Hand Sanitiser Provision for Reducing Illness Absences in Primary School Children: A Cluster Randomised Trial
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{"title"=>"Hand sanitiser provision for reducing illness absences in primary school children: A cluster randomised trial", "type"=>"journal", "authors"=>[{"first_name"=>"Patricia", "last_name"=>"Priest", "scopus_author_id"=>"7003680232"}, {"first_name"=>"Joanne E.", "last_name"=>"McKenzie", "scopus_author_id"=>"7202100187"}, {"first_name"=>"Rick", "last_name"=>"Audas", "scopus_author_id"=>"6603247574"}, {"first_name"=>"Marion", "last_name"=>"Poore", "scopus_author_id"=>"35503780800"}, {"first_name"=>"Cheryl", "last_name"=>"Brunton", "scopus_author_id"=>"23090414300"}, {"first_name"=>"Lesley", "last_name"=>"Reeves", "scopus_author_id"=>"35503861900"}], "year"=>2015, "source"=>"PLoS Medicine", "identifiers"=>{"sgr"=>"84936135283", "doi"=>"10.1371/journal.pmed.1001700", "pui"=>"605099218", "pmid"=>"25117155", "scopus"=>"2-s2.0-84936135283", "issn"=>"15491676", "isbn"=>"1549-1676 (Electronic)\\r1549-1277 (Linking)"}, "id"=>"d7578108-b5fa-316d-9d57-b684fc4f3a55", "abstract"=>"BACKGROUND: The potential for transmission of infectious diseases offered by the school environment are likely to be an important contributor to the rates of infectious disease experienced by children. This study aimed to test whether the addition of hand sanitiser in primary school classrooms compared with usual hand hygiene would reduce illness absences in primary school children in New Zealand.\\n\\nMETHODS AND FINDINGS: This parallel-group cluster randomised trial took place in 68 primary schools, where schools were allocated using restricted randomisation (1:1 ratio) to the intervention or control group. All children (aged 5 to 11 y) in attendance at participating schools received an in-class hand hygiene education session. Schools in the intervention group were provided with alcohol-based hand sanitiser dispensers in classrooms for the winter school terms (27 April to 25 September 2009). Control schools received only the hand hygiene education session. The primary outcome was the number of absence episodes due to any illness among 2,443 follow-up children whose caregivers were telephoned after each absence from school. Secondary outcomes measured among follow-up children were the number of absence episodes due to specific illness (respiratory or gastrointestinal), length of illness and illness absence episodes, and number of episodes where at least one other member of the household became ill subsequently (child or adult). We also examined whether provision of sanitiser was associated with experience of a skin reaction. The number of absences for any reason and the length of the absence episode were measured in all primary school children enrolled at the schools. Children, school administrative staff, and the school liaison research assistants were not blind to group allocation. Outcome assessors of follow-up children were blind to group allocation. Of the 1,301 and 1,142 follow-up children in the hand sanitiser and control groups, respectively, the rate of absence episodes due to illness per 100 child-days was similar (1.21 and 1.16, respectively, incidence rate ratio 1.06, 95% CI 0.94 to 1.18). The provision of an alcohol-based hand sanitiser dispenser in classrooms was not effective in reducing rates of absence episodes due to respiratory or gastrointestinal illness, the length of illness or illness absence episodes, or the rate of subsequent infection for other members of the household in these children. The percentage of children experiencing a skin reaction was similar (10.4% hand sanitiser versus 10.3% control, risk ratio 1.01, 95% CI 0.78 to 1.30). The rate or length of absence episodes for any reason measured for all children also did not differ between groups. Limitations of the study include that the study was conducted during an influenza pandemic, with associated public health messaging about hand hygiene, which may have increased hand hygiene among all children and thereby reduced any additional effectiveness of sanitiser provision. We did not quite achieve the planned sample size of 1,350 follow-up children per group, although we still obtained precise estimates of the intervention effects. Also, it is possible that follow-up children were healthier than non-participating eligible children, with therefore less to gain from improved hand hygiene. However, lack of effectiveness of hand sanitiser provision on the rate of absences among all children suggests that this may not be the explanation.