title: A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home.
abstract: OBJECTIVE
  Good hand hygiene may reduce the spread of infections in families with children who are in out-of-home child care. Alcohol-based hand sanitizers rapidly kill viruses that are commonly associated with respiratory and gastrointestinal (GI) infections. The objective of this study was to determine whether a multifactorial campaign centered on increasing alcohol-based hand sanitizer use and hand-hygiene education reduces illness transmission in the home.
  
  
  METHODS
  A cluster randomized, controlled trial was conducted of homes of 292 families with children who were enrolled in out-of-home child care in 26 child care centers. Eligible families had > or =1 child who was 6 months to 5 years of age and in child care for > or =10 hours/week. Intervention families received a supply of hand sanitizer and biweekly hand-hygiene educational materials for 5 months; control families received only materials promoting good nutrition. Primary caregivers were phoned biweekly and reported respiratory and GI illnesses in family members. Respiratory and GI-illness-transmission rates (measured as secondary illnesses per susceptible person-month) were compared between groups, adjusting for demographic variables, hand-hygiene practices, and previous experience using hand sanitizers.
  
  
  RESULTS
  Baseline demographics were similar in the 2 groups. A total of 1802 respiratory illnesses occurred during the study; 443 (25%) were secondary illnesses. A total of 252 GI illnesses occurred during the study; 28 (11%) were secondary illnesses. The secondary GI-illness rate was significantly lower in intervention families compared with control families (incidence rate ratio [IRR]: 0.41; 95% confidence interval [CI]: 0.19-0.90). The overall rate of secondary respiratory illness was not significantly different between groups (IRR: 0.97; 95% CI: 0.72-1.30). However, families with higher sanitizer usage had a marginally lower secondary respiratory illness rate than those with less usage (IRR: 0.81; 95% CI: 0.65-1.09).
  
  
  CONCLUSIONS
  A multifactorial intervention emphasizing alcohol-based hand sanitizer use in the home reduced transmission of GI illnesses within families with children in child care. Hand sanitizers and multifaceted educational messages may have a role in improving hand-hygiene practices within the home setting.
authors.affiliation: Division of Infectious Diseases, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA. thomas.sandora@childrens.harvard.edu
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Sandora
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
authors.forename: Mei-Chiung
authors.initials: MC
authors.lastname: Shih
authors.forename: Elissa A
authors.initials: EA
authors.lastname: Resnick
authors.forename: Grace M
authors.initials: GM
authors.lastname: Lee
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.forename: Donald A
authors.initials: DA
authors.lastname: Goldmann
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D002656:Child Day Care Centers; D002675:Child, Preschool; D003140:Communicable Disease Control; D000431:Ethanol / Q000008:administration & dosage*; D005192:Family Health; D005767:Gastrointestinal Diseases / Q000517:prevention & control*; D006235:Hand Disinfection; D006266:Health Education; D006801:Humans; D007223:Infant; D012141:Respiratory Tract Infections / Q000517:prevention & control* / Q000635:transmission
chemical_list: D000891:Anti-Infective Agents, Local; D000431:Ethanol