Hand hygiene instruction decreases illness-related absenteeism in elementary schools: a prospective cohort study

Abstract

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.

A cross sectional descriptive study of hand washing knowledge and practices among primary school children in Mumbai, Maharashtra, India

“…18 Illness related absenteeism have been found to be reduced by hand washing interventions. 19 In a school based study conducted by Lopez-Quintero, 2009, it was found that few children reported gastrointestinal symptoms in the preceding month and absenteeism in last year. 20 An intervention based study needs to be carried out to study the implication of proper hand washing behaviour on illness and related absenteeism in the present study population.…”

“…19 In an interventional study conducted in Kolkata in primary school children it was found that 85.4% children washed their hands before eating food while 55.2% washed hands after going to the toilet. 27 Hand washing after going to the toilet was practiced by 55.2% of the respondents in a study conducted in south India.…”

Access to Waterless Hand Sanitizer Improves Student Hand Hygiene Behavior in Primary Schools in Nairobi, Kenya

“…5,[11][12][13] Hand sanitizer interventions conducted in elementary schools in the United States have reduced illness-related absenteeism by 14-51%. 3,[14][15][16][17] Home-based hand sanitizer interventions have also been found to reduce respiratory and gastrointestinal illness transmission among households with children enrolled in daycare. 18,19 Alcohol-based hand sanitizers have limited efficacy against some enteric pathogens, such as the sporeforming bacteria Clostridium difficile and Norwalk virus.…”

Intestinal Protozoa Infections and Associated Risk Factors in Rural Community of Samosir Island Indonesia

“…Washing hands regularly with soap and water protects man from getting infected with the parasites [20], although other studies reported otherwise [1], [21]. Some records have documented that children engaged with washing habit had lower levels of medical leave from school [22], [23]. In Indonesia, since a lot of people eat with bare hands particularly in rural community, hand-washing is mostly practiced prior to eat than after defecation.…”