title: The effect of hand-hygiene interventions on infectious disease-associated absenteeism in elementary schools: A systematic literature review.
abstract: BACKGROUND
  Hand-hygiene interventions are widely used in schools but their effect on reducing absenteeism is not well known.
  
  
  METHODS
  The aim of our literature review was to determine whether implementation of a hand-hygiene intervention reduced infectious disease-associated absenteeism in elementary schools. The eligible studies (N = 19), published between 1996 and 2014, were summarized and the methodologic quality of each was assessed.
  
  
  RESULTS
  Our review indicated evidence is available to show hand-hygiene interventions had an effect on reducing acute gastrointestinal illness-associated absenteeism but inadequate evidence is available to show an effect on respiratory illness-associated absenteeism.
  
  
  CONCLUSIONS
  The methodologic quality assessment of eligible studies revealed common design flaws, such as lack of randomization, blinding, and attrition, which must be addressed in future studies to strengthen the evidence base on the effect of hand-hygiene interventions on school absenteeism.
authors.affiliation: Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC.
authors.forename: Zhangqi
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Communication, Michigan State University, East Lansing, MI.
authors.forename: Maria
authors.initials: M
authors.lastname: Lapinski
authors.affiliation: Department of Advertising and Public Relations, Michigan State University, East Lansing, MI.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Quilliam
authors.affiliation: Department of Food, Bioprocessing, and Nutrition Sciences, and Department of Microbiology, North Carolina State University, Raleigh, NC.
authors.forename: Lee-Ann
authors.initials: LA
authors.lastname: Jaykus
authors.affiliation: Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC. Electronic address: afraser@clemson.edu.
authors.forename: Angela
authors.initials: A
authors.lastname: Fraser
mesh_terms: D000041:Absenteeism; D002648:Child; D003140:Communicable Disease Control / Q000379:methods*; D003141:Communicable Diseases / Q000453:epidemiology*; D005260:Female; D063373:Hand Hygiene / Q000379:methods*; D006801:Humans; D008297:Male; D012574:Schools / Q000706:statistics & numerical data*
keywords: Acute gastroenteritis; Children; Hand washing; Health education; Respiratory illness