Impact of a Multifactorial Program of Hand Hygiene on Infections in Children Attending in Day-care Centres
Condition: Respiratory Tract Infections; Gastroenteritis
MeSH terms: Infections; Communicable Diseases; Respiratory Tract Infections; Gastroenteritis
Study type: Interventional

Summary: 
      It is well known that attending Day Care Centres (DCCs) can lead to an increase in the
      frequency of infections, due to the high incidence at this age and also the ease of
      transmission among children. This high incidence respiratory tract infections (RTIs) and
      acute gastroenteritis can also have a significant impact on the cost of health care systems,
      increasing the number of medical visits, hospitalizations and prescribing medications as
      symptomatic drugs or unnecessary antibiotics in some cases.The aim of the study was to
      determine whether a multifactorial hand-hygiene program (handwashing with soap and water vs
      hand sanitizer vs control group) reduce episodes due to RTIs and gastroenteritis in children
      attending DCCs. In addition, analyze the cost-effectiveness of these interventions.
    

Detailed description: 
      A randomized, controlled, and open study of 3 cohorts of families with children attending to
      DCCs, between the ages of 0 and 3, attending 25 DCC (911 children) in Almeria (Spain) was
      designed. This study was carried out over the course of 8 months (November 2013 to June
      2014). A group of DCCs/families will perform hand hygiene with soap and water (SWG), another
      group with hand sanitizer gel (HSG) and a control group (CG) practiced usual handwashing
      techniques.

      Intervention: The families and DCCs staff randomly assigned to HSG and SWG attended
      handwashing workshops of 2-hour duration. These took place one month before the beginning of
      the study. Workshop content included education about the most frequent infections in DCCs,
      their transmission, prevention, treatment, instructions on how and when hands should be
      washed, use of hand sanitizers and possible side effects in the HSG. Every 2 weeks, the
      research assistant and the teachers (staff) performed activities such as stories, songs and
      posters in the classroom, which are linked to hand hygiene and infection's transmission. In
      the Children/families in the HSG and SWG were instructed by the researchers, teachers, and
      research assistant to maintain the usual handwashing procedure after going to the toilet and
      when their hands were visibly dirty. They also were told to use the hand sanitizer and
      handwashing with water and liquid soap correctly in the following circumstances: after coming
      into the classroom; before and after lunch; after playing outside; when they went home; and
      after coughing; sneezing; or blowing their noses; after diapering.

      Parents of the three groups completed the survey on sociodemographic characteristics and
      questions about hand hygiene referred to when and how their children wash their hands.
      Progenitors of children whit episodes due to RTIs and gastroenteritis collected the symptoms
      and handed in the completed form to the teacher. A research assistant collected the absence
      sheets of the participating classes weekly, called the parents of absent children to enquire
      about the cause of their absence, visited the classrooms and collaborated with the teachers
      in activities related to the hygiene of hands.
    

Intervention name(s): hand sanitizer; liquid soap
Intervention type(s): Other; Other
Intervention description(s): DCCs received alcohol-based hand sanitizer and a program educational.; DCCs received liquid soap and a program educational.
Other intervention name(s): educational intervention; educational intervention
Intervention MeSH terms: Hand Sanitizers
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Respiratory Tract Infections; gastroenteritis; hand sanitizer; handwashing; day care