Can a handwashing intervention make a difference? Results from a randomized controlled trial in Jerusalem preschools.
BACKGROUND
Preschools are often focal points for the spread of illness among young children. The objective of this preschool intervention trial was to determine whether a hygiene program can promote handwashing and thereby reduce illness absenteeism.


METHODS
This cluster randomized trial included 40 Jerusalem preschools with 1029 children for 6 baseline days and 66 study days, yielding 73,779 child days. The main outcomes were rates of handwashing and illness absenteeism. The intervention included an educational program and environmental changes. A simultaneous subtrial was run to test a home component.


RESULTS
This multi-site intervention program produced sustained behavioral and environmental changes over a 6-month period. An approximately threefold increase in handwashing with soap was observed among preschool children exposed to the intervention. Neither the preschool nor the home intervention program reduced illness absenteeism or overall absenteeism.


CONCLUSIONS
This trial illuminates the potential of the preschool as a promising venue for health promotion activities leading to sustained behavioral change, yet suggests the need for enhanced approaches for reducing illness absenteeism.
Rosen
Laura
L
Hebrew University School of Public Health, P.O.B. 12272, Jerusalem 91120, Israel. Lrosen@vms.huji.ac.il
Manor
Orly
O
Engelhard
Dan
D
Brody
David
D
Rosen
Bruce
B
Peleg
Hannah
H
Meir
Marina
M
Zucker
David
D
D000041:Absenteeism; D002656:Child Day Care Centers; D002675:Child, Preschool; D006235:Hand Disinfection; D015438:Health Behavior; D006266:Health Education; D006293:Health Promotion; D006801:Humans; D007557:Israel; D017063:Outcome Assessment, Health Care; D012572:School Health Services; D012578:Schools, Nursery; D017592:Skin Care / Q000379:methods*; D012915:Soaps
D012915:Soaps