\\n\\nCONCLUSIONS: The provision of hand sanitiser in addition to usual hand hygiene in primary schools in New Zealand did not prevent disease of severity sufficient to cause school absence.\\n\\nTRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12609000478213. Please see later in the article for the Editors' Summary.", "link"=>"http://www.mendeley.com/research/hand-sanitiser-provision-reducing-illness-absences-primary-school-children-cluster-randomised-trial", "reader_count"=>42, "reader_count_by_academic_status"=>{"Unspecified"=>2, "Professor > Associate Professor"=>2, "Researcher"=>6, "Student > Doctoral Student"=>3, "Student > Ph. D. Student"=>6, "Student > Postgraduate"=>4, "Student > Master"=>9, "Other"=>1, "Student > Bachelor"=>7, "Lecturer"=>2}, "reader_count_by_user_role"=>{"Unspecified"=>2, "Professor > Associate Professor"=>2, "Researcher"=>6, "Student > Doctoral Student"=>3, "Student > Ph. D. Student"=>6, "Student > Postgraduate"=>4, "Student > Master"=>9, "Other"=>1, "Student > Bachelor"=>7, "Lecturer"=>2}, "reader_count_by_subject_area"=>{"Unspecified"=>4, "Environmental Science"=>3, "Nursing and Health Professions"=>2, "Biochemistry, Genetics and Molecular Biology"=>1, "Medicine and Dentistry"=>19, "Agricultural and Biological Sciences"=>4, "Psychology"=>1, "Social Sciences"=>2, "Immunology and Microbiology"=>3, "Earth and Planetary Sciences"=>1, "Economics, Econometrics and Finance"=>2}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>19}, "Social Sciences"=>{"Social Sciences"=>2}, "Psychology"=>{"Psychology"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>3}, "Earth and Planetary Sciences"=>{"Earth and Planetary Sciences"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>4}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>2}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}, "Unspecified"=>{"Unspecified"=>4}, "Environmental Science"=>{"Environmental Science"=>3}}, "reader_count_by_country"=>{"Bangladesh"=>1, "United States"=>1}, "group_count"=>3}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1632538"], "description"=>"<p>*School-level deprivation uses the decile assigned to each school by the New Zealand Ministry of Education for funding purposes. It reflects the proportion of students who live in more or less advantaged communities, using information from the census on household income, occupation, household crowding, educational qualifications, and income support. Decile 1 schools are in the least advantaged communities, and decile 10 schools in the most advantaged.</p>†<p>Respondents were asked to tick all the ethnicities represented in their household. Prioritised ethnicity, in New Zealand, codes as Māori participants who report Māori as one of their ethnic groups, as Pacific those who do not report Māori but do report a Pacific ethnicity as one of their ethnic groups, as Asian those who do not report Māori or Pacific ethnicity but report an Asian ethnicity, and the remainder as European (if New Zealand European or another European ethnicity reported) or other (if not).</p>", "links"=>[], "tags"=>["skin reaction", "Hand Sanitiser Provision", "group allocation", "illness absence episodes", "hand hygiene", "absence episodes", "hand sanitiser", "Cluster Randomised Trial BackgroundThe", "hand hygiene education session", "ci", "Primary School Children", "cause school absence.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN 12609000478213Please", "school liaison research assistants", "school children"], "article_id"=>1136576, "categories"=>["Biological Sciences"], "users"=>["Patricia Priest", "Joanne E. McKenzie", "Rick Audas", "Marion Poore", "Cheryl Brunton", "Lesley Reeves"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001700.t003", "stats"=>{"downloads"=>1, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Baseline_characteristics_/1136576", "title"=>"Baseline characteristics.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-08-12 03:43:10"}
  • {"files"=>["https://ndownloader.figshare.com/files/1632539"], "description"=>"1<p>All quotes from protocol <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001700#pmed.1001700-McKenzie1\" target=\"_blank\">[19]</a>.</p>", "links"=>[], "tags"=>["skin reaction", "Hand Sanitiser Provision", "group allocation", "illness absence episodes", "hand hygiene", "absence episodes", "hand sanitiser", "Cluster Randomised Trial BackgroundThe", "hand hygiene education session", "ci", "Primary School Children", "cause school absence.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN 12609000478213Please", "school liaison research assistants", "school children"], "article_id"=>1136577, "categories"=>["Biological Sciences"], "users"=>["Patricia Priest", "Joanne E. McKenzie", "Rick Audas", "Marion Poore", "Cheryl Brunton", "Lesley Reeves"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001700.t002", "stats"=>{"downloads"=>1, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Summary_of_protocol_deviations_/1136577", "title"=>"Summary of protocol deviations.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-08-12 03:43:10"}
