| Methods |
Prospective cohort study conducted at 3 adult daycare centres in Rochester, New York. The study assessed the value of a staff educational programme combined with the use of a portable virucidal hand foam for the reduction of respiratory infections in daycare participants. The authors report in the same paper an ecological study of the incidence of ILI in 3 previous seasons (1992 to 1996) which does not report numerators and denominators and was not extracted |
| Participants |
In December 1995 when the study started there were centre 1: 69 elderly and 36 staff members; centre 2: 67 elderly and 45 staff members; centre 3: 68 elderly and 16 staff members |
| Interventions |
Addition of virucidal hand foam as a supplement versus normal handwashing and educational programme |
| Outcomes |
Laboratory: serological evidence and virology cultures (Table 1 reports a series of isolated pathogens, with no tie in with actual cases)
Effectiveness: viral pathogens: influenza A/B, RSV, coronavirus, parainfluenza, rhinovirus
Safety: n/a |
| Notes |
Risk of bias: low
Notes: the authors conclude that the educational programme for staff was associated with an almost 50% decrease in the infection rate in daycare attendees. The programme was effective only in the last of the 4 years of the programme (rates of infection in daycare patients fell from 14.5 to 10.4 per 100 person‐months to 5.7 per 100 person months, P < 0.001). This is a conclusion based on an ecological study of the incidence of ILI in 3 previous seasons which the authors report in the same paper, but which does not report numerators and denominators and was not extracted. The lower infection rate is likely to reflect the combination of interventions and education, which increased staff awareness and more broadly changed behaviour. There was no apparent additional benefit from the virucidal foam. This is one of the few identified studies reporting circulating viruses in the daycare setting, both in staff and patients. The decline in influenza‐like illness episodes across the 4 study years is reflected in the decline in viral isolates, suggesting that aspecific measures such as handwashing are effective against the main respiratory viruses |
| 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 |
