| Methods |
Prospective, cluster open‐label cross‐over cohort study of programmed use of a hand sanitiser in conjunction with at‐will soap‐and‐water handwashing conducted in a private elementary school in California. The aim of the study was to assess the effectiveness of the SAB sanitiser at reducing illness absenteeism in a school setting. Subjects were grouped by classroom without formal randomisation. 7 classes received the instant sanitiser, while the remaining 7 classes were assigned to the control group. Male‐to‐female ratios and age distributions of the 2 groups did not differ significantly
Prior to study commencement all students participated in an educational programme about germs and the importance of handwashing to prevent illnesses. Children in the hand sanitiser group received a spray to use under teacher supervision to supplement normal, at‐will handwashing with soap and water. The control group was instructed to wash hands with water and soap, and it was not supervised. Data were collected for 10 weeks. After this period, there was a 2‐week wash‐out period, during which neither group of students used SAB sanitiser. Then SAB sanitiser was distributed to the student group that had previously served as the control and the study proceeded for another 4 weeks |
| Participants |
420 children in a private elementary school in California aged 5 to 12 years; cluster, open‐label, cross‐over cohort study over 10 weeks |
| Interventions |
Educational programme plus the SAB (surfactant, allantoin and benzalkonium chloride) spray hand sanitiser in 1 oz bottles fitted with a pump spray top and with at‐will soap‐and‐water handwashing versus nothing |
| Outcomes |
Laboratory: serological evidence: n/a
Effectiveness: days of absences from school for respiratory illness (and gastrointestinal illness ‐ data not extracted)
Safety: n/a
Respiratory illness and gastrointestinal illness: reduced absenteeism by 41.9%; respiratory illnesses by 49.7% |
| Notes |
Risk of bias: medium
Notes: the authors conclude that daily use of the SAB instant hand sanitiser with at‐will handwashing using soap and water significantly decreased absences due to acute communicable illness. Use of the sanitiser reduced illness absenteeism by 41.9% (reduction in respiratory illnesses of 49.7% over the 10‐week period of the study). The authors also described some limitations of the study, as limited socio‐economic diversity in the study population, limitation to a single study site and lack of blinding. Further soap‐and‐water washing was not monitored. Generalisability of the results is questionable as all participants underwent the educational programme |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Random sequence generation (selection bias) |
Unclear risk |
N/A |
| Allocation concealment (selection bias) |
Unclear risk |
N/A |
| Blinding (performance bias and detection bias)
All outcomes |
Unclear risk |
N/A |
| Incomplete outcome data (attrition bias)
All outcomes |
Unclear risk |
N/A |
| Selective reporting (reporting bias) |
Unclear risk |
N/A |
