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Graichen J, Stingl C, Pakarinen A, Rosio R, Terho K, Günther SA, Salanterä S, Staake T. Improving hand hygiene of young children with a digital intervention: a cluster-randomised controlled field trial. Sci Rep 2024; 14:6157. [PMID: 38486036 PMCID: PMC10940613 DOI: 10.1038/s41598-024-56233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
Contagious diseases that affect young children place a great burden on them and their families. Proper hand hygiene is an important measure to reduce the disease burden, however, its implementation in day care centres is challenging. This paper introduces a digital intervention to support independent and good handwashing among young children. The intervention leverages animated instructions triggered by water and soap use, together with a symbolic reward shown to children on a screen during and immediately after handwashing. We tested the intervention in a pre-registered, cluster-randomised controlled field trial in 4 day care centres in Finland and Germany with 162 children over 42 days. The intervention increased soaping time, used as a proxy for handwashing quality, by 5.30 s (+ 62%, p < 0.001). The effect occurs immediately at the onset of the intervention and is maintained throughout the intervention phase.
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Affiliation(s)
- Joanna Graichen
- Department of Information Systems and Applied Computer Sciences, University of Bamberg, Bamberg, Germany.
| | - Carlo Stingl
- Department of Information Systems and Applied Computer Sciences, University of Bamberg, Bamberg, Germany
| | - Anni Pakarinen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Riitta Rosio
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Kirsi Terho
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Sebastian A Günther
- Department of Information Systems and Applied Computer Sciences, University of Bamberg, Bamberg, Germany
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Thorsten Staake
- Department of Information Systems and Applied Computer Sciences, University of Bamberg, Bamberg, Germany
- Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
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Mattison CP, Calderwood LE, Marsh ZA, Wikswo ME, Balachandran N, Kambhampati AK, Gleason ME, Lawinger H, Mirza SA. Childcare and School Acute Gastroenteritis Outbreaks: 2009-2020. Pediatrics 2022; 150:e2021056002. [PMID: 36278284 PMCID: PMC10061552 DOI: 10.1542/peds.2021-056002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVES Acute gastroenteritis (AGE) outbreaks commonly occur in congregate settings, including schools and childcare facilities. These outbreaks disrupt institutions, causing absences and temporary facility closures. This study analyzed the epidemiology of school and childcare AGE outbreaks in the United States. METHODS We analyzed AGE outbreaks occurring in kindergarten to grade 12 schools and childcare facilities reported via the National Outbreak Reporting System in the United States from 2009 to 2019 and compared this information to 2020 data. Outbreak and case characteristics were compared using the Kruskal-Wallis rank sum test, χ2 goodness-of-fit test, and Fisher exact test. RESULTS From 2009 to 2019, there were 2623 school, 1972 childcare, and 38 school and childcare outbreaks. School outbreaks were larger (median, 29 cases) than childcare outbreaks (median, 10 cases). Childcare outbreaks were longer (median, 15 days) than school outbreaks (median, 9 days). Norovirus (2383 outbreaks; 110 190 illnesses) and Shigella spp. (756 outbreaks; 9123 illnesses) were the most reported etiologies. Norovirus was the leading etiology in schools; norovirus and Shigella spp. were dominant etiologies in childcare centers. Most (85.7%) outbreaks were spread via person-to-person contact. In 2020, 123 outbreaks were reported, 85% in the first quarter. CONCLUSIONS Schools and childcare centers are common AGE outbreak settings in the United States. Most outbreaks were caused by norovirus and Shigella spp. and spread via person-to-person transmission. Fewer outbreaks were reported in 2020 from the COVID-19 pandemic. Prevention and control efforts should focus on interrupting transmission, including environmental disinfection, proper handwashing, safe diapering, and exclusion of ill persons.
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Affiliation(s)
- Claire P. Mattison
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
- Cherokee Nation Assurance, Arlington, Virginia
| | - Laura E. Calderwood
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
- Cherokee Nation Assurance, Arlington, Virginia
| | - Zachary A. Marsh
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E. Wikswo
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Neha Balachandran
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
- Cherokee Nation Assurance, Arlington, Virginia
| | - Anita K. Kambhampati
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Michelle E. Gleason
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hannah Lawinger
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sara A. Mirza
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
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Ralph F, Large DR, Burnett G, Lang A, Morris A. U can't touch this! Face touching behaviour whilst driving: implications for health, hygiene and human factors. ERGONOMICS 2022; 65:943-959. [PMID: 34747334 DOI: 10.1080/00140139.2021.2004241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
Analysis of thirty-one hours of video-data documenting 36 experienced drivers highlighted the prevalence of face-touching, with 819 contacts identified (mean frequency: 26.4 face touches/hour (FT/h); mean duration: 3.9-seconds). Fewer face-touches occurred in high primary workload conditions (where additional physical/cognitive demands were placed on drivers), compared to low workload (4.4 and 26.1 FT/h, respectively). In 42.5% of touches (or 11.2 FT/h), mucous membrane contact was made, with fingertips (33.1%) and thumbs (35.6%) most commonly employed. Individual behaviours differed (ranging from 5.1 to 90.7 FT/h), but there were no significant differences identified between genders, age-groups or hand used. Results are of relevance from an epidemiological/hygiene perspective within the context of the COVID-19 pandemic (and can therefore inform the design of practical solutions and encourage behavioural change to reduce the risk of self-inoculation while driving), but they also help to elucidate how habitual human behaviours are imbricated with the routine accomplishment of tasks.
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Affiliation(s)
- Finian Ralph
- Human Factors Research Group, University of Nottingham, University Park, UK
| | - David R Large
- Human Factors Research Group, University of Nottingham, University Park, UK
| | - Gary Burnett
- Human Factors Research Group, University of Nottingham, University Park, UK
| | - Alexandra Lang
- Human Factors Research Group, University of Nottingham, University Park, UK
| | - Andrew Morris
- Transport Safety Research Centre, Loughborough University, Loughborough, UK
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4
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Lam T, Chew D, Zhao H, Zhu P, Zhang L, Dai Y, Liu J, Xu J. Species-Resolved Metagenomics of Kindergarten Microbiomes Reveal Microbial Admixture Within Sites and Potential Microbial Hazards. Front Microbiol 2022; 13:871017. [PMID: 35418963 PMCID: PMC8996153 DOI: 10.3389/fmicb.2022.871017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/02/2022] [Indexed: 12/01/2022] Open
Abstract
Microbiomes on surfaces in kindergartens, the intermediate transfer medium for microbial exchange, can exert significant impact on the hygiene and wellbeing of young children, both individually and as a community. Here employing 2bRAD-M, a novel species-resolved metagenomics approach for low-biomass microbiomes, we surveyed over 100 samples from seven frequently contacted surfaces by children, plus individual children’s palms, in two kindergartens. Microbiome compositions, although kindergarten-specific, were grouped closely based on the type of surface within each kindergarten. Extensive microbial admixture were found among the various sampled sites, likely facilitated by contact with children’s hands. Notably, bacterial species with potential human health concerns and potentially antibiotic-resistant, although found across all sampled locations, were predominantly enriched on children’s hands instead of on the environmental sites. This first species-resolved kindergarten microbiome survey underscores the importance of good hand hygiene practices in kindergartens and provides insights into better managing hygiene levels and minimizing spread of harmful microbes in susceptible indoor environments.
