title: Effectiveness of hand hygiene interventions in reducing illness absence among children in educational settings: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  Randomised-controlled trials (RCTs).
  
  
  METHODS
  Schools and other settings with a formal educational component in any country.
  
  
  METHODS
  Children aged 3-11 years, and/or staff working with them.
  
  
  METHODS
  Interventions with a hand hygiene component.
  
  
  METHODS
  Incidence of RT or GI infections or symptoms related to such infections; absenteeism; laboratory results of RT and/or GI infections.
  
  
  RESULTS
  Eighteen 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.
  
  
  CONCLUSIONS
  Studies 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.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Micky
authors.identifier: http://orcid.org/0000-0003-4656-4760
authors.initials: M
authors.lastname: Willmott
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Nicholson
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Heide
authors.initials: H
authors.lastname: Busse
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Georgina J
authors.initials: GJ
authors.lastname: MacArthur
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Brookes
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Rona
authors.initials: R
authors.lastname: Campbell
mesh_terms: D000041:Absenteeism; D002648:Child; D003140:Communicable Disease Control / Q000379:methods*; D003141:Communicable Diseases / Q000635:transmission*; D005767:Gastrointestinal Diseases / Q000517:prevention & control; D006235:Hand Disinfection; D063373:Hand Hygiene / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000517:prevention & control / Q000635:transmission; D012574:Schools
keywords: Infectious Diseases; Respiratory; School Health