  • {"files"=>["https://ndownloader.figshare.com/files/1632540", "https://ndownloader.figshare.com/files/1632541", "https://ndownloader.figshare.com/files/1632542", "https://ndownloader.figshare.com/files/1632543"], "description"=>"<div><p>Background</p><p>The potential for transmission of infectious diseases offered by the school environment are likely to be an important contributor to the rates of infectious disease experienced by children. This study aimed to test whether the addition of hand sanitiser in primary school classrooms compared with usual hand hygiene would reduce illness absences in primary school children in New Zealand.</p><p>Methods and Findings</p><p>This parallel-group cluster randomised trial took place in 68 primary schools, where schools were allocated using restricted randomisation (1∶1 ratio) to the intervention or control group. All children (aged 5 to 11 y) in attendance at participating schools received an in-class hand hygiene education session. Schools in the intervention group were provided with alcohol-based hand sanitiser dispensers in classrooms for the winter school terms (27 April to 25 September 2009). Control schools received only the hand hygiene education session. The primary outcome was the number of absence episodes due to any illness among 2,443 follow-up children whose caregivers were telephoned after each absence from school. Secondary outcomes measured among follow-up children were the number of absence episodes due to specific illness (respiratory or gastrointestinal), length of illness and illness absence episodes, and number of episodes where at least one other member of the household became ill subsequently (child or adult). We also examined whether provision of sanitiser was associated with experience of a skin reaction. The number of absences for any reason and the length of the absence episode were measured in all primary school children enrolled at the schools. Children, school administrative staff, and the school liaison research assistants were not blind to group allocation. Outcome assessors of follow-up children were blind to group allocation. Of the 1,301 and 1,142 follow-up children in the hand sanitiser and control groups, respectively, the rate of absence episodes due to illness per 100 child-days was similar (1.21 and 1.16, respectively, incidence rate ratio 1.06, 95% CI 0.94 to 1.18). The provision of an alcohol-based hand sanitiser dispenser in classrooms was not effective in reducing rates of absence episodes due to respiratory or gastrointestinal illness, the length of illness or illness absence episodes, or the rate of subsequent infection for other members of the household in these children. The percentage of children experiencing a skin reaction was similar (10.4% hand sanitiser versus 10.3% control, risk ratio 1.01, 95% CI 0.78 to 1.30). The rate or length of absence episodes for any reason measured for all children also did not differ between groups. Limitations of the study include that the study was conducted during an influenza pandemic, with associated public health messaging about hand hygiene, which may have increased hand hygiene among all children and thereby reduced any additional effectiveness of sanitiser provision. We did not quite achieve the planned sample size of 1,350 follow-up children per group, although we still obtained precise estimates of the intervention effects. Also, it is possible that follow-up children were healthier than non-participating eligible children, with therefore less to gain from improved hand hygiene. However, lack of effectiveness of hand sanitiser provision on the rate of absences among all children suggests that this may not be the explanation.</p><p>Conclusions</p><p>The provision of hand sanitiser in addition to usual hand hygiene in primary schools in New Zealand did not prevent disease of severity sufficient to cause school absence.