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Affiliation(s)
- TzeHau Lam
- Global BioScience, Procter & Gamble Singapore Innovation Center, Singapore, Singapore
| | - Dillon Chew
- Global BioScience, Procter & Gamble Singapore Innovation Center, Singapore, Singapore
| | - Helen Zhao
- Global BioScience, Procter & Gamble Singapore Innovation Center, Singapore, Singapore
| | - Pengfei Zhu
- Single-Cell Center, CAS Key Laboratory of Biofuels and Shandong Key Laboratory of Energy Genetics, Shandong Energy Institute, Qingdao Institute of BioEnergy and Bioprocess Technology, Chinese Academy of Sciences, Qingdao, China
| | - Lili Zhang
- Single-Cell Center, CAS Key Laboratory of Biofuels and Shandong Key Laboratory of Energy Genetics, Shandong Energy Institute, Qingdao Institute of BioEnergy and Bioprocess Technology, Chinese Academy of Sciences, Qingdao, China
| | - Yajie Dai
- Single-Cell Center, CAS Key Laboratory of Biofuels and Shandong Key Laboratory of Energy Genetics, Shandong Energy Institute, Qingdao Institute of BioEnergy and Bioprocess Technology, Chinese Academy of Sciences, Qingdao, China
| | - Jiquan Liu
- Global BioScience, Procter & Gamble Singapore Innovation Center, Singapore, Singapore
| | - Jian Xu
- Single-Cell Center, CAS Key Laboratory of Biofuels and Shandong Key Laboratory of Energy Genetics, Shandong Energy Institute, Qingdao Institute of BioEnergy and Bioprocess Technology, Chinese Academy of Sciences, Qingdao, China.,College of Life Science, University of Chinese Academy of Sciences, Beijing, China
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Mohd Rani MD, Mohamed NA, Jamaluddin TZMT, Ismail Z, Ramli S, Faroque H, Samad FNA, Ariffien AR, Farid AARCA, Isahak I. Electronic Hand Hygiene Quality and Duration Monitoring in Pre-School Children: A Feasibility Study. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021:272684X211033448. [PMID: 34256634 DOI: 10.1177/0272684x211033448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hand hygiene is regarded as the most important measure to prevent spread of infectious diseases. The aim of this study was to assess the feasibility of a prototype application in an electronic device in educating, stimulating and monitoring hand hygiene quality in young children. METHOD A pre-school was provided with an interactive hand hygiene application for two months. The device features an online administrator dashboard for data collection and for monitoring the children's hand washing steps and duration. A good hand washing is defined as hand washing which comprise all of the steps outlined in the World Health Organization (WHO) guidelines. RESULTS The prototype managed to capture 6882 hand wash performed with an average of 20.85 seconds per hand wash. Washing hands palm to palm was the most frequent (79.9%) step performed, whereas scrubbing fingernails and wrists were the least (56%) steps performed. CONCLUSIONS The device is a good prototype to educate, stimulate and monitor good hand hygiene practices. However, other measures should be undertaken to ensure sustainability of the practices.
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Affiliation(s)
| | | | | | - Zarini Ismail
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Shalinawati Ramli
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Habibah Faroque
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | | | - Abdul Rasyid Ariffien
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | | | - Ilina Isahak
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
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Sanni UA, Offiong UM, Anigilaje EA, Airede KI, Imam A. A pre-COVID-19 assessment of aspects of the school health programme in some selected Nigerian primary schools: implications for school re-opening during the COVID-19 pandemic in developing country contexts. BMC Public Health 2021; 21:1214. [PMID: 34167515 PMCID: PMC8223233 DOI: 10.1186/s12889-021-11258-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/10/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Following the COVID-19 pandemic, school closures were part of the global public health response to limit community spread of the virus. In recent times, there has been an emphasis on safe school re-opening. This concept is likely to differ between developed and developing country settings. There are however no published studies on barriers hindering safe school re-opening within developing country contexts. This study evaluates aspects of the school health program (SHP) in some selected Nigerian schools that might relate to the pandemic control during school re-opening. METHODS In 2017, we conducted a cross-sectional survey of the SHP of 146 registered primary schools in Gwagwalada Area Council in Abuja, Nigeria. These schools provided services to about 54,562 students. We used direct observational methods and interviewer-administered questionnaires to assess the SHP of each school. We compare SHP characteristics that might relate to COVID-19 control in schools across government-owned (public) and privately-owned (private) schools using a pre-defined framework. RESULTS Public school to pupil ratios was more than six times that of private schools. Only 6.9% of all surveyed schools employed qualified health personnel. Although 8 in every 10 schools conducted health talks for communicable disease control, the use of temporary isolation and school-based immunization were low at 1.4 and 2.7% respectively. Pipe-borne water access was present in 4 of 10 schools, with public schools having more limited access than private schools (p = 0.009). Similarly, less proportion of public schools had access to soap for handwashing (p < 0.001). Adequate classroom ventilation was present in 63% of surveyed schools, with private schools having more limited ventilation (p < 0.001). CONCLUSIONS Overcrowding and infrastructural deficits within developing country contexts represent barriers to safe school re-opening during the COVID-19 pandemic. In these settings, there needs to be tailored and innovative strategies which consider local practical realities when designing the COVID-19 control programs during school re-opening.
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Affiliation(s)
- Usman A Sanni
- Department of Paediatrics, Federal Medical Centre, Birnin-Kebbi, Kebbi, Nigeria
| | - Uduak M Offiong
- Department of Paediatrics, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Emmanuel A Anigilaje
- Department of Paediatrics, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.,Department of Paediatrics, University of Abuja, Gwagwalada, P.M.B 117, Abuja, Nigeria
| | - Kareem I Airede
- Department of Paediatrics, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.,Department of Paediatrics, University of Abuja, Gwagwalada, P.M.B 117, Abuja, Nigeria
| | - Abdulazeez Imam
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, P.O. Box 273, Fajara, Gambia.
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7
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Gold-Watts A, Aamodt G, Gandhimathi S, Sudha R, Bastien S. Understanding Adolescents' Perceptions of Diarrhea: A Formative Research Study of a Visual Scale to Measure Self-Reported Diarrhea in Low-Resource Settings. Front Public Health 2021; 9:561367. [PMID: 34113594 PMCID: PMC8185169 DOI: 10.3389/fpubh.2021.561367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Although water, sanitation, and hygiene interventions are effective in reducing diarrhea, there are methodological issues regarding the research tools used to evaluate their health impact. Moreover, there is limited research on individuals' subjective interpretations of diarrheal illness which may introduce further limitations in relying on self-reported data. Therefore, we conducted a study that aims to understand adolescents' perceptions of diarrheal illness in rural Tamil Nadu, India. Next, we wish to explore the acceptability of the Bristol Stool Form Scale to assess self-reported diarrhea in water, sanitation, and hygiene interventions involving adolescent participants in low-resource settings. Materials and Methods: The study was conducted as part of the formative research phase in the cultural adaptation of Project SHINE, a school-based educational water, sanitation, and hygiene intervention in Thirumalaikodi, Tamil Nadu, India. A convergent parallel mixed-methods study design with a purposive sampling strategy was used. Qualitative data included 10 in-depth interviews with student participants aged 13–14. Quantitative data were collected through interviewer-administered face-to-face surveys (n = 14) and one-week stool diaries (n = 14). Each data set was analyzed separately and compiled during the interpretation of the findings. Results: Across all data sets, diarrhea was reported to be perceived as unhealthy and an irregular occurrence among participants. Participants also reported diarrheal-taboos, local methods to cure or control diarrhea, and discussed how diarrheal illness can lead to absenteeism or withdrawal from school and social activities. Moreover, participants were able to understand and answer questions about their stool using the Bristol Stool Form Scale, suggesting that is an acceptable tool. Discussion: Visual tools demonstrate promise in improving self-reported diarrheal illness among adolescents in low-resource settings in India. However, until we address diarrhea-related taboos it will be difficult to address methodological issues in the assessment and reporting of diarrheal illness among adolescents.
