Effectiveness of a hand hygiene program to reduce acute gastroenteritis at child care centers: A cluster randomized trial |
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| Affiliation: | 1. Andalusian Deparment of Health, Distrito Sanitario de Atención Primaria, Almería, Spain;2. Deparment of Bioestadistica, SEPLIN, Soluciones Estadísticas, Granada, Spain;3. Department of Public Health, University of Copenhagen, Copenhagen, Denmark;4. Castilla-La Mancha Deparment of Health, Centro de salud de Illescas, Toledo, Spain;5. Cantalan Deparment of Health, CAP St Ildefons, Cornellà de Llobregat, Barcelona, Spain;6. Andalusian Deparment of Pediatrics, Servicio de Pediatría, Hospital Torrecárdenas, Almería, Spain;7. Andalusian Deparment of Pediatrics, Instituto Hispalense de Pediatría, Instituto Balmis de Vacunas, Almeria, Spain;1. Institute for Disaster Management and Reconstruction/West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China;2. School of Political Science and Public Administration, Shandong University, Qingdao, China;3. School of Humanitarian Studies, Royal Roads University, Victoria, Canada;1. Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH;2. Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH;3. Case Western Reserve University School of Medicine, Cleveland, OH;4. University of Utah School of Medicine, Salt Lake City, UT;5. Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT;1. Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Departamento de Microbiología e Inmunología, Pedro de Alba S/N, Ciudad Universitaria, San Nicolás de los Garza, Nuevo León, Mexico;2. Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’, e Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico;3. Universidad Autónoma de Nuevo León, Facultad de Ciencias Químicas, Pedro de Alba S/N, Ciudad Universitaria, San Nicolás de los Garza, Nuevo León, Mexico;4. Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.;1. Department of Basic Health Sciences, State University of Maringá, Maringá, Paraná, Brazil;2. Maringá University Hospital, State University of Maringá, Maringá, Paraná, Brazil;3. Department of Statistics, State University of Maringá, Maringá, Paraná, Brazil;1. Department of Internal Medicine B, Laniado Hospital, Netanya, Israel;2. Ruth and Bruce Rappaport School of Medicine, Technion, Haifa, Israel;3. Department of Internal medicine C, Laniado Hospital, Netanya, Israel;4. Department of Internal Medicine A, Laniado Hospital, Netanya, Israel;5. Central Laboratory, Laniado Hospital Netanya, Israel;6. Clinical Utility Department, Sanz Medical Center, Laniado Hospital, Netanya, Israel;7. School of Public Health, University of Tel Aviv, Israel;1. Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada;2. Hamilton Health Sciences, Hamilton, Ontario, Canada;3. Division of Infectious Diseases, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada |
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| Abstract: | We aimed to assess the effectiveness of an educational and hand hygiene program in daycare centers (DCCs) and homes on acute gastroenteritis (AGE) incidence in children attending DCCs.METHODSA randomized, controlled, and open study of 911 children aged 0-3 years attending 24 DCCs in Almería (Spain) with an 8-month follow-up was employed. Two intervention groups of DCCs families performed educational and hand hygiene measures, 1 with soap and water (soap and water group; n = 274), another with hand sanitizer (hand sanitizer group [HSG]; n = 339), and the control group (CG; n = 298) followed usual handwashing procedures. We compared AGE episode rates with Poisson regression model.RESULTSseven hundred fourteen AGE episodes were registered, significant differences between HSG and CG children were found during December and January. A multivariate model was applied and the adjusted incidence rate ratios by rotavirus vaccination found significant differences when children were previously vaccinated, the children in the soap and water group had a higher risk of AGE episodes (incidence rate ratio: 1.28, 95% confidence interval:1.0-1.64), compared with those in the HSG.CONCLUSIONSThis study demonstrated that hand hygiene programs that included hand sanitizer were most effective in the winter months. Further, the largest reduction of AGE episodes occurred in the children that followed hand hygiene programs including hand sanitizer and educational measures for DCC staff, parents, and children, and were vaccinated for rotavirus. |
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