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

About AJIC: American Journal of Infection Control 
AJIC: American Journal of Infection Control ( covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.

About APIC
APIC’s mission is to create a safer world through prevention of infection. The association’s more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at Follow APIC on Twitter: and Facebook: For information on what patients and families can do, visit APIC’s Infection Prevention and You website at

About Elsevier
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Research Intelligence and ClinicalKey— and publishes over 2,500 journals, including The Lancet and Cell, and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group, a world-leading provider of information and analytics for professional and business customers across industries.

Media contact
Liz Garman
+1 732 202 454 2604