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Affiliation(s)
- Anise Gold-Watts
- Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | - Geir Aamodt
- Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | | | - Rajamani Sudha
- Department of Obstetrics and Gynecology Nursing, Sri Narayani College and School of Nursing, Vellore, India
| | - Sheri Bastien
- Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Anthonj C, Githinji S, Höser C, Stein A, Blanford J, Grossi V. Kenyan school book knowledge for water, sanitation, hygiene and health education interventions: Disconnect, integration or opportunities? Int J Hyg Environ Health 2021; 235:113756. [PMID: 34004452 DOI: 10.1016/j.ijheh.2021.113756] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/08/2021] [Accepted: 04/18/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Schools, depending on their access to and quality of water, sanitation and hygiene (WASH) and the implementation of healthy behaviours, can be critical for the control and spread of many infectious diseases, including COVID-19. Schools provide opportunities for pupils to learn about the importance of hygiene and WASH-related practice, and build healthy habits and skills, with beneficial medium- and long-term consequences particularly in low- and middle-income countries: reducing pupils' absenteeism due to diseases, promoting physical, mental and social health, and improving learning outcomes. WASH services alone are often not sufficient and need to be combined with educational programmes. As pupils disseminate their acquired health-promoting knowledge to their (extended) families, improved WASH provisions and education in schools have beneficial effects also on the community. International organisations frequently roll out interventions in schools to improve WASH services and, in some cases, train pupils and teachers on safe WASH behaviours. How such interventions relate to local school education on WASH, health promotion and disease prevention knowledge, whether and how such knowledge and school books are integrated into WASH education interventions in schools, are knowledge gaps we fill. METHODS We analyzed how Kenyan primary school science text book content supports WASH and health education by a book review including books used from class 1 through class 8, covering the age range from 6 to 13 years. We then conducted a rapid literature review of combined WASH interventions that included a behaviour change or educational component, and a rapid review of international policy guidance documents to contextualise the results and understand the relevance of books and school education for WASH interventions implemented by international organisations. We conducted a content analysis based on five identified thematic categories, including drinking water, sanitation, hygiene, environmental hygiene & health promotion and disease risks, and mapped over time the knowledge about WASH and disease prevention. RESULTS The books comprehensively address drinking water issues, including sources, quality, treatment, safe storage and water conservation; risks and transmission pathways of various waterborne (Cholera, Typhoid fever), water-based (Bilharzia), vector-related (Malaria) and other communicable diseases (Tuberculosis); and the importance of environmental hygiene and health promotion. The content is broadly in line with internationally recommended WASH topics and learning objectives. Gaps remain on personal hygiene and handwashing, including menstrual hygiene, sanitation education, and related health risks and disease exposures. The depth of content varies greatly over time and across the different classes. Such locally available education materials already used in schools were considered by none of the WASH education interventions in the considered intervention studies. CONCLUSIONS The thematic gaps/under-representations in books that we identified, namely sanitation, hygiene and menstrual hygiene education, are all high on the international WASH agenda, and need to be filled especially now, in the context of the current COVID-19 pandemic. Disconnects exist between school book knowledge and WASH education interventions, between policy and implementation, and between theory and practice, revealing missed opportunities for effective and sustainable behaviour change, and underlining the need for better integration. Considering existing local educational materials and knowledge may facilitate the buy-in and involvement of teachers and school managers in strengthening education and implementing improvements. We suggest opportunities for future research, behaviour change interventions and decision-making to improve WASH in schools.
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Affiliation(s)
- Carmen Anthonj
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands; Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, GeoHealth Centre, Bonn, Germany.
| | | | - Christoph Höser
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, GeoHealth Centre, Bonn, Germany.
| | - Alfred Stein
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | - Justine Blanford
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | - Valentina Grossi
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, GeoHealth Centre, Bonn, Germany.
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Tengku Jamaluddin TZM, Mohamed NA, Mohd Rani MD, Ismail Z, Ramli S, Faroque H, Abd Samad FN, Ariffien AR, Che Amir Farid AAR, Isahak I. Assessment on Hand Hygiene Knowledge and Practices Among Pre-school Children in Klang Valley. Glob Pediatr Health 2020; 7:2333794X20976369. [PMID: 33335950 PMCID: PMC7724414 DOI: 10.1177/2333794x20976369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 12/01/2022] Open
Abstract
Background. Pre-school children are at a higher risk to acquire
infectious diseases such as hand, foot and mouth disease due to their immature
immune system. Good hand hygiene prevents transmission of infectious diseases.
This study aimed to determine the knowledge and practices of hand hygiene among
pre-schoolers. Methods. In this prospective, multi-center
study, the pre-schools were selected according to the selection criteria. A
questionnaire consisting of socio-demographics, knowledge and practices of hand
hygiene were administered via face-to-face interview during the pre- and
post-intervention period. A total of 435 pre-schoolers aged 5 and 6 years old
from 2 pre-schools within Klang Valley, School P (test group) and School C
(control group) were involved in this study. The test group was provided with
comprehensive hand hygiene education including video on proper handwashing
technique during the 2 months intervention period, whereas the control group did
not receive any form of intervention. The data were statistically analyzed using
descriptive analysis and independent t-test.
Results. Majority of pre-schoolers gained knowledge of
handwashing from their parents. However, only 63% demonstrated good handwashing
technique. Test group were significantly better (P < 0.05)
in handwashing technique and hand hygiene routine score.
Conclusion. A comprehensive hand hygiene education program
should include proper handwashing facilities, resources, and awareness of the
care-givers in instilling and sustaining good hand hygiene behavior.
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Affiliation(s)
| | | | | | - Zarini Ismail
- Universiti Sains Islam Malaysia, Pandan Indah, Kuala Lumpur, Malaysia
| | - Shalinawati Ramli
- Universiti Sains Islam Malaysia, Pandan Indah, Kuala Lumpur, Malaysia
| | - Habibah Faroque
- Universiti Sains Islam Malaysia, Pandan Indah, Kuala Lumpur, Malaysia
| | | | | | | | - Ilina Isahak
- Universiti Sains Islam Malaysia, Pandan Indah, Kuala Lumpur, Malaysia
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10
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Munn Z, Tufanaru C, Lockwood C, Stern C, McAneney H, Barker TH. Rinse-free hand wash for reducing absenteeism among preschool and school children. Cochrane Database Syst Rev 2020; 4:CD012566. [PMID: 32270476 PMCID: PMC7141998 DOI: 10.1002/14651858.cd012566.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Illness-related absenteeism is an important problem among preschool and school children for low-, middle- and high- income countries. Appropriate hand hygiene is one commonly investigated and implemented strategy to reduce the spread of illness and subsequently the number of days spent absent. Most hand hygiene strategies involve washing hands with soap and water, however this is associated with a number of factors that act as a barrier to its use, such as requiring running water, and the need to dry hands after cleaning. An alternative method involves washing hands using rinse-free hand wash. This technique has a number of benefits over traditional hand hygiene strategies and may prove to be beneficial in reducing illness-related absenteeism in preschool and school children. OBJECTIVES 1. To assess the effectiveness of rinse-free hand washing for reducing absenteeism due to illness in preschool and school children compared to no hand washing, conventional hand washing with soap and water or other hand hygiene strategies. 2. To determine which rinse-free hand washing products are the most effective (if head-to-head comparisons exist), and what effect additional strategies in combination with rinse-free hand washing have on the outcomes of interest. SEARCH METHODS In February 2020 we searched CENTRAL, MEDLINE, Embase, CINAHL, 12 other databases and three clinical trial registries. We also reviewed the reference lists of included studies and made direct contact with lead authors of studies to collect additional information as required. No date or language restrictions were applied. SELECTION CRITERIA Randomized controlled trials (RCTs), irrespective of publication status, comparing rinse-free hand wash in any form (hand rub, hand sanitizer, gel, foam etc.) with conventional hand washing using soap and water, other hand hygiene programs (such as education alone), or no intervention. The population of interest was children aged between two and 18 years attending preschool (childcare, day care, kindergarten, etc.) or school (primary, secondary, elementary, etc.). Primary outcomes included child or student absenteeism for any reason, absenteeism due to any illness and adverse skin reactions. DATA COLLECTION AND ANALYSIS Following standard Cochrane methods, two review authors (out of ZM, CT, CL, CS, TB), independently selected studies for inclusion, assessed risk of bias and extracted relevant data. Absences were extracted as the number of student days absent out of total days. This was sometimes reported with the raw numbers and other times as an incidence rate ratio (IRR), which we also extracted. For adverse event data, we calculated effect sizes as risk ratios (RRs) and present these with 95% confidence intervals (CIs). We used standard methodological procedures expected by Cochrane for data analysis and followed the GRADE approach to establish certainty in the findings. MAIN RESULTS This review includes 19 studies with 30,747 participants. Most studies were conducted in the USA (eight studies), two were conducted in Spain, and one each in China, Colombia, Finland, France, Kenya, Bangladesh, New Zealand, Sweden, and Thailand. Six studies were conducted in preschools or day-care centres (children aged from birth to < five years), with the remaining 13 conducted in elementary or primary schools (children aged five to 14 years). The included studies were judged to be at high risk of bias in several domains, most-notably across the domains of performance and detection bias due to the difficulty to blind those delivering the intervention or those assessing the outcome. Additionally, every outcome of interest was graded as low or very low certainty of evidence, primarily due to high risk of bias, as well as imprecision of the effect estimates and inconsistency between pooled data. For the outcome of absenteeism for any reason, the pooled estimate for rinse-free hand washing was an IRR of 0.91 (95% CI 0.82 to 1.01; 2 studies; very low-certainty evidence), which indicates there may be little to no difference between groups. For absenteeism for any illness, the pooled IRR was 0.82 (95% CI 0.69 to 0.97; 6 studies; very low-certainty evidence), which indicates that rinse-free hand washing may reduce absenteeism (13 days absent per 1000) compared to those in the 'no rinse-free' group (16 days absent per 1000). For the outcome of absenteeism for acute respiratory illness, the pooled IRR was 0.79 (95% CI 0.68 to 0.92; 6 studies; very low-certainty evidence), which indicates that rinse-free hand washing may reduce absenteeism (33 days absent per 1000) compared to those in the 'no rinse-free' group (42 days absent per 1000). When evaluating absenteeism for acute gastrointestinal illness, the pooled estimate found an IRR of 0.79 (95% CI 0.73 to 0.85; 4 studies; low-certainty evidence), which indicates rinse-free hand washing may reduce absenteeism (six days absent per 1000) compared to those in the 'no rinse-free' group (eight days absent per 1000). There may be little to no difference between rinse-free hand washing and 'no rinse-free' group regarding adverse skin reactions with a RR of 1.03 (95% CI 0.8 to 1.32; 3 studies, 4365 participants; very low-certainty evidence). Broadly, compliance with the intervention appeared to range from moderate to high compliance (9 studies, 10,749 participants; very-low certainty evidence); narrativley, no authors reported substantial issues with compliance. Overall, most studies that included data on perception reported that teachers and students perceived rinse-free hand wash positively and were willing to continue its use (3 studies, 1229 participants; very-low certainty evidence). AUTHORS' CONCLUSIONS The findings of this review may have identified a small yet potentially beneficial effect of rinse-free hand washing regimes on illness-related absenteeism. However, the certainty of the evidence that contributed to this conclusion was low or very low according to the GRADE approach and is therefore uncertain. Further research is required at all levels of schooling to evaluate rinse-free hand washing regimens in order to provide more conclusive, higher-certainty evidence regarding its impact. When considering the use of a rinse-free hand washing program in a local setting, there needs to be consideration of the current rates of illness-related absenteeism and whether the small beneficial effects seen here will translate into a meaningful reduction across their settings.
