's mobility patterns, other solutions such as hand washing appear to be more cost-and reward-effective. A future research on the socio-economic impact of global pandemics and the cost-effectiveness ratio of different mitigation strategies (e.g. hand washing, vaccination, airport closures, mobility routing diversions) against disease spreading would evaluate the efficiency and significance of hand-hygiene interventions. However, while hand hygiene is considered as the first prevention step in the case of an epidemic emergency, the capacity of hand washing facilities in crowded places, including airports, is limited only to wash basins at restrooms. It is not known, however, if increased capacity would enhance hand washing engagement by air travelers. New technology is being developed aiming to increase the capacity of facilities even outside restrooms, thus expanding the options for hand hygiene and the solutions for air and surface sterilization. Airbus 47 , for example, is exploring an innovative antimicrobial technology that is able to eliminate viruses and pathogens from aircraft surfaces (e.g. tray tables, seat covers, touch screens, galley areas). Boeing is also exploring a prototype self-sanitizing lavatory that uses ultraviolet light to kill 99.99% of pathogens 48 . At the same time, robotic systems for dirt detection and autonomous cleaning of contaminated surfaces 49 and smart touch-free hand washing systems 50 are promising tools on the evolution of cleaning technologies.