State of the Science Review
The effect of hand-hygiene interventions on infectious disease-associated absenteeism in elementary schools: A systematic literature review

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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.

Section snippets

Search strategy

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles to create a transparent, systematic review of published studies to report the effect of hand-hygiene interventions on absenteeism in elementary schools (Fig 1).16 A comprehensive literature search was conducted to identify eligible studies written in English. We performed the search using the following databases: ScienceDirect (1980-2015), Academic Search Complete (1980-2015), Academic OneFile (1980-2015),

Search strategy

Across all 5 electronic databases, 1,567 records were identified (Fig 1). A total of 79 potentially eligible studies were included for full-text review after duplicates were removed and titles and abstracts screened. Hand searching the reference list of the 10 review articles resulted in 13 additional articles, which were also reviewed for eligibility. After screening the full text, 73 studies were excluded because they did not meet the eligibility criteria, including type of intervention

Discussion

Our results show that evidence is available to suggest that hand-hygiene interventions have an effect on AGI- but not ARI-associated absenteeism, which is consistent with the findings of 2 published reviews that examined the effect of hand-hygiene interventions in community settings.15, 39 However, because we did not perform a quantitative meta-analyses, the strength of the evidence could not be determined.

Several reasons could explain our findings. First, the type of contamination events that

Conclusions

Hand-hygiene interventions had an effect on reducing AGI-associated absenteeism in elementary schools, but the strength of that evidence was not determined. There is also inadequate evidence to show that hand-hygiene interventions are associated with the reduction of ARI-associated absenteeism. The use of hand sanitizers (ABHRs and alcohol-free) and soap was also associated with reducing nonspecific illness- and AGI-associated absenteeism, but not absences attributed to ARI. The effect of

Acknowledgments

The authors thank Morgan Getty Chao, Lalani Jayasekara, and Cortney Leone for their assistance in reviewing all eligible studies.

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    This material is based on work supported by the Integrated Research, Education, and Extension Comp. Grants Program, US Department of Agriculture, under Award No. 2011-51110-31020; of the National Institute of Food and Agriculture. Any opinions, findings, conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the US Department of Agriculture.

    Conflicts of interest: None to report.

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