title: Improving hand hygiene compliance in child daycare centres: a randomized controlled trial.
abstract: Gastrointestinal and respiratory infections in children attending daycare centres (DCCs) are common and compliance with hand hygiene (HH) guidelines to prevent infections is generally low. An intervention was developed to increase HH compliance and reduce infections in DCCs. The objective of this paper was to evaluate the effectiveness of this intervention on HH compliance. The intervention was evaluated in a two-arm cluster randomized controlled trial in 71 DCCs in The Netherlands. Thirty-six DCCs received the intervention including: (1) HH products; (2) training about HH guidelines; (3) two team training sessions aimed at goal setting and formulating HH improvement activities; and (4) reminders and cues for action (posters/stickers). Intervention DCCs were compared to 35 control DCCs that continued usual practice. HH compliance of caregivers and children was observed at baseline and at 1, 3 and 6 months follow-up. Using multilevel logistic regression, odds ratios (ORs) with 95% confidence intervals (CIs) were obtained for the intervention effect. Of 795 caregivers, 5042 HH opportunities for caregivers and 5606 opportunities for supervising children's HH were observed. At 1 month follow-up caregivers' compliance in intervention DCCs was 66% vs. 43% in control DCCs (OR 6·33, 95% CI 3·71-10·80), and at 6 months 59% vs. 44% (OR 4·13, 95% CI 2·33-7·32). No effect of the intervention was found on supervising children's HH (36% vs. 32%; OR 0·64, 95% CI 0·18-2·33). In conclusion, HH compliance of caregivers increased due to the intervention, therefore dissemination of the intervention can be considered.
authors.affiliation: Department of Infectious Disease Control,Municipal Public Health Service Rotterdam-Rijnmond,Rotterdam,The Netherlands.
authors.forename: T P
authors.initials: TP
authors.lastname: Zomer
authors.affiliation: Department of Public Health,Erasmus MC,University Medical Centre Rotterdam,Rotterdam,The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Erasmus
authors.affiliation: Department of Public Health,Erasmus MC,University Medical Centre Rotterdam,Rotterdam,The Netherlands.
authors.forename: C W
authors.initials: CW
authors.lastname: Looman
authors.affiliation: Department of Public Health,Erasmus MC,University Medical Centre Rotterdam,Rotterdam,The Netherlands.
authors.forename: E F
authors.initials: EF
authors.lastname: VAN Beeck
authors.affiliation: Department of Infectious Disease Control,Municipal Public Health Service Rotterdam-Rijnmond,Rotterdam,The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Tjon-A-Tsien
authors.affiliation: Department of Infectious Disease Control,Municipal Public Health Service Rotterdam-Rijnmond,Rotterdam,The Netherlands.
authors.forename: J H
authors.initials: JH
authors.lastname: Richardus
authors.affiliation: Department of Infectious Disease Control,Municipal Public Health Service Rotterdam-Rijnmond,Rotterdam,The Netherlands.
authors.forename: H A C M
authors.initials: HA
authors.lastname: Voeten
mesh_terms: D017028:Caregivers / Q000706:statistics & numerical data; D002656:Child Day Care Centers / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005767:Gastrointestinal Diseases / Q000517:prevention & control*; D019983:Guideline Adherence; D063373:Hand Hygiene; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D009426:Netherlands; D012141:Respiratory Tract Infections / Q000517:prevention & control*
keywords: Child daycare; guidelines; hand hygiene; infectious disease control; intervention