A hand hygiene intervention to decrease hand, foot and mouth disease and absence due to sickness among kindergarteners in China: A cluster-randomized controlled trial

Liu, Xiaona; Hou, Wanli; Zhao, Zhiguang; Cheng, Jinquan; Beeck, Ed F. van; Peng, Xian; Jones, Kylah; Fu, Xianliang; Zhou, Yan; Zhang, Zhen; Richardus, Jan Hendrik; Erasmus, Vicki

doi:10.1016/j.jinf.2018.08.009

Cited by 18 publications

(21 citation statements)

References 19 publications

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“…A frequency-matched case-control study in China found that good hand-washing habits which include washing hands with soap, children always wash hands before meals, and adult always wash hands before feeding child, were protective against HFMD with a risk reduction of >95% during outbreaks [33]. A cluster-randomized controlled trial on hand hygiene intervention among kindergartens in China shown to be effective at reducing HFMD in children [35]. A community intervention study in China suggested that community education on hand washing can improve personal hygiene and prevent HFMD transmission [36].…”

Section: Protective Factors Of Hfmdmentioning

confidence: 99%

The epidemiological risk factors of hand, foot, mouth disease among children in Singapore: A retrospective case-control study

Kua

Pang

2020

PLoS ONE

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The incidence of hand, foot, and mouth disease (HFMD) is increasing over the years despite current prevention and control policies in Singapore. A retrospective case-control study was conducted among parents whose children attended childcare centres in Singapore to assess the epidemiological risk factors associated with HFMD among children below 7 years old. Parents of 363 children with HFMD (as cases) and 362 children without HFMD (as controls) were enrolled from 22 childcare centres. Data of potential risk factors were collected through a standardised self-administered questionnaire from parents which include demographics and hygiene practices. Multivariate analysis were adjusted for age group, parent's education level, mother's age, HFMD-infected siblings, and preschool admission period. Child's age between 1.5 and 4.9 years, child who had been in childcare for more than 1.9years, having HFMD-infected siblings, two or more children in a family, higher educated parents, parents who had HFMD episode previously, wash toys with soap once every two to three weeks, sanitise toys once every two to three weeks, out-sourced cleaner in childcare centre, no domestic helper at home and more than 22 children in a classroom were independent risk factors of HFMD. These evidence provide crucial implications to guide more effective prevention and control of HFMD in Singapore.

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Section: Protective Factors Of Hfmdmentioning

confidence: 99%

The epidemiological risk factors of hand, foot, mouth disease among children in Singapore: A retrospective case-control study

Kua

Pang

2020

PLoS ONE

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“…Children are prone to place things in their mouths, eat with their hands, and pick their noses [ 6 , 7 , 8 ]. Proper hand hygiene (HH) practice can effectively reduce the incidence of upper respiratory infection; diarrhea; and/or hand, foot, and mouth disease (HFMD) among children in childcare settings, thereby reducing absenteeism associated with these illnesses [ 1 , 2 , 5 , 9 ]. HFMD, for example, is a widespread pediatric disease that has become an endemic childhood disease in East and Southeast Asia.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of “Hand Hygiene Fun Month” for Kindergarten Children: A Pilot Quasi-Experimental Study

Suen

Cheung

2020

IJERPH

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Early childhood is a formative period during which healthy habits are developed, including proper hand hygiene practices. The aim of this quasi-experimental study was to determine the effectiveness of a 4-week series of educational sessions that consider the cognitive developmental stage of children on increasing their knowledge and promoting hand hygiene practices. The intervention group (n = 33) observed the hand hygiene program, whereas another group served as the waitlist control (n = 20). Creative activities were planned for the illustration of hand hygiene concepts in terms of “right moments”, “right steps”, and “right duration”. Hand sanitizer coverage was evaluated using a hand scanner. After the intervention, the experimental group had higher knowledge level toward hand hygiene than the control group (p < 0.001). Significant improvements in hand hygiene performance at the left palm and dorsum (p < 0.05), right palm (p < 0.05), and overall hand coverage (p < 0.05) were observed in the experimental group. The study demonstrated that the knowledge and proper hand hygiene (HH) practice of children can be positively influenced by the use of an age-appropriate education program. The results of this study have implications for school health educators and parents for promoting HH practices among children at home and at the school level.