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Affiliation(s)
- Zachary Munn
- The University of AdelaideJoanna Briggs Institute, Faculty of Health Sciences55 King William RoadAdelaideSouth AustraliaAustralia5005
| | - Catalin Tufanaru
- Macquarie UniversityAustralian Institute of Health Innovation75 Talavera RdSydneyNew South Wales (NSW)Australia2113
| | - Craig Lockwood
- The University of AdelaideJoanna Briggs Institute, Faculty of Health Sciences55 King William RoadAdelaideSouth AustraliaAustralia5005
| | - Cindy Stern
- The University of AdelaideJoanna Briggs Institute, Faculty of Health Sciences55 King William RoadAdelaideSouth AustraliaAustralia5005
| | - Helen McAneney
- Queen's University BelfastMedicine, Dentistry and Biomedical Sciences97 Lisburn RoadHealth Sciences BuildingBelfastUKBT9 7BL
| | - Timothy H Barker
- The University of AdelaideJoanna Briggs Institute, Faculty of Health Sciences55 King William RoadAdelaideSouth AustraliaAustralia5005
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Dingman D, Wu J, Murphy HM. School-based, blacklight handwashing program can improve handwashing quality and knowledge among pre-school aged children. EVALUATION AND PROGRAM PLANNING 2020; 78:101731. [PMID: 31756601 DOI: 10.1016/j.evalprogplan.2019.101731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 09/23/2019] [Accepted: 10/10/2019] [Indexed: 06/10/2023]
Abstract
In the United States, lack of proper handwashing is associated with respiratory and gastrointestinal illnesses. Interventions to improve handwashing practices have led to an increase in handwashing knowledge and behavior, and decreases in gastrointestinal illnesses. Most studies have evaluated their interventions in the context of reported handwashing rates by observation, reduction of illnesses, as well as reduced absences, however none of these studies examined handwashing quality or knowledge as outcome measures. The objective of this paper is to present the results from a handwashing program with a special focus on the evaluation methods. A pre-post design was used to evaluate a handwashing program that took place in two pre-schools the northeast of the United States. The program utilized a black light technology to demonstrate to children the importance of good quality. The evaluation consisted of assessing knowledge and quality of handwashing using a linear puzzle and individual handwashing observation, respectively. Students from both schools improved on both knowledge and quality over time (p-values 0.071 and <0.001, respectively). The present study demonstrates that the use of black light technology as an educational tool may help to improve handwashing quality among pre-school aged children, even after only one instructional session.
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Affiliation(s)
- Deirdre Dingman
- Department of Social Behavioral Science, College of Public Health, 1301 Cecil B. Moore, 9th Floor, Ritter Annex, Temple University, Philadelphia, PA, 19122, USA.
| | - Jingwei Wu
- Department of Epidemiology and Biostatistics, College of Public Health, 1301 Cecil B. Moore, 9th Floor, Ritter Annex, Temple University, Philadelphia, PA, 19122, USA.
| | - Heather M Murphy
- Department of Epidemiology and Biostatistics, College of Public Health, 1301 Cecil B. Moore, 9th Floor, Ritter Annex, Temple University, Philadelphia, PA, 19122, USA.
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Mohamed NA, Mohd Rani MD, Tengku Jamaluddin TZM, Ismail Z, Ramli S, Faroque H, Abd Samad FN, Ariffien AR, Che Amir Farid AAR, Isahak I. Effect of hand hygiene intervention on the absenteeism of pre-school children in Klang Valley, Malaysia: a quasi-experimental study. World J Pediatr 2020; 16:416-421. [PMID: 31286426 PMCID: PMC7376078 DOI: 10.1007/s12519-019-00283-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/25/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Absenteeism amongst pre-school children is often due to illnesses such as hand, foot, and mouth disease, acute gastroenteritis, cold and flu, which are easily spread amongst them. This is because of weak immunity and lack of knowledge on proper hand hygiene. This quasi-experimental study assessed the efficacy of an intervention consisting of a hand hygiene education programme, along with digital tools in bringing about a change in behaviour and health conditions amongst pre-school children in Klang Valley, Malaysia. METHODS A total of 377 school children, male and female, aged 5-6 years old, participated and were assigned to either the intervention or a control group. During the 2 months intervention period, children in the test group were trained on proper hand hygiene practices and techniques with the aid of the interactive android-based tablets. The numbers of absent days of all the children were recorded for 2 months before the intervention and during the intervention. RESULTS In the test group, there was a 25% increase in the total number of absent days from the pre-intervention period to the intervention period, a much lesser increment observed as compared to that of control group in which the increase was much higher at 89%. Results showed a significant difference (P < 0·05) between the absenteeism rates for the test and control group during the intervention period. CONCLUSION These results suggest that proper education and intervention increase hand hygiene compliance, which may help decrease school absenteeism due to illness; however, a longer study duration may be necessary to evaluate the benefit further.
