| Methods |
Prospective cohort study conducted in an elementary school, Detroit, to evaluate the effect of a mandatory scheduled handwashing programme on absenteeism due to acute communicable illness (including upper respiratory disease). Classrooms were divided into either control or experimental groups without formal randomisation. Six classrooms were assigned to the handwashing group and 8 classrooms were assigned to the control group. Data were collected for 37 school days. Information about absent children was recorded daily by the school secretary. Symptoms were used to classify students as having respiratory or gastrointestinal illness. Upper respiratory infections and gastrointestinal symptoms (data not extracted) were not considered mutually exclusive |
| Participants |
14 classrooms including 305 healthy, predominantly upper middle‐class children ranging from ages 5 to 12. All grade levels from kindergarten through fifth grade were included. Six classrooms (143 students) were the handwashing group and 8 classrooms (162 students) were the control group |
| Interventions |
Handwashing programme versus usual practice. Children in the handwashing group were asked to wash their hands after arrival at school, before eating lunch, after lunch recess, and before going home. Children in the control group washed at their normal frequency. All children in both groups washed with the school soap, which was not antibacterial |
| Outcomes |
Laboratory: no
Effectiveness: upper respiratory infections (URTI) ‐ cough sneeze, pink eye, headache, mononucleosis, acute exacerbation of asthma, sinus trouble, fever alone, bronchitis
Safety: N/A |
| Notes |
Risk of bias: high
Notes: the authors conclude that handwashing among children can be effective in preventing transmission of disease, but the difference in days of absence is statistically significant only for gastrointestinal symptoms (RR for ARIs 0.79, P = 0.756). Limitations in the study design are: use of a discrete population without socio‐economically diverse backgrounds, use of a single institution, lack of blind assessment, low specificity of symptoms, and lack of accurate symptom definition |
| 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 |
