title: A hand hygiene intervention to decrease infections among children attending day care centers: design of a cluster randomized controlled trial.
abstract: BACKGROUND
  Day care center attendance has been recognized as a risk factor for acquiring gastrointestinal and respiratory infections, which can be prevented with adequate hand hygiene (HH). Based on previous studies on environmental and sociocognitive determinants of caregivers' compliance with HH guidelines in day care centers (DCCs), an intervention has been developed aiming to improve caregivers' and children's HH compliance and decrease infections among children attending DCCs. The aim of this paper is to describe the design of a cluster randomized controlled trial to evaluate the effectiveness of this intervention.
  
  
  METHODS
  The intervention will be evaluated in a two-arm cluster randomized controlled trial among 71 DCCs in the Netherlands. In total, 36 DCCs will receive the intervention consisting of four components: 1) HH products (dispensers and refills for paper towels, soap, alcohol-based hand sanitizer, and hand cream); 2) training to educate about the Dutch national HH guidelines; 3) two team training sessions aimed at goal setting and formulating specific HH improvement activities; and 4) reminders and cues to action (posters/stickers). Intervention DCCs will be compared to 35 control DCCs continuing usual practice. The primary outcome measure will be observed HH compliance of caregivers and children, measured at baseline and one, three, and six months after start of the intervention. The secondary outcome measure will be the incidence of gastrointestinal and respiratory infections in 600 children attending DCCs, monitored over six months by parents using a calendar to mark the days their child has diarrhea and/or a cold. Multilevel logistic regression will be performed to assess the effect of the intervention on HH compliance. Multilevel poisson regression will be performed to assess the incidence of gastrointestinal and respiratory infections in children attending DCCs.
  
  
  CONCLUSIONS
  This is one of the first DCC intervention studies to assess HH compliance of both caregivers and children, as well as the incidence of gastrointestinal and respiratory infections in children, as outcome measures. When an effect of the intervention on improving HH compliance and/or reducing incidence of infections is shown, (inter)national dissemination of the intervention in other DCCs may be considered.
  
  
  BACKGROUND
  Netherlands trial registry: NTR3000.
authors.affiliation: Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands. t.zomer@rotterdam.nl
authors.forename: Tizza P
authors.initials: TP
authors.lastname: Zomer
authors.forename: Vicki
authors.initials: V
authors.lastname: Erasmus
authors.forename: Nico
authors.initials: N
authors.lastname: Vlaar
authors.forename: Ed F
authors.initials: EF
authors.lastname: van Beeck
authors.forename: Aimée
authors.initials: A
authors.lastname: Tjon-A-Tsien
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Richardus
authors.forename: Hélène A C M
authors.initials: HA
authors.lastname: Voeten
mesh_terms: D000328:Adult; D002648:Child; D002656:Child Day Care Centers / Q000379:methods* / Q000592:standards; D003139:Common Cold / Q000517:prevention & control; D003967:Diarrhea / Q000517:prevention & control; D063373:Hand Hygiene / Q000379:methods* / Q000592:standards; D006801:Humans; D016015:Logistic Models; D016012:Poisson Distribution; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012107:Research Design