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Affiliation(s)
- Nurul Azmawati Mohamed
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia.
| | - Mohd Dzulkhairi Mohd Rani
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
| | | | - Zarini Ismail
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
| | - Shalinawati Ramli
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
| | - Habibah Faroque
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
| | - Farisha Nur Abd Samad
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
| | - Abdul Rashid Ariffien
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
| | | | - Ilina Isahak
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
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13
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Biezen R, Grando D, Mazza D, Brijnath B. Visibility and transmission: complexities around promoting hand hygiene in young children - a qualitative study. BMC Public Health 2019; 19:398. [PMID: 30975108 PMCID: PMC6460784 DOI: 10.1186/s12889-019-6729-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/31/2019] [Indexed: 11/19/2022] Open
Abstract
Background Effective hand hygiene practice can reduce transmission of diseases such as respiratory tract infections (RTIs) and gastrointestinal infections, especially in young children. While hand hygiene has been widely promoted within Australia, primary care providers’ (PCPs) and parents’ understanding of hand hygiene importance, and their views on hand hygiene in reducing transmission of diseases in the community are unclear. Therefore, the aim of this study was to explore the views of PCPs and parents of young children on their knowledge and practice of hand hygiene in disease transmission. Methods Using a cross-sectional qualitative research design, we conducted 30 in-depth interviews with PCPs and five focus groups with parents (n = 50) between June 2014 and July 2015 in Melbourne, Australia. Data were thematically analysed. Results Participants agreed that hand hygiene practice was important in reducing disease transmissions. However, barriers such as variations of hand hygiene habits, relating visibility to transmission; concerns around young children being obsessed with washing hands; children already being ‘too clean’ and the need to build their immunity through exposure to dirt; and scepticism that hand hygiene practice was achievable in young children, all hindered participants’ motivation to develop good hand hygiene behaviour in young children. Conclusion Despite the established benefits of hand hygiene, sustained efforts are needed to ensure its uptake in routine care. To overcome the barriers identified in this study a multifaceted intervention is needed that includes teaching young children good hand hygiene habits, PCPs prompting parents and young children to practice hand hygiene when coming for an RTI consultation, reassuring parents that effective hand hygiene practice will not lead to abnormal psychological behaviour in their children, and community health promotion education campaigns.
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Affiliation(s)
- Ruby Biezen
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
| | - Danilla Grando
- School of Science, RMIT University, Building 223, Level 1, Bundoora Campus, Plenty Road, Bundoora, VIC, 3083, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
| | - Bianca Brijnath
- National Ageing Research Institute LTD, 34-54 Poplar Road, Parkville, VIC, 3052, Australia
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Wang Z, Lapinski M, Quilliam E, Jaykus LA, Fraser A. The effect of hand-hygiene interventions on infectious disease-associated absenteeism in elementary schools: A systematic literature review. Am J Infect Control 2017; 45:682-689. [PMID: 28242074 DOI: 10.1016/j.ajic.2017.01.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 12/15/2022]
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.
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Affiliation(s)
- Zhangqi Wang
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC
| | - Maria Lapinski
- Department of Communication, Michigan State University, East Lansing, MI
| | - Elizabeth Quilliam
- Department of Advertising and Public Relations, Michigan State University, East Lansing, MI
| | - Lee-Ann Jaykus
- Department of Food, Bioprocessing, and Nutrition Sciences, and Department of Microbiology, North Carolina State University, Raleigh, NC
| | - Angela Fraser
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC.
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15
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Qualls N, Levitt A, Kanade N, Wright-Jegede N, Dopson S, Biggerstaff M, Reed C, Uzicanin A. Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017. MMWR Recomm Rep 2017. [PMID: 28426646 DOI: 10.15585/mmwr.rr6601a1externalicon] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023] Open
Abstract
When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).
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Affiliation(s)
- Noreen Qualls
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | | | - Neha Kanade
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
- Eagle Medical Services, San Antonio, Texas
| | - Narue Wright-Jegede
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
- Karna, Atlanta, Georgia
| | - Stephanie Dopson
- Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta, Georgia
| | - Matthew Biggerstaff
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Amra Uzicanin
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
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16
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Qualls N, Levitt A, Kanade N, Wright-Jegede N, Dopson S, Biggerstaff M, Reed C, Uzicanin A. Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017. MMWR Recomm Rep 2017; 66:1-34. [PMID: 28426646 PMCID: PMC5837128 DOI: 10.15585/mmwr.rr6601a1] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).
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Affiliation(s)
- Noreen Qualls
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | | | - Neha Kanade
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia.,Eagle Medical Services, San Antonio, Texas
| | - Narue Wright-Jegede
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia.,Karna, Atlanta, Georgia
| | - Stephanie Dopson
- Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta, Georgia
| | - Matthew Biggerstaff
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Amra Uzicanin
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
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17
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Azor-Martinez E, Cobos-Carrascosa E, Seijas-Vazquez ML, Fernández-Sánchez C, Strizzi JM, Torres-Alegre P, Santisteban-Martínez J, Gimenez-Sanchez F. Hand Hygiene Program Decreases School Absenteeism Due to Upper Respiratory Infections. THE JOURNAL OF SCHOOL HEALTH 2016; 86:873-881. [PMID: 27866386 DOI: 10.1111/josh.12454] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 03/17/2016] [Accepted: 06/22/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND We assessed the effectiveness of a handwashing program using hand sanitizer to prevent school absenteeism due to upper respiratory infections (URIs). METHODS This was a randomized, controlled, and open study on a sample of 1341 children 4-12 years old, attending 5 state schools in Almería (Spain), with an 8-month follow-up. The experimental group (EG) washed their hands with soap and water, together with using hand sanitizer, and the control group followed their usual handwashing procedures. Absenteeism rates due to URIs were compared between the 2 groups through a multivariate Poisson regression analysis. The percent of days missed in both groups were compared with a z test. RESULTS Overall, 1271 cases of school absenteeism due to URIs were registered. Schoolchildren from the EG had a 38% lower risk of absenteeism due to URIs, incidence rate ratio: 0.62, 95% confidence interval: 0.55-0.70, and a decrease in absenteeism of 0.45 episodes/child/academic year, p < .001. Pupils missed 2734 school days due to URIs and the percentage of days absent was significantly lower in the EG, p < .001. CONCLUSIONS Use of hand sanitizer plus handwashing with soap accompanied by educational support is an effective measure to reduce absenteeism due to URIs.
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Affiliation(s)
- Ernestina Azor-Martinez
- Distrito Sanitario, Atención Primaria Almería, España, C) Haza de Acosta S/N 04009, Almería, Spain
| | - Elena Cobos-Carrascosa
- Servicio de Pediatría, Hospital Torrecárdenas, Almería, España, C) Ramon y Cajal N° 11 Villanueva Mesia 18369, Granada, Spain
| | | | - Carmen Fernández-Sánchez
- Servicio de Farmacia Hospital Torrecardenas, C) Hermandad de Donantes de Sangre S/N, CP 04009, Almería, Spain
| | - Jenna M Strizzi
- Roger Williams University, 1 Old Ferry Rd, Bristol, RI 02809
| | - Pilar Torres-Alegre
- Unidad de Formación, e Investigación Distrito Almería España, C) Pablo Neruda 2, portal 12, 6° 1, 04009, Almería, Spain
| | | | - Francisco Gimenez-Sanchez
- Servicio de Pediatría, Hospital Torrecárdenas, Almería, España, C) Pepe Isbert 55, 04007, Almería. Spain
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18
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Michail KA, Ioannidou C, Galanis P, Tsoumakas K, Pavlopoulou ID. Promotion of Preventive Measures in Public Nursery Schools: Lessons From the H1N1 Pandemic. Health Promot Pract 2016; 18:636-644. [PMID: 27807196 DOI: 10.1177/1524839916676073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nursery schools serve as reservoirs of transmission of infectious diseases, and teachers should be able to implement and monitor hygiene measures to prevent them. The aim of the present study was to assess the compliance of nursery school teachers on promoting preventive interventions and to identify associated factors, during the novel H1N1 influenza pandemic. A secondary objective was to evaluate their knowledge and vaccination status regarding the novel virus. A cross-sectional study was performed, with the use of a predesigned anonymous, questionnaire, and distributed to all public nursery teachers of Athens, Greece. General etiquette practices were highly acceptable to over 92% of teachers. Those with longer teaching experience promoted simple preventive measures, such as hand washing and use of hand sanitizer, more often while older children were more likely to familiarize with them. However, teachers presented inadequate knowledge concerning the novel virus and their vaccination rates with the pandemic vaccine were unacceptably low (1.1%). Our study showed that promotion of simple preventive measures is feasible and may contribute to the prevention of outbreaks in nursery schools, although knowledge gaps and fear concerning the pandemic vaccine highlight communication issues.