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“…Additionally, this is a part of a larger study on evaluating our developed intervention targeted to decrease HFMD among children attending kindergartens in China. The findings in this study contribute to explain why our intervention was effective at reducing HFMD infections [19].…”

Section: Discussionmentioning

confidence: 87%

“…We calculated the sample size of the trial using methods recommend by Breukelen and colleagues [20], taking into account the intra-cluster correlation coefficient of kindergartens, the cost per cluster and cost per person, the expected effect on behavior change, the power and the significance level of the study. Our process of randomization and calculating sample size have been previously reported [19]. This trial’s protocol is registered and approved by the Ethics Committee of Shenzhen CDC (Registration no.…”

Section: Methodsmentioning

confidence: 99%

“…The purpose of the present study is to assess the social cognitive factors that influence the hand-washing behavior of kindergarten teachers in China; to evaluate the effectiveness of our theory- and evidence-based intervention at changing hand-washing behavior, as well as the determinants thereof using self-reported HH compliance as the outcome measure. Our intervention has lately proven to be effective in decreasing HFMD [19], this evaluation thus will also enable us to gain insights on possible reasons behind the success of behavioral change techniques to prevention infections in kindergartens.…”

Section: Introductionmentioning

confidence: 99%

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A multimodal intervention to improve hand hygiene compliance via social cognitive influences among kindergarten teachers in China

et al. 2019

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Children attending kindergarten are at high risk for contracting infections, for which hand hygiene (HH) has been recognized as the most cost-effective prevention measure globally. Kindergarten teachers’ HH behavior plays a vital role in encouraging favorable hygiene techniques and environment. This study aims to evaluate the effectiveness of a multimodal intervention at changing kindergarten teachers’ HH behavior and social cognitive factors that influences HH behavior in China. The intervention named “Clean Hands, Happy Life” includes HH products with refills, reminders and cues for action, a kick-off event with awards, and training programs. We evaluated the intervention using a self-administrative questionnaire with a stratified random sample of 12 kindergartens. Two surveys was completed by 176 teachers at baseline and 185 after the 6-month intervention. Compared with the baseline scores, there was a significant improvement in the overall self-reported HH compliance of teachers (9.38 vs. 9.68 out of 10, p = 0.006), as well as teachers’ perceived disease susceptibility, disease severity and behavioral control after the intervention ( p <0.05). We found that teachers’ HH compliance was likely to be higher among those who have better HH guideline awareness (β = 0.48, p <0.01) and perceived behavioral control (β = 0.26, p = 0.01), which explained 24.2% of the variance of self-reported compliance of teachers at baseline. The assessed intervention may provide Chinese kindergarten teachers with behavioral skills and cognitions that associated with the compliance of HH behavior. We thus recommend future intervention studies consider our HH behavior change techniques, address multiple social cognitive determinants of HH behavior and include the change of targeted influences in the impact evaluation.

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A hand hygiene intervention to decrease hand, foot and mouth disease and absence due to sickness among kindergarteners in China: A cluster-randomized controlled trial

Abstract: Our intervention is effective at reducing HFMD infections and absence due to sickness in children attending kindergartens in China.

Cited by 18 publications

References 19 publications

The epidemiological risk factors of hand, foot, mouth disease among children in Singapore: A retrospective case-control study

The epidemiological risk factors of hand, foot, mouth disease among children in Singapore: A retrospective case-control study

Effectiveness of “Hand Hygiene Fun Month” for Kindergarten Children: A Pilot Quasi-Experimental Study

A multimodal intervention to improve hand hygiene compliance via social cognitive influences among kindergarten teachers in China

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