</p><p>Trial registration</p><p>Australian New Zealand Clinical Trials Registry <a href=\"https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83697\" target=\"_blank\">ACTRN12609000478213</a></p><p><i>Please see later in the article for the Editors' Summary</i></p></div>", "links"=>[], "tags"=>["skin reaction", "Hand Sanitiser Provision", "group allocation", "illness absence episodes", "hand hygiene", "absence episodes", "hand sanitiser", "Cluster Randomised Trial BackgroundThe", "hand hygiene education session", "ci", "Primary School Children", "cause school absence.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN 12609000478213Please", "school liaison research assistants", "school children"], "article_id"=>1136578, "categories"=>["Biological Sciences"], "users"=>["Patricia Priest", "Joanne E. McKenzie", "Rick Audas", "Marion Poore", "Cheryl Brunton", "Lesley Reeves"], "doi"=>[nil, nil, nil, nil], "stats"=>{"downloads"=>15, "page_views"=>19, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Hand_Sanitiser_Provision_for_Reducing_Illness_Absences_in_Primary_School_Children_A_Cluster_Randomised_Trial/1136578", "title"=>"Hand Sanitiser Provision for Reducing Illness Absences in Primary School Children: A Cluster Randomised Trial", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2014-08-12 03:43:10"}
  • {"files"=>["https://ndownloader.figshare.com/files/1632534"], "description"=>"<p><sup>1</sup>Includes all children in school years 1 to 6 (generally aged from 5 to 11 y). The number given here is the average roll over the period of the trial. <sup>2</sup>Follow-up children were a randomly selected sample of all children attending the participating schools, whose caregivers were followed up for detailed information about their illness absences. The primary outcome, absence episodes due to illness, is measured only in this group of children. <sup>3</sup>We may not have been informed about all children who left the schools. <sup>4</sup>All follow-up children were included in the analysis. The period of time that each child was in the trial (the exposure period) was adjusted for through the statistical model. <sup>5</sup>All children who had an absence (for any reason) were included in the analysis, even if they were lost to follow-up at some point (e.g., moved schools). The exposure period was calculated as the average of the school roll over the period of the trial (multiplied by 100; the number of school days that were encompassed by the trial period). Figure adapted from <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001700#pmed.1001700-Campbell1\" target=\"_blank\">[29]</a>.</p>", "links"=>[], "tags"=>["skin reaction", "Hand Sanitiser Provision", "group allocation", "illness absence episodes", "hand hygiene", "absence episodes", "hand sanitiser", "Cluster Randomised Trial BackgroundThe", "hand hygiene education session", "ci", "Primary School Children", "cause school absence.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN 12609000478213Please", "school liaison research assistants", "school children"], "article_id"=>1136572, "categories"=>["Biological Sciences"], "users"=>["Patricia Priest", "Joanne E. McKenzie", "Rick Audas", "Marion Poore", "Cheryl Brunton", "Lesley Reeves"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001700.g001", "stats"=>{"downloads"=>4, "page_views"=>19, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Flow_diagram_of_the_progress_of_schools_and_children_through_the_trial_/1136572", "title"=>"Flow diagram of the progress of schools and children through the trial.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-08-12 03:43:10"}
  • {"files"=>["https://ndownloader.figshare.com/files/1632535"], "description"=>"<p>“H1N1” absences (asterisk) were absences where the child had been asked to stay at home because of possible contact with a known case of H1N1, rather than because they were sick themselves.</p>", "links"=>[], "tags"=>["skin reaction", "Hand Sanitiser Provision", "group allocation", "illness absence episodes", "hand hygiene", "absence episodes", "hand sanitiser", "Cluster Randomised Trial BackgroundThe", "hand hygiene education session", "ci", "Primary School Children", "cause school absence.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN 12609000478213Please", "school liaison research assistants", "school children"], "article_id"=>1136573, "categories"=>["Biological Sciences"], "users"=>["Patricia Priest", "Joanne E. McKenzie", "Rick Audas", "Marion Poore", "Cheryl Brunton", "Lesley Reeves"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001700.g002", "stats"=>{"downloads"=>6, "page_views"=>20, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Flow_diagram_outlining_process_for_identifying_the_reason_for_school_absences_/1136573", "title"=>"Flow diagram outlining process for identifying the reason for school absences.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-08-12 03:43:10"}
