1. Description of interventions in included studies, using the items from the Template for Intervention Description and Replication (TIDieR) checklist.
| Author, year | Brief name | Recipient | Why | What (materials) | What (procedures) | Who provided | How | Where | When and how much | Tailoring | Modification of intervention throughout trial | Strategies to improve or maintain intervention fidelity | Extent of intervention fidelity |
| Masks compared to either no masks or different mask types | |||||||||||||
|
Abaluck 2022 (additional sources: Abaluck 2021a, Abaluck 2021b, Kwong 2021) |
Community‐level mask promotion and distribution of free masks. A. Cloth masks or B. Surgical masks with possible additional village level elements: i) incentive ii) signage iii) text message reminder and household elements: i) altruism or self‐protection messages ii) amount of households receiving texts iii) commitment to mask‐wearing |
Leaders and adult householders of rural and peri‐urban villages | Increase large‐scale adoption and proper wearing of face masks to slow the spread of COVID‐19 and save lives informed by research in public health, psychology, economics, marketing, and other social sciences on product promotion and dissemination strategies | Masks colour‐coded by households, either: A. cloth masks: an exterior layer of 100% non‐woven polypropylene (70 grams/m2 [gsm]), 2 interior layers of 60% cotton/40% polyester interlocking knit (190 gsm), an elastic loop that goes around the head above and below the ears, and a nose bridge; filtration efficiency: 37%[1] B. 3 layers of 100% non woven polypropylene[2], elastic ear loops, and a nose bridge; filtration efficiency: 95%. Sticker that had a logo of a mask with an outline of the Bangladeshi flag and a phrase in Bengali that noted the mask could be washed and reused[3]; filtration efficiency of 76% Initial 3 masks per household Video of notable public figures[4] discussing why, how, and when to wear a mask Brochure based on WHO materials depicting proper mask‐wearing Scripted speeches for use by role models and local leaders at Friday prayers Scripted text messages Monetary rewards (USD 190) or non‐monetary reward (certificate) for villages Signage for household doors declaring they are a mask‐wearing household Smart phone for delivery and receipt of text message reminders Loudspeaker for announcements in markets by research staff Masks woven by and procured from local Bangladeshi garment factories within 6 weeks after ordering: $0.50 per cloth mask and $0.13 per surgical mask Masks and hand sanitiser for staff delivering intervention Costs: Cloth masks: $275.10/village Surgical masks: $88.90/village PPE for staff: $70/village Media costs: $100/village Transport and other costs: $30/village Handouts and written and some audio scripts for role models, leaders, surveillance officers and texts etc provided by the research team and in online protocol supplement via osf.io/23mws/ |
All villages: 1. household distribution of surgical or cloth masks and showing of mask‐wearing video; 2. distribution and promotion of masks at village markets; 3. mask distribution at mosques; 4. mask promotion in public spaces; 5. role modelling and advocacy by local leaders, including Imams during Friday prayers using a scripted speech. Periodic monitoring of passers‐by and reminding people to put on masks Some villages: village police accompanying mask promoters, providing monetary rewards or certificates to villages if mask‐wearing rate improves. Some villages: public signalling of mask‐wearing via signage, text message reminders, messaging emphasizing either altruistic or self‐protection motives for mask‐wearing, and extracting verbal commitments from households. Modelling of safe mask wearing by study staff Detailed procedures outlined in online protocol supplement osf.io/23mws/ |
Local NGO staff and volunteers (Bangladeshi NGO GreenVoice)[5] and Innovations for Poverty Action (IPA) Village Imams and police officers No “specialized skills” needed as intervention designed to be easily adopted by other NGOs or agencies Training of staff provided by researchers for mask promotion |
Masks and promotion delivered face to face in households, markets, mosques and streets of villages both as groups and individually Text messages delivered by phone and individually |
