Ladegaard 1999.

Methods	RCT with cluster‐randomisation to intervention or control. Out of 10 institutions they excluded 2 because they wanted institutions to be comparable in uptake area (that means housing and income). Interventions were given to children, parents and teachers at the institutions
Participants	Children 0 to 6 years old
Interventions	Multifaceted: information, t‐shirts to the children with: "Clean hands ‐ yes, thank you", performance of a fairytale "The princess who did not want to wash her hands", exercise in handwashing, importance of clean and fresh air. The aims of the intervention were: ‐ to increase the hygiene education of the daycare teachers ‐ to motivate the children by practical learning to have a better hand hygiene ‐ to inform the parents about better hand hygiene
Outcomes	34% decrease in 'sickness' (probably mostly gastroenteritis)
Notes	Risk of bias: limited data only available Notes: the authors conclude that there was a 34% decrease in sickness in the intervention arm, this is probably overall sickness as gastroenteritis is part of the outcomes (data no extracted). Limited data only available from translation by Jørgen Lous
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not described
Allocation concealment (selection bias)	Unclear risk	Randomisation by "lottery", the same as "flip the coin" Concealment not reported
Blinding (performance bias and detection bias) All outcomes	High risk	Not possible
Incomplete outcome data (attrition bias) All outcomes	High risk	No total numbers of children included in each arm reported
Selective reporting (reporting bias)	High risk	Limited data reported, especially denominators missing