  • {"files"=>["https://ndownloader.figshare.com/files/1632536"], "description"=>"<p>Estimates obtained from marginal models using GEEs with an exchangeable correlation structure and robust variance estimation. All models include the stratification variable “city” (Invercargill, Dunedin, or Christchurch).</p><p>*ICC point estimates are those resulting from the GEE models with no adjustment for the stratification variable. Confidence intervals for the ICCs were bootstrapped using the combination of the <i>bootstrap</i> and <i>xtgee</i> commands in Stata. Bootstrapping allowed for the clustering of observations within schools (using both the <i>cluster()</i> and <i>idcluster()</i> options). Bias-corrected 95% bootstrap confidence intervals were calculated from 5,000 replicates.</p>‡<p>The exposure period was the number of school days.</p>↑<p>The exposure period was the period the child was enrolled in the study minus the length of the school holidays.</p>†<p>The ICC point estimate resulting from the GEE model for these outcomes was negative. In this circumstance, the model GEE model was refitted with an independent correlation structure, making the assumption that in the context of a cluster-based evaluation such as this, negative ICCs are more likely to occur through sampling error than because of a true negative ICC <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001700#pmed.1001700-Eldridge1\" target=\"_blank\">[20]</a>,<a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001700#pmed.1001700-Ukoumunne1\" target=\"_blank\">[21]</a>. Assuming an independent correlation provides more conservative estimates of the estimated standard errors.</p><p>**Data aggregated to the level of the school, and analysed at the school level. The exposure period was calculated as the average school roll over the period of the trial multiplied by 100 (the number of school days encompassed by the trial period).</p>", "links"=>[], "tags"=>["skin reaction", "Hand Sanitiser Provision", "group allocation", "illness absence episodes", "hand hygiene", "absence episodes", "hand sanitiser", "Cluster Randomised Trial BackgroundThe", "hand hygiene education session", "ci", "Primary School Children", "cause school absence.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN 12609000478213Please", "school liaison research assistants", "school children"], "article_id"=>1136574, "categories"=>["Biological Sciences"], "users"=>["Patricia Priest", "Joanne E. McKenzie", "Rick Audas", "Marion Poore", "Cheryl Brunton", "Lesley Reeves"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001700.t004", "stats"=>{"downloads"=>3, "page_views"=>28, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Estimates_of_effectiveness_of_hand_sanitiser_on_outcome_measures_/1136574", "title"=>"Estimates of effectiveness of hand sanitiser on outcome measures.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-08-12 03:43:10"}
  • {"files"=>["https://ndownloader.figshare.com/files/1632537"], "description"=>"1<p>Follow-up children only.</p>2<p>See <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001700#pmed-1001700-t002\" target=\"_blank\">Table 2</a> for detail of change to definition.</p>", "links"=>[], "tags"=>["skin reaction", "Hand Sanitiser Provision", "group allocation", "illness absence episodes", "hand hygiene", "absence episodes", "hand sanitiser", "Cluster Randomised Trial BackgroundThe", "hand hygiene education session", "ci", "Primary School Children", "cause school absence.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN 12609000478213Please", "school liaison research assistants", "school children"], "article_id"=>1136575, "categories"=>["Biological Sciences"], "users"=>["Patricia Priest", "Joanne E. McKenzie", "Rick Audas", "Marion Poore", "Cheryl Brunton", "Lesley Reeves"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001700.t001", "stats"=>{"downloads"=>5, "page_views"=>16, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Planned_outcomes_from_protocol_19_and_outcomes_actually_measured_/1136575", "title"=>"Planned outcomes from protocol [19] and outcomes actually measured.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-08-12 03:43:10"}

PMC Usage Stats | Further Information

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Relative Metric

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