| Methods |
Cross‐over study to evaluate the effectiveness of an alcohol gel as an adjunct to regular handwashing for decreasing absenteeism among elementary children by reducing specific communicable diseases such cold, flu and conjunctivitis. The study was conducted in an elementary school in New England, US. In the cross‐over design classrooms in each grade level were randomised to begin as the experimental group (alcohol gel) or the control group (regular handwashing). A study protocol for hand hygiene was introduced following the germ unit education. The handwashing product was a soap and water alternative that is approximately 60% ethyl alcohol. In phase 1 (46 days) children in 9 classrooms were in the experimental group, and children in 8 classrooms were in the control group. After a 1 week washout period when no children had access to the alcohol gel, Phase 2 (47 days) started, and the classroom that had participated before as an experimental group passed in the control group and vice versa. Data were collected by the parents that informed the secretary or the school nurse of the reasons for a child's absence, including symptoms of any illness. Respiratory illnesses were defined by symptoms of URTI |
| Participants |
253 children, 120 girls and 133 boys, from kindergarten to 3rd grade. 32 children dropped out (10 due to skin irritation and 22 because of lack of parental consent) |
| Interventions |
Use of an alcohol gel as an adjunct to regular handwashing and educational programme versus regular handwashing and educational program |
| Outcomes |
Laboratory: no
Effectiveness: days of absences from school for respiratory illness
Safety: N/A |
| Notes |
Risk of bias: high (no description of randomisation; partial reporting of outcomes, numerators and denominators)
Notes: the authors conclude that significantly fewer children became ill while using the alcohol gel as an adjunct to regular handwashing than when using regular handwashing only (decreased school absenteeism of 43% with the use of alcohol gel on top of handwashing). The authors also described, as a limitation of the study, the fact that the school nurse served as the data collector, and this could be perceived as bias in measurement of the outcome variable
Randomisation and allocation are not described, there are no cluster coefficients reported and attrition is not taken into consideration during the analysis. Unit of randomisation and analysis are different. No reporting by arm. No ORs, no CIs reported |
| 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 |
