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BackgroundIllness-related absences have been shown to lead to negative educational and economic outcomes. Both hand washing and hand sanitizer interventions have been shown to be effective in reducing illness-related absences. However, while the importance of hand hygiene in schools is clear, the role of instruction in use is less obvious. The purpose of this study was to compare absenteeism rates among elementary students given access to hand hygiene facilities versus students given both access and short repetitive instruction in use, particularly during influenza season when illness-related absences are at a peak.MethodsA hand hygiene intervention was implemented from October to May during the 2009/2010 academic year, including peak flu season, in two Chicago Public Elementary Schools among students grades pre-kindergarten to eighth grade (ages 4–14). Classrooms were systematically assigned to an intervention or control group by grade (cluster design). Hand hygiene facilities (sanitizer and soap) were made available to all students. Students in the intervention group also received short repetitive instruction in hand hygiene every 2 months. Only absences as a result of respiratory or gastrointestinal illness were used to establish illness-related absenteeism rates. Percent absent days were calculated and bivariate analyses were performed to compare percent absent days among students given access to hand hygiene facilities versus students given both access and instruction. Prior to the intervention, teachers’ perceptions of students’ hand hygiene were also evaluated. Teacher perceptions were analysed to describe attitudes and beliefs.ResultsData were collected and analysed for 773 students reporting 1,886 absences during the study period (1.73% of total school days). Both the percent total absent days and percent illness-related absent days were significantly lower in the group receiving short instruction during flu season (P = 0.002, P < 0.001, respectively). This difference peaked during the influenza season (when intervention began) and declined in the following months. Teachers (n = 23) agreed that hand hygiene is not performed properly among students and reported time constraints as a barrier to frequent hand washing.ConclusionsAdding hand hygiene instruction to existing hand hygiene practices improved attendance at public elementary schools during the flu season. Standardized and brief repetitive instruction in hand hygiene holds potential to significantly reduce absenteeism.

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Background Many parents of food allergic children have concerns about the development of food allergies in their other children. Objective We sought to determine prevalence of food sensitization and clinical food allergy among siblings of food allergic children. Methods Two thousand eight hundred and thirty-four children were enrolled in the Chicago Family Cohort Food Allergy study. One thousand one hundred and twenty children (ages 0–21 years) with a food allergy (defined by a reported reaction history and evidence of food-specific IgE or skin prick test) and at least one biological sibling were included in this study. Results Among siblings of children with food allergy, 33.4% had no sensitization and no clinical symptoms to food. Fifty-three percent had a positive food serum-specific IgE or skin prick test, but no reported symptoms of food allergy. Only 13.6% of siblings were both sensitized and clinically reactive to the same food. Milk allergy was the most common allergy among siblings (5.9%), followed by egg allergy (4.4%) and peanut allergy (3.7%). Conclusions In a large cohort of food allergic families, only a small proportion of siblings were both sensitized and clinically reactive to a food. Sensitization without reactivity was common among siblings. Testing for food allergy in siblings without a history of clinical reactivity appears to be unjustified. Screening may lead to negative consequences related to potential misdiagnosis and unnecessary avoidance of a food. More data are needed to determine the absolute risk of food allergy development in siblings of food allergic children.