Households, markets, mosques and streets of 572 villages (in rural Bangladesh) | 8 weeks per village rolled out over a 6 week period (November 2020 to January 2021) 1 day of training per village Once off mask distribution and promotion at households (4 days / village) Mask distribution 3 to 6 days / week at markets and on 3 Fridays at mosques during the first 4 weeks Weekly or biweekly mask promotion Role‐modelling and leader advocacy at Friday prayers Periodic monitoring: 1/week on weeks 1, 2, 4, 6, 8, and 10; daily schedule provided in Protocol – 1 hour per site for 9 sites 8am to 5pm Each village observed on 2 alternating days of the week. Observations occurred 7 days of the week (9 am to 7 pm) Detailed schedules provided in online protocol supplement via osf.io/23mws/ |
Periodic monitoring and then additional training of staff provided as needed Different locations and timing of observation across different days |
In the first 5 weeks of the study staff found low engagement in some villages with local mask use, so mask promotion staff were retrained by researcher part‐way through the intervention “to work more closely with local leaders and set specific milestones for that partnership” After 5 weeks, monitoring of mask‐wearing was limited to those who appeared to be 18 years or older. |
Numbers of masks distributed was noted Promoters periodically monitored passers‐by and reminded people to put on masks Direct surveillance of mask wearing, correct mask‐wearing (wearing either a project mask or an alternative face‐covering over the mouth and nose) and physical distancing (if s/he was at least one arm’s length away from the nearest person)[6] Monetary rewards or certificates to villages if mask‐wearing rate improved Additional training for mask promotion staff Recording of activities undertaken by intervention staff including the degree to which leaders or imams understood the script, sites observed etc (see p.9 of Protocol osf.io/23mws/) “consistent with the WHO guideline that defines physical distancing as one meter of separation.” www.who.int/westernpacific/emergencies/covid-19/information/physical-distancing (accessed 13 June 2022). |
Numbers of masks distributed: A. 370,643 B. 924,849 Mask‐wearing: IGs: 42.3% CG: 13.3% Increase was largest in mosques (37% points) and 25% to 29% points in other locations Proper mask‐wearing increased by 29.0% Physical distancing increased from 24.1% in CG villages to 29.2% in IG villages No difference between IGs and CGs in number of people observed in public areas, as an indication of social distancing. |
| Alfelali 2020 | Face masks | Hajj pilgrims aged ≥ 18 years | Prevent and control viral respiratory infections at mass gatherings | 50 surgical face masks per participant (3M™ Standard Tie‐On surgical mask, Cat No: 1816) Written instructions for mask use (See S1 Appendix) |
Provide masks and verbal and printed instructions, rules for mask use and demonstration of appropriate mask usage provided (See S1 Appendix) Rules for mask use: • ”Try to avoid touching the front of the mask. • Change your mask if it is damp, wet or dirty. • Always clean your hands before and after changing the masks. • Put used masks in a plastic bag and throw it into a rubbish bin. You will find bins somewhere close to your tent in Mina.” |
464 volunteer trained research team members approached pilgrims in their tents Training included how to approach pilgrims and explanation and demonstration of mask use |
Individually and face to face to groups of pilgrims in tents | Tents of pilgrims for Hajj in Makkah (Saudi Arabia) 50 to 150 pilgrims per large tent, sleeping head‐to‐head and sharing meals and rites |
Mask wearing for 24 hours if possible, over days of Hajj season inside and outside assigned tents 3 consecutive Hajj seasons (5 to 6 days, October 2013 to 2015) |
Written information provided in preferred language (Arabic or English) Pilgrims who used at least 1 mask each day were considered to have used the mask during that day (i.e. could be < 24 hours) |
None described | 4 day diaries of mask use: number of masks used and hours worn each day (see S1 Appendix) | Mask use: IG: Daily: 24.7% Intermittently: 47.7% None: 20.9% CG: Daily: 14.3% Intermittently: 34.9% None: 43.7% Mask use of at least 4 hours consistently greater in IG than CG |
|
Barasheed 2014 |
