Table 1.
Characteristics of the eight studies of handwashing included in the review
| Study | Location/setting | Study design | Exposure/intervention | Age group | Methodological shortcomings* | Outcome | Measure of effect (95% CI) | Sample size and follow‐up |
|---|---|---|---|---|---|---|---|---|
| (A) Dyer et al. (2000) | Private elementary school in California | Cross‐over intervention | Hand sanitiser given to all study children for supervised use after entering classroom, before eating, after sneezing or coughing, after using restroom | 5–12 | 1/2/5/6/8/9/ | Days of respiratory illness | Risk ratio 1.37 (0.78–2.40) | Four hundred and twenty children in 14 classes 4 weeks plus 4 weeks |
| (B) Ladegaard & Stage (1999) | Eight child day‐care centres, Denmark | Intervention trial using blocked randomisation | Training of centre personnel and distribution of t‐shirts with the imprint ‘Clean hands – yes please’ to all children. Older children were given handwashing exercises, heard a fairy tale about handwashing, coloured drawings from fairy tale, sang ‘wash your hands’ songs and received a copy of the fairy tale. Children also given material to pass on to parents about handwashing. | 0–6 | 4/5/6/8/9/ | Parents/personnel reporting of common cold/sore throat | Risk ratio 1.25 (0.81–1.92) | Four intervention centres with 212 children, four control centres with 263 children. 2 months baseline, 2 months intervention, and 2 months post‐intervention. |
| Parents/personnel reporting of bronchitis/pneumonia | Risk ratio 1.13 (0.36–3.51) | |||||||
| Parents/personnel reporting of otitis media Combined | Risk ratio 1.93 (0.69–5.41) Risk ratio 1.29 (0.90–1.84) | |||||||
| (C) Master et al. (1997) | Elementary school, MI, USA | Intervention in six classes, none in eight classes: experimental | Required to WHWS 4× a day plus after toilet | 5–12 | 1/2/5/6/8/9/ | URI days of illness | Risk ratio 1.06 (0.78–1.44) | Three hundred and five children in 14 clusters 37 days |
| (D) Niffenegger (1997) | Two childcare facilities, IN, USA | Intervention in one facility compared with none in control facility | Instructional programme on germs and WHWS for teachers and children | 3–5 | 1/4/5/8/9/ | Incidence of colds | Risk ratio 1.47 (1.01–2.13) | Twenty‐six intervention children, 12 control 70 days |
| (E) Roberts et al. (2000) | Childcare centres Australian Capital Territories | Cluster randomised‐ controlled trial | Training sessions for staff using ‘GloGerm’, visits and newsletters. Staff and child handwashing after toileting, before eating, after changing a diaper, after wiping a nose | 0–3 years | 2/5/ | Parental recall of illness symptoms over 2 weeks by telephone interview, plus illness calendars | Rate ratio compliant children 1.12 (1.03–1.22) | Eleven intervention, 12 control centres 458 children 113 677 child days |
| (F) Ryan et al. (2001) | US Navy Recruits, IL, USA | Intervention baseline and follow‐up | Directive to recruits to WHWS 5× daily, wet sinks allowed, liquid soap dispensers, monthly education and inspection | Young adults | 1/3/6/8/ | Self‐reporting of respiratory infection | Rate ratio 1.80 (1.78–1.82) | A total of 44797 recruits in pre‐intervention year – 45714 (average) in 2 years post‐intervention |
| (G) White et al. 2001 | One private and two elementary schools, CA, USA | Double‐blind placebo controlled | Hand sanitiser, placebo without active ingredients upon entering classroom, before and after eating, before leaving class | 5–12 | 1/2/4/6/7/8/9/ | Days of illness with respiratory symptoms | Risk ratio 1.34 (0.96–1.89) | Thirty‐two classes 769 children 5 weeks |
| (H) White et al. (2003) | Student residence halls, CO, USA | Intervention in two halls, not in two controls | Gel dispensers installed in rooms and public places of intervention halls plus handwashing campaign | Students | 1/2/5/6/7/8/9/ | Weekly self‐report of symptoms | Risk ratio 1.25 (1.14–1.37) | Four residence halls 430 students 8 weeks |
*Methodological shortcomings of studies: 1/intervention not randomised, 2/baseline incidences not given, 3/no concurrent control group, 4/unsatisfactory case definition, 5/no placebo intervention, 6/impact on behaviour not assessed, 7/high loss to follow‐up, 8/no correction for repeated episodes and 9/no control for clustering.
WHWS, wash hands with soap; URI, upper respiratory tract infection; RR, relative risk.