Simplified Handwashing Steps Help Reduce Sickness-Related Absenteeism for Kids

Washington, DC, September 1, 2015

A simplified handwashing routine, with five steps instead of seven, helps to reduce sickness-related absenteeism for students with mild intellectual disability (MID), according to a study published in the September issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

The study was conducted in two special education schools in Hong Kong. Researchers from The Hong Kong Polytechnic University developed a 12-week handwashing intervention which reduced the World Health Organization’s seven-step handwashing technique to five steps by combining two of the steps (palm-to-palm and palm-to-palm with fingers interlaced) and omitting one (wrist-rubbing).

The researchers compared hand hygiene improvement measurements between the intervention (five-step method) and control (seven-step method) groups after the implementation of the simplified program using fluorescent stain test photos to analyze the results. The pre- to post-test difference in the intervention school (+1.03, P <.001) was 212 percent greater than the difference in the control school where the seven-step guideline was followed (+0.34, P = .001).

Sickness-related absenteeism was also reduced by 40 percent more in the intervention school (0.0167) compared with the control school (0.028).

“It is very important in the public health agenda to standardize a handwashing program for school teachers and school nurses to teach vulnerable high-risk groups about handwashing procedures and ultimately to prevent the spread of germs in the school community,” the researchers concluded.

The intervention consisted of the following: (1) the simplified 5-step handwashing technique, including demonstrations and return demonstrations; (2) a handwashing song; (3) a video for behavior modeling; (4) a poster giving visual cues for the five steps of the handwashing procedure; (5) a reward card system for behavioral reinforcement; and (6) a validated handwashing checklist for concordance observation.


Notes for editors
“Comparative efficacy of a simplified handwashing program for improvement in hand hygiene and reduction of school absenteeism among children with intellectual ability,” by Regina LT Lee, Cynthia Leung, Wah Kun Tong, Hong Chen, and Paul H. Lee appears in the American Journal of Infection Control, Volume 43, Issue 9 (September 2015).


Regina L.T. Lee, Ph.D. (Corresponding Author)
World Health Organization Collaborating Center, School of Nursing
The Hong Kong Polytechnic University, Hong Kong, China

Cynthia Leung, Ph.D.
Department of Applied and Social Sciences
The Hong Kong Polytechnic University, Hong Kong, China

Wah Kun Tong, Ph.D.
Hospital Authority Infectious Disease Centre, Princess Margaret Hospital
New Territory, Hong Kong, China

Center for Health Protection
Hong Kong, China

Paul H. Lee, Ph.D.
World Health Organization Collaborating Center, School of Nursing
The Hong Kong Polytechnic University, Hong Kong, China

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