Abstract
ObjectiveTo undertake a systematic review and meta-analysis to establish the effectiveness of handwashing in reducing absence and/or the spread of respiratory tract (RT) and/or gastrointestinal (GI) infection among school-aged children and/or staff in educational settings.DesignRandomised-controlled trials (RCTs).SettingSchools and other settings with a formal educational component in any country.PatientsChildren aged 3–11 years, and/or staff working with them.InterventionInterventions with a hand hygiene component.Main outcome measuresIncidence of RT or GI infections or symptoms related to such infections; absenteeism; laboratory results of RT and/or GI infections.ResultsEighteen cluster RCTs were identified; 13 school-based, 5 in child day care facilities or preschools. Studies were heterogeneous and had significant quality issues including small numbers of clusters and participants and inadequate randomisation. Individual study results suggest interventions may reduce children's absence, RT infection incidence and symptoms, and laboratory confirmed influenza-like illness. Evidence of impact on GI infection or symptoms was equivocal.ConclusionsStudies are generally not well executed or reported. Despite updating existing systematic reviews and identifying new studies, evidence of the effect of hand hygiene interventions on infection incidence in educational settings is mostly equivocal but they may decrease RT infection among children. These results update and add to knowledge about this crucial public health issue in key settings with a vulnerable population. More robust, well reported cluster RCTs which learn from existing studies, are required.
Highlights
Young children are susceptible to respiratory tract (RT) and gastrointestinal (GI) infections
What is already known on this topic
▸ Three systematic reviews of studies of hand hygiene interventions to prevent respiratory and/or gastrointestinal infections focus on educational settings; each has significant limitations
Summary
Young children are susceptible to respiratory tract (RT) and gastrointestinal (GI) infections. Infections affect child health, causing missed educational opportunities which may have a detrimental effect on educational outcomes,[1 2] lost productivity and days off work for school staff.[3] Educational settings where large numbers of children with immature immunity congregate are promising sites for preventing infection, as outbreaks can affect whole schools and spread to vulnerable populations (eg, younger siblings) in the community.[4 5]. Four SRs have included studies evaluating interventions in educational settings alongside other settings;[8 9 11 14] two focus on RT infection,[11 14] two focus on diarrhoea prevention.[8 9] Two of these are Cochrane reviews;[8 11] one recommended that:
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