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19
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Costa-Tutusaus L, Guerra-Balic M. Relationship between Healthy Lifestyle and Sociodemographic Factors in Adolescents in Catalonia: Application of VISA-TEEN Questionnaire. PLoS One 2016; 11:e0163381. [PMID: 27684476 PMCID: PMC5042508 DOI: 10.1371/journal.pone.0163381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/06/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction There is a clear relationship between the way of life and the health of individuals, and therefore, we can speak of healthy and unhealthy lifestyles. There are different surveys and questionnaires that evaluate the lifestyles of adolescents, but none of them offers a final score that can quantify the healthfulness of an adolescent’s lifestyle. It was with this goal that the VISA-TEEN questionnaire is developed and validated. The objective of this study is to apply the questionnaire to a sample of adolescents who attend school in Catalonia to evaluate the healthfulness of their lifestyles and to relate the scores obtained to different sociodemographic variables. Methods Cross-sectional study. A total of 2,832 students from 25 schools in Catalonia responded to the questionnaire. A descriptive analysis was performed, calculating the mean (Standard deviation), median (p25, p75), and confidence interval. The results were calculated for the total population, factoring according to gender, age, urban/rural population, origin (native/immigrant), and family wealth, which was based on the Family Affluence Scale (FAS II). The significance of the difference was calculated for each factor with the appropriate statistical test. Results For the total score of healthy lifestyle, the youngest students and those with the highest family wealth obtained higher scores. With respect to eating habits, girls scored higher than boys, and higher scores were observed in natives and those with high family wealth. For physical activity, boys scored higher, as well as younger individuals, natives, and those from rural areas. With respect to substance abuse, the worst scores were found in older individuals, students from rural areas, and natives. The rational use of leisure technology was only associated with age (worsening scores with older age). Lastly, hygiene was better with girls, decreased with age, and was worse with natives than immigrants.
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Affiliation(s)
- Lluís Costa-Tutusaus
- Blanquerna School of Health Science, Ramon Llull University, Barcelona, Spain
- Research Group on Health, Physical Activity and Sport (SAFE), Ramon Llull University, Barcelona, Spain
- * E-mail:
| | - Myriam Guerra-Balic
- Research Group on Health, Physical Activity and Sport (SAFE), Ramon Llull University, Barcelona, Spain
- Faculty of Psychology, Education and Sport Sciences, Ramon Llull University, Barcelona, Spain
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Lam W, Fowler C, Dawson A. The approaches Hong Kong Chinese mothers adopt to teach their preschool children to prevent influenza: a multiple case study at household level. BMC Nurs 2016; 15:51. [PMID: 27587982 PMCID: PMC5007988 DOI: 10.1186/s12912-016-0172-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/26/2016] [Indexed: 11/25/2022] Open
Abstract
Background In Hong Kong, the population is at risk of seasonal influenza infection twice a year. Seasonal influenza is significantly associated with the increased hospitalization of children. Maintaining personal hygiene and vaccination are the most effective measures to prevent influenza infection. Research demonstrates a positive relationship between the health practices applied by parents and the behaviour of their children highlighting the importance of parental heath education. However, there is minimal research that provides an understanding of how Hong Kong Chinese parents teach their children to prevent seasonal influenza. Methods Mixed methods research was undertaken that employed a multiple-case study approach to gain an understanding of parental teaching practices regarding seasonal influenza prevention. Purposive intensity sampling was adopted to recruit twenty parents and their healthy children. A thematic analysis was employed to examine the qualitative interview data and the quantitative survey data were examined descriptively. These data were then integrated to provide a more rigorous understanding of parental teaching strategies. Comparisons were made across cases to reveal commonalities and differences. Results Five major themes were identified: processes parents used to teach personal hygiene; parent-child interaction during teaching; approaches to managing children’s health behaviours; enhancing children’s healthy practices; and parents’ perspective of the role of the nurse in health promotion. Conclusions This study provided valuable insight into the approach of Hong Kong Chinese parents in teaching their children to prevent seasonal influenza. The results indicate that parents can be better supported to develop effective strategies to teach their preschool children hygiene practices for seasonal influenza prevention. Partnerships with community nurses can play a role in building effective parent-child interactions to enhance children’s learning and adoption of healthy practices.
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Affiliation(s)
- Winsome Lam
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China ; Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Cathrine Fowler
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Angela Dawson
- Faculty of Health, University of Technology Sydney, Sydney, Australia
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Costa-Tutusaus L, Guerra-Balic M. Development and psychometric validation of a scoring questionnaire to assess healthy lifestyles among adolescents in Catalonia. BMC Public Health 2016; 16:89. [PMID: 26821644 PMCID: PMC4731967 DOI: 10.1186/s12889-016-2778-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 01/25/2016] [Indexed: 11/11/2022] Open
Abstract
Background Lifestyle is intimately related to health. A questionnaire that specifically scores the healthiness of lifestyle of Catalan adolescents is needed. The objective of this study was to develop and validate a scoring questionnaire called VISA-TEEN to assess the healthy lifestyle of young Catalans that can be answered quickly and user-friendly. Methods A lifestyle questionnaire was developed based on the analysis of contributions from two focus groups, one with adolescents and the other with people who work with them (teachers and doctors). A panel of experts validated the content of items that were ultimately selected for the VISA-TEEN questionnaire. Three hundred ninety-six adolescents (215 boys and 181 girls, age = 13–19 years) completed the VISA-TEEN. Internal consistency was assessed using Cronbach's alpha (α) reliability coefficient. Test-retest reliability, using an intraclass correlation coefficient (ICC), was calculated based on scores attained two weeks apart. Construct validity was assessed by the extraction of components with an exploratory factor analysis. The relationship between the scores was measured using the health-related quality of life (HRQoL) KIDSCREEN-10 Index (the relationship was assessed by calculating Pearson’s r correlation coefficient). The association of scores in the VISA-TEEN for self-rated health (SRH) was also examined by executing an analysis of variance (ANOVA) between the different categories of this variable. We also calculated the index of fit for factor scales (IFFS) for each component, as well as the discriminatory power of the instrument using Ferguson’s δ (delta) coefficient. Results The VISA-TEEN questionnaire showed acceptable reliability (α = 0.66, αest = 0.77) and a very good test-retest agreement (ICC = 0.860). It could be broken down into the following five components, all with an acceptable or very good IFFS (0.7–0.96): diet, substance abuse, physical activity, Rational Use of Technological Leisure (RUTL), and hygiene. Scores on the VISA-TEEN showed significant correlation with the KIDSCREEN index (r = 0.21, p < 0.001) and were associated with SRH (p < 0.001). The discriminatory power was found to be δ = 0.97. Conclusions The VISA-TEEN questionnaire developed to study the lifestyle of Catalan adolescents is a valid instrument to apply in this population as it is shown in the present psychometric tests to understand the role of lifestyle in the health of teenagers or to test the efficacy of health campaigns intended to improve teenagers' lifestyle. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2778-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lluís Costa-Tutusaus
- Research Group Physical Activity, Sport and Health, School of Health Science, University Ramon Llull, FCS Blanquerna, C/ Padilla 326-332, Barcelona, 08025, Spain.
| | - Myriam Guerra-Balic
- Research Group Physical Activity, Sport and Health, Faculty of Psychology, Education and Sport Sciences, University Ramon Llull, Barcelona, 08022, Spain
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Agreement between children and parents demonstrated that illness-related absenteeism was validly reported by children. J Clin Epidemiol 2016; 69:61-9. [DOI: 10.1016/j.jclinepi.2015.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/26/2015] [Accepted: 05/06/2015] [Indexed: 11/20/2022]
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Hoffmann K, van Bijnen EM, George A, Kutalek R, Jirovsky E, Wojczewski S, Maier M. Associations between the prevalence of influenza vaccination and patient's knowledge about antibiotics: a cross-sectional study in the framework of the APRES-project in Austria. BMC Public Health 2015; 15:981. [PMID: 26416304 PMCID: PMC4587920 DOI: 10.1186/s12889-015-2297-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/16/2015] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to identify associations between GP patient’s knowledge about the spectrum of effectiveness of antibiotics and the probability of vaccination against influenza. The underlying hypothesis was that individuals with an understanding that antibiotics are ineffective against viruses, common colds, and flu were more likely to be vaccinated than persons lacking this knowledge. Methods This cross-sectional study was conducted within the context of the European APRES project in Austria. Between November 2010 and July 2011, patients were recruited from GP practices to complete questionnaires about their knowledge about antibiotics and their influenza vaccination status. Statistical analyses included subgroup analyses and logistic regression models. Results Data of 3224 patients was analyzed, demonstrating that patients with better knowledge concerning antibiotics had a significantly higher likelihood of being vaccinated (OR 1.35, CI 95 % 1.18–1.54). While the overall vaccination rate was low (18.6 % in 2009/2010 and 14.0 % in 2010/2011), elderly compared to younger adults (OR 0.06 CI 95 % 0.03–0.13) and healthcare workers (OR 2.24, CI 95 % 1.42–3.54) demonstrated higher likelihood of vaccination. Additionally, female GPs had significantly more vaccinated patients than male GPs (OR 2.90, CI 95 % 1.32–6.40). Discussion There has been little prior study on the association between a patient’s knowledge of the effectiveness spectrum of antibiotics and influenza vaccination status. Given the public health imperative to increase annual prevalence of influenza vaccination, understanding this educational gap can improve specificity in counseling as well as vaccination rates. Ultimately, we found that those with a better knowledge on about antibiotics had a significantly higher likelihood of being vaccinated. Conclusions The results of this study demonstrate that vaccination prevalence is associated with patient’s knowledge about antibiotics. It can be concluded that one strategy to improve the overall low vaccination rates for seasonal influenza in Austria would be, particularly for male GPs, to have a specific discussion with patients about these circumstances by focusing on younger patients. Further, public health efforts could supplement in-office strategies to improve this area of health literacy. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2297-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathryn Hoffmann
- Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, 1090, Vienna, Austria.
