Nonpharmacological interventions to reduce respiratory viral transmission: an evidence-based review with recommendations.

BACKGROUND: Viral respiratory infections are a leading cause of worldwide mortality and exert the potential to cause global socioeconomic crises. However, inexpensive, efficacious, and rapidly deployable strategies to reduce viral transmission are increasingly important in the setting of an ongoing pandemic, though not entirely understood. This article provides a comprehensive review of commonly employed nonpharmacological interventions to interrupt viral spread and provides evidence-based recommendations for their use. METHODOLOGY: A systematic review of three databases was performed. Studies with defined endpoints of subjects receiving one of five interventions (nasal washing, gargling, personal protective equipment (PPE), social distancing, and hand hygiene) were included. An evidence-based review of the highest level of evidence, with recommendations, was created in accordance with a previously described, rigorous, iterative process. RESULTS: Fifty-four primary studies were included. The most commonly studied intervention was hand hygiene, followed by PPE, gargling, saline nasal washing, and social distancing. CONCLUSIONS: Mask use and hand hygiene are strong recommendations for prevention of viral transmission. Donning gloves, gowns, and eye protection are a recommendation in healthcare settings. Saline nasal washing and gargling are options in selected populations. Although an aggregate level of evidence is not provided, the authors recommend social distancing.

Acetate uptake by intestinal brush border membrane vesicles.

The mechanism of acetate absorption in the small intestine is not yet established. One possible mechanism is by carrier mediated Na(+)-acetate cotransport since acetate, like glucose, stimulates intestinal Na+ and water absorption in vivo. Uptake of radioactive carbon acetate by small intestinal brush border membrane vesicles was not saturable or Na+ dependent and did not respond to osmotic shrinkage of the vesicles. This suggests that acetate binds to the membranes but is not transported into the intravesicular space and argues against carrier mediated Na+ acetate cotransport. These results are consistent with acetate absorption by a non-mediated diffusion and suggest that the stimulation of water and Na+ absorption by acetate in vivo is largely due to osmotic forces and solvent drag.