Putting alcohol-based hand sanitizers in classrooms in the hopes of reducing school absences because of illness may not be worth the expense in high-income countries where clean water for washing hands is readily available, a study says. The findings, reported in this week's PLOS Medicine,report that adding the sanitizers to school-age kids' usual hand-hygiene routine -- washing with soap and water -- did not reduce illness-related absences.
The study looked at 2,443 students, ages 5 to 11, in 68 schools in New Zealand. They each received a 30-minute lesson that reinforced knowledge about "germs causing sickness, and the need to wash hands with soap and water after using the toilet, before eating ... etc.," says Patricia Priest, lead study author and a public health physician and infectious disease epidemiologist at the University of Otego's Dunedin School of Medicine.
In half of the schools, dispensers containing alcohol-based hand sanitizer were installed in classrooms over two winter terms, and students were asked to use them after coughing or sneezing and on the way out of the classroom for morning recess or lunch. The remaining schools served as a control, receiving only the hand hygiene lesson. Parents and caregivers were contacted to explain the reason for absences.
Researchers found that the rate of absences because of illness was similar in both the intervention schools that received the dispensers and the control schools that washed with soap and water.
The study notes that because it was conducted during the 2009 swine flu pandemic, widespread public health messages from government agencies about hand hygiene, along with other influenza-prevention actions such as covering coughs and sneezes, "may have increased hand hygiene among all children" and obscured any effectiveness of the hand sanitizer intervention.
"I am not convinced that the extra exhortation to wash hands would have had a major, sustained, impact on primary-school children's hand hygiene practice over 20 weeks, but it has to be considered," Priest says.
The study's findings are not surprising, Allison Aiello, an epidemiologist at the University of North Carolina's Gillings School of Global Public Health, says in an e-mail. She was not involved in the new research.
She adds that alcohol-based sanitizers have shown a large benefit in terms of reductions in infections in hospital settings.
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