| | - Evelien Me van Bijnen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
| | - Aaron George
- Department of Community and Family Medicine, Duke Medical Center, Durham, NC, USA.
| | - Ruth Kutalek
- Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, 1090, Vienna, Austria.
| | - Elena Jirovsky
- Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, 1090, Vienna, Austria.
| | - Silvia Wojczewski
- Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, 1090, Vienna, Austria.
| | - Manfred Maier
- Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, 1090, Vienna, Austria.
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Zhou G, Jiang T, Knoll N, Schwarzer R. Improving hand hygiene behaviour among adolescents by a planning intervention. PSYCHOL HEALTH MED 2015; 20:824-31. [PMID: 25774807 DOI: 10.1080/13548506.2015.1024138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To improve regular hand hygiene in adolescents, educational messages based on medical information have not been very successful. Therefore, a theory-guided self-regulatory intervention has been designed with a particular focus on planning strategies. A randomised controlled trial with 307 adolescents, aged 12-18 years, was conducted in high schools. The control group received educational hand hygiene leaflets, whereas the experimental group received a self-regulatory treatment which required them to generate specific action plans and coping plans. Three times during one month, both groups received verbal reminder messages about planning to wash their hands properly. At one-month follow-up, hand hygiene behaviour as well as planning to practise hand hygiene were higher in the self-regulation than in the education group (p < .01). Moreover, changes in planning levels operated as a mediator between experimental conditions and changes in behavioural outcomes. Teaching self-regulatory planning strategies may constitute a superior approach than educational messages to improve regular hand hygiene practice in adolescents.
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Affiliation(s)
- Guangyu Zhou
- a Department of Educational Science and Psychology , Freie Universität Berlin , Berlin , Germany
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Johansen A, Denbæk AM, Bonnesen CT, Due P. The Hi Five study: design of a school-based randomized trial to reduce infections and improve hygiene and well-being among 6-15 year olds in Denmark. BMC Public Health 2015; 15:207. [PMID: 25886286 PMCID: PMC4351932 DOI: 10.1186/s12889-015-1556-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infectious illnesses such as influenza and diarrhea are leading causes of absenteeism among Danish school children. Interventions in school settings addressing hand hygiene have shown to reduce the number of infectious illnesses. However, most of these studies include small populations and almost none of them are conducted as randomized controlled trials. The overall aim of the Hi Five study was to develop, implement and evaluate a multi-component school-based intervention to improve hand hygiene and well-being and to reduce the prevalence of infections among school children in intervention schools by 20% compared to control schools. This paper describes the development and the evaluation design of Hi Five. METHODS/DESIGN The Hi Five study was designed as a tree-armed cluster-randomized controlled trial. A national random sample of schools (n = 44) was randomized to one of two intervention groups (n = 29) or to a control group with no intervention (n = 15). A total of 8,438 six to fifteen-year-old school children were enrolled in the study. The Hi Five intervention consisted of three components: 1) a curriculum component 2) mandatory daily hand washing before lunch 3) extra cleaning of school toilets during the school day. Baseline data was collected from December 2011 to April 2012. The intervention period was August 2012 to June 2013. The follow-up data was collected from December 2012 to April 2013. DISCUSSION The Hi Five study fills a gap in international research. This large randomized multi-component school-based hand hygiene intervention is the first to include education on healthy and appropriate toilet behavior as part of the curriculum. No previous studies have involved supplementary cleaning at the school toilets as an intervention component. The study will have the added value of providing new knowledge about usability of short message service (SMS, text message) for collecting data on infectious illness and absenteeism in large study populations. TRIAL REGISTRATION Current Controlled Trials ISRCTN19287682 , 21 December 2012.
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Affiliation(s)
- Anette Johansen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A 2., København K, DK-1353, Denmark.
| | - Anne Maj Denbæk
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A 2., København K, DK-1353, Denmark.
| | - Camilla Thørring Bonnesen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A 2., København K, DK-1353, Denmark.
| | - Pernille Due
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A 2., København K, DK-1353, Denmark.
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Sams KA, Reich RR, Boyington AR, Barilec EM. Community respiratory virus infection in hematopoietic stem cell transplantation recipients and household member characteristics. Oncol Nurs Forum 2014; 42:74-9. [PMID: 25542323 DOI: 10.1188/15.onf.74-79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To determine if children or the number of contacts living in an immediate household increases the risk of community respiratory virus (CRV) acquisition in hematopoietic stem cell transplantation (HSCT) recipients. DESIGN Retrospective, exploratory study. SETTING National Cancer Institute-designated comprehensive cancer center located in the Southeast. SAMPLE 720 adult outpatients post-autologous or allogeneic HSCT. METHODS Data were gathered using a retrospective medical record review from July 1, 2006, to December 31, 2009. Summary statistics were used to describe sample characteristics. Binary logistic regression was used to determine whether the number of household member contacts or number of children in each age group was a significant predictor of CRV infection. Multivariate linear regression was used to investigate predictors of the number of CRV infections. MAIN RESEARCH VARIABLES The dependent variable was acquisition of CRV infection. Independent variables included the number of children in the household and the number of household members. FINDINGS Across all HSCT recipients, children aged 0-4 years (p = 0.01) and 5-12 years (p = 0.001) predicted CRV infection. The allogeneic group had the greatest incidence of CRV infection and was most sensitive to the presence of young children. The total number of household members was not a predictor of CRV infection. CONCLUSIONS Households with children aged 12 years and younger more than doubled the risk of an HSCT recipient acquiring CRV infection. Additional studies are needed to test interventions designed to interrupt household transmission of CRV infection from children to vulnerable HSCT recipients. IMPLICATIONS FOR NURSING Household contacts, particularly children, should be included in HSCT teaching. As indicated by the potentially high number of days from transplantation to acquisition of CRV infection, re-education and continuing focus on prevention of CRV infection should be reinforced throughout the lengthy transplantation period.
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Affiliation(s)
- Kay A Sams
- Moffitt Cancer Center and Research Institute (MCCRI), Tampa, FL
| | - Richard R Reich
- Department of Psychology, University of South Florida Sarasota-Manatee
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Padaruth SK, Biranjia-Hurdoyal SD. Hygiene practices and faecal contamination of the hands of children attending primary school in Mauritius. Int Health 2014; 7:280-4. [PMID: 25424722 DOI: 10.1093/inthealth/ihu080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/20/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND An increasing prevalence of paediatric infections have been associated with poor levels of hygienic practices. METHODS This study aimed at investigating the level of hygiene practices among 200 school children aged 6-10 years. Their hands were swabbed and the bacteria were identified by Gram staining and conventional biochemical tests. RESULTS Of the 200 samples, 91.0% (182) showed bacterial growth. Coagulase negative Staphylococcus was the most common bacterium isolated from 76.9% (140) of the samples followed by Micrococcus, Bacillus, Pseudomonas, Proteus and Escherichia coli. Children aged 9-10 years were more likely to wash their hands before eating than those aged 6-8 years (OR=2.0; p<0.05). A higher bacterial growth was noted from children who washed their hands with water only than those who used soap (OR=5.9; p<0.05). Furthermore, children aged 6-8 years were more likely to have oral-digital habits (OR=2.5; p<0.05), less likely to wash hands after using the toilet, more prone to use water only to wash their hands at home and had higher bacterial growth (p<0.05). CONCLUSIONS A scarcity of soap was noted in the schools which could prevent the children from adopting proper hygiene practices. Furthermore, children should be often reminded of the importance of hygienic practices.
