title: Comparative efficacy of a simplified handwashing program for improvement in hand hygiene and reduction of school absenteeism among children with intellectual disability.
abstract: Infectious diseases are common among schoolchildren as a result of their poor hand hygiene, especially in those who have developmental disabilities.
  
  
  
  A quasi-experimental study using a pre- to post-test design with a control group was used to test the feasibility and sustainability of simplified 5-step handwashing techniques to measure the hand hygiene outcome for students with mild intellectual disability. Sickness-related school absenteeism was compared.
  
  
  
  The intervention group experienced a significant increase in the rating of their handwashing quality in both hands from pre- to post-test: left dorsum (+1.05, P < .001); right dorsum (+1.00, P < .001); left palm (+0.98, P < .001); and right palm (+1.09, P < .001). The pre- to post-test difference in the intervention group (+1.03, P < .001) was significantly greater than the difference in the control group (+0.34, P = .001). There were no differences between the post-test and the sustainability assessment in the intervention group. The intervention school experienced a significantly lower absenteeism rate (0.0167) than the control group in the same year (0.028, P = .04).Students in this study showed better performance in simplified handwashing techniques and experienced lower absenteeism than those using usual practice in special education school settings.
  
  
  
  The simplified 5-step hand hygiene technique has been proven effective in reducing the spread of infectious diseases.
authors.affiliation: World Health Organization Collaborating Centre, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China. Electronic address: regina.lee@polyu.edu.hk.
authors.forename: Regina L T
authors.initials: RL
authors.lastname: Lee
authors.affiliation: Department of Applied and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Leung
authors.affiliation: Hospital Authority Infectious Disease Centre, Princess Margaret Hospital, New Territory, Hong Kong, China.
authors.forename: Wah Kun
authors.initials: WK
authors.lastname: Tong
authors.affiliation: Center for Health Protection, Hong Kong, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Chen
authors.affiliation: World Health Organization Collaborating Centre, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Lee
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D002648:Child; D003625:Data Collection; D004495:Education of Persons with Intellectual Disabilities; D005240:Feasibility Studies; D005260:Female; D006235:Hand Disinfection; D063373:Hand Hygiene; D006801:Humans; D008607:Intellectual Disability; D008297:Male; D012574:Schools; D013334:Students
keywords: Multidimensional strategies