Effect of several interventions on the frequency of handwashing among elementary public school children

Background: The purpose of this educational project was to assess the effect of several interventions on the frequency of handwashing among elementary public school children. Methods: Participants in this project were first-graders and fourth-graders from jurisdictions within a mid-Atlantic metropolitan area. Phase I included a baseline assessment of bathroom cleanliness as well as adequacy of supplies for handwashing in each school. During phase 2, the frequency of handwashing before lunch or after bathroom use was monitored and recorded during a 2-month period. The schools were separated into four groups: a peer education group, a hand wipes and instructional poster group, a combination of the education and hand wipes/poster groups, and a (control) comparison school. Results: Overall, a significant increase occurred in the proportion of handwashing frequency from preintervention to postintervention for each intervention group (wipes: 0.50 vs 0.66, p=0.03; education only: 0.64 vs 0.72, p=0.02; and education and wipes: 0.45 vs 0.67, p=0.03) but not in the control group (0.42 vs 0.46, p=0.26). When the first 3 weeks and the last 3 weeks after intervention were compared, handwashing frequency remained unchanged in the wipes only group (0.66 vs 0.66, p=0.96), decreased in the education group (0.77 vs 0.65, p=0.006), and increased in the education and wipes group (0.58 vs 0.75, p=0.003), as well as in the control group (0.37 vs 0.52, p=0.01). Conclusion: Education combined with accessible convenient hand hygiene may result in a sustainable increase in the frequency of handwashing among elementary school children.