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Affiliation(s)
- S K Padaruth
- Medical Laboratory Technologist, Victoria Hospital, Ministry of Health & Quality of Life, Candos, Mauritius
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Azor-Martínez E, Gonzalez-Jimenez Y, Seijas-Vazquez ML, Cobos-Carrascosa E, Santisteban-Martínez J, Martínez-López JM, Jimenez-Noguera E, Galan-Requena MDM, Garrido-Fernández P, Strizzi JM, Gimenez-Sanchez F. The impact of common infections on school absenteeism during an academic year. Am J Infect Control 2014; 42:632-7. [PMID: 24837113 DOI: 10.1016/j.ajic.2014.02.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/18/2014] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND School absenteeism because of infections is one of the most important problems facing both public and private primary schools. The aim of the study was to assess the impact of infections on school absenteeism and their reduction with a handwashing program using hand sanitizer. METHODS The study was an 8-month-long, randomized, controlled open study (N = 1,609 children, aged 4-12 years old) at 5 state schools in Almeria (Spain). The experimental group (EG) washed their hands with soap and water, complemented with the use of hand sanitizer, and the control group (CG) followed the usual handwashing procedure. The total number of episodes and days missed as well as those because of upper respiratory infections and gastrointestinal infections were compared in both groups with a Z-test. RESULTS The students were absent 12,386 days in 7,945 episodes. The incidence of total absent episodes and percent of missed days, including those because of upper respiratory infections and gastrointestinal infections, were significantly lower in the EG than the CG (P < .001), and this was maintained through the flu pandemic period. CONCLUSION School absenteeism because of infections in schools is reduced when a hand hygiene program utilizing sanitizing gels is properly carried out, especially during the flu season.
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Hand hygiene and risk of influenza virus infections in the community: a systematic review and meta-analysis. Epidemiol Infect 2014; 142:922-32. [PMID: 24572643 DOI: 10.1017/s095026881400003x] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Community-based prevention strategies for seasonal and pandemic influenza are essential to minimize their potential threat to public health. Our aim was to evaluate the efficacy of hand hygiene interventions in reducing influenza transmission in the community and to investigate the possible modifying effects of latitude, temperature and humidity on hand hygiene efficacy. We identified 979 articles in the initial search and 10 randomized controlled trials met our inclusion criteria. The combination of hand hygiene with facemasks was found to have statistically significant efficacy against laboratory-confirmed influenza while hand hygiene alone did not. Our meta-regression model did not identify statistically significant effects of latitude, temperature or humidity on the efficacy of hand hygiene. Our findings highlight the potential importance of interventions that protect against multiple modes of influenza transmission, and the modest efficacy of hand hygiene suggests that additional measures besides hand hygiene may also be important to control influenza.
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Impact of water, sanitation, and hygiene interventions on improving health outcomes among school children. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2013; 2013:984626. [PMID: 24454415 PMCID: PMC3888759 DOI: 10.1155/2013/984626] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/27/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE This review was done to explore the impact of water treatment, hygiene, and sanitary interventions on improving child health outcomes such as absenteeism, infections, knowledge, attitudes, and practices and adoption of point-of-use water treatment. METHODS A literature search was conducted using the databases PubMed and Google scholar for studies published between 2009 and 2012 and focusing on the effects of access to safe water, hand washing facilities, and hygiene education among school-age children. Studies included were those that documented the provision of water and sanitation in schools for children less than 18 years of age, interventions which assessed WASH practices, and English-language, full-text peer reviewed papers. RESULTS Fifteen studies were included in the final analysis. 73% (n = 11) of the studies were conducted in developing countries and were rural based (53%, n = 8). The child's age, gender, grade level, socioeconomic index, access to hygiene and sanitary facilities, and prior knowledge of hygiene practices were significantly associated with the outcomes. Nutrition practices which are key factors associated with the outcomes were rarely assessed. CONCLUSION Further research is required to assess the long-term impact of such interventions in different settings.
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Pickering AJ, Davis J, Blum AG, Scalmanini J, Oyier B, Okoth G, Breiman RF, Ram PK. Access to waterless hand sanitizer improves student hand hygiene behavior in primary schools in Nairobi, Kenya. Am J Trop Med Hyg 2013; 89:411-8. [PMID: 23836575 DOI: 10.4269/ajtmh.13-0008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Handwashing is difficult in settings with limited resources and water access. In primary schools within urban Kibera, Kenya, we investigated the impact of providing waterless hand sanitizer on student hand hygiene behavior. Two schools received a waterless hand sanitizer intervention, two schools received a handwashing with soap intervention, and two schools received no intervention. Hand cleaning behavior after toilet use was monitored for 2 months using structured observation. Hand cleaning after toileting was 82% at sanitizer schools (N = 2,507 toileting events), 38% at soap schools (N = 3,429), and 37% at control schools (N = 2,797). Students at sanitizer schools were 23% less likely to have observed rhinorrhea than control students (P = 0.02); reductions in student-reported gastrointestinal and respiratory illness symptoms were not statistically significant. Providing waterless hand sanitizer markedly increased student hand cleaning after toilet use, whereas the soap intervention did not. Waterless hand sanitizer may be a promising option to improve student hand cleansing behavior, particularly in schools with limited water access.
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Affiliation(s)
- Amy J Pickering
- Civil and Environmental Engineering and Woods Institute for the Environment, Stanford University, Stanford, CA, USA.
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Gerald LB, Gerald JK, Zhang B, McClure LA, Bailey WC, Harrington KF. Can a school-based hand hygiene program reduce asthma exacerbations among elementary school children? J Allergy Clin Immunol 2012; 130:1317-24. [PMID: 23069487 PMCID: PMC3511646 DOI: 10.1016/j.jaci.2012.08.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/16/2012] [Accepted: 08/17/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Viral upper respiratory tract infections have been implicated as a major cause of asthma exacerbations among school-aged children. Regular hand washing is the most effective method to prevent the spread of viral respiratory tract infections, but effective hand-washing practices are difficult to establish in schools. OBJECTIVES This randomized controlled trial evaluated whether a standardized regimen of hand washing plus alcohol-based hand sanitizer could reduce asthma exacerbations more than schools' usual hand hygiene practices. METHODS This was a 2-year, community-based, randomized controlled crossover trial. Schools were randomized to usual care and then intervention (sequence 1) or intervention and then usual care (sequence 2). Intervention schools were provided with alcohol-based hand sanitizer, hand soap, and hand hygiene education. The primary outcome was the proportion of students experiencing an asthma exacerbation each month. Generalized estimating equations were used to model the difference in the marginal rate of exacerbations between sequences while controlling for individual demographic factors and the correlation within each student and between students within each school. RESULTS Five hundred twenty-seven students with asthma were enrolled among 31 schools. The hand hygiene intervention did not reduce the number of asthma exacerbations compared with the schools' usual hand hygiene practices (P = .132). There was a strong temporal trend because both sequences experienced fewer exacerbations during year 2 compared with year 1 (P < .001). CONCLUSIONS Although the intervention was not found to be effective, the results were confounded by the H1N1 influenza pandemic that resulted in substantially increased hand hygiene behaviors and resources in usual-care schools. Therefore these results should be viewed cautiously.
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Affiliation(s)
- Lynn B. Gerald
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, Arizona Respiratory Center, University of Arizona, 1295 N Martin Avenue, PO Box 245163, Tucson, AZ 85724-5163, (520)626-3243, (520)626-6093 FAX
| | - Joe K. Gerald
- Division of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Bin Zhang
- Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center
| | | | - William C. Bailey
- Lung Health Center School Of Medicine, University of Alabama at Birmingham
| | - Kathy F. Harrington
- Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham
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