Supervised mask use | Religious pilgrims ≥ 15 years | Prevent respiratory virus infections at mass gatherings through mask use | Plain surgical face masks (3M Standard Tie‐On Surgical Mask, Cat No: 1816) manufactured by 3M company, USA; 5 masks per day Written instructions on face mask use Special polythene bags for disposal | Masks provided to index case and their contacts with advice on mask use (before prayers, in seminars, and after meals). Written instructions provided on face mask use, need to change them, and disposal. | Not described, presumably the medical researchers | Face‐to‐face provision of masks, instructions, and reminders | Tents of pilgrimage site (Mina Valley, Saudi Arabia) | Advice on mask use given throughout pilgrimage stay (5 days) | None reported. | None reported. | The medical researchers followed pilgrims each day to remind participants about recording their mask usage in health diary. | Face mask use: mask group: 56/75 (76%), control group: 11/89 (12%) (P < 0.001) 76% of intervention tents wore masks. 10 of 75 (13%) pilgrims in ‘mask’ tents wore face masks during sleep. |
|
Bundgaard 2021 (additional source Bundgaard 2020) |
Face masks (surgical) | Community‐dwelling adults aged 18 years or older with internet access | Reduce wearers' risk for SARS‐CoV‐2 infection outside the home through protection of the nose and mouth from droplets or aerosols or contaminated fingers and hands |
Per participant: 50 x 3‐layer, disposable, surgical face masks with ear loops (TYPE II EN 14683 (Abena, Denmark); filtration rate, 98%; made in China) 1 badge (saying: “I am testing face masks – for you and me”) Written instructions and instructional videos for proper use of masks (See supplement 8) of published paper including link to video for proper face mask use [in Danish] vimeo.com/406952695 |
Supply of masks sent to home address by courier Provision of written instructions sent by courier about how and when to wear masks including links to instructional video for face mask use Instruction to follow advice of local health authorities (in Denmark) Provision of follow‐up support by email and a phone help‐line for questions |
Researchers provided the masks (funded by Salling Group), instructions and follow‐up support Background and training of researcher not described Hotline provided medical expertise and guidance, (qualification and training needed for this support not specified) |
Individually by mail, email, online and telephone | Mask wearing: when outside the home ‐ and in the home when they had guests (in Denmark) Instructions and support at home and online |
Mask wearing: whenever outside the home or when guests in the home, up to 8 hours for 1 mask, for 1 month (April to May 2020) 1 off instructions for mask use and again as needed Weekly follow‐up emails Hotline available at all times during study period |
Changing of mask if worn for more than 8 hours If guests in the home, wear mask Individualised support as needed via email or telephone |
None described | Face mask adherence: Self‐report (Yes / Partial / No) (Suppl 4) Average mask use per day Self‐assessed adherence with health authority guideline on social distancing and hygiene (Suppl) |
Face mask adherence: % Adhere: 46% Partial: 47% No: 7% Mean face masks used: Weekdays: 1.7 Weekends: 1.3 Health authority guidance adherence not reported |
| Canini 2010 | Surgical face masks | Householders (over 5 years) | Limit transmission of influenza transmission by large droplets produced during coughing in households | Initial supply of 30 masks: for adults and children > 10: surgery masks with ear loops, 3 plys, anti fog (AEROKYN, LCH medical products, Paris, France) Children 5 to 10: face mask KC47127, (Kimberly‐Clark, Dallas, TX, USA) Closed plastic bags for disposal | Masks given immediately on home visit by attending general practitioner with demonstration of proper use and instruction to be worn for 5 days in presence of another household member or in confined space (e.g. car) and to change every 3 hours or if damaged. | General practitioners | Face‐to‐face individually | Households in France | One‐off provision of masks worn for 5 days | None described. | None described. | Not described, but reported mask usage was measured | 34/51 (66%) wore masks > 80% of the duration. Reported mask‐wearing: 11 ± 7.2 masks during 4.0 ± 1.6 days with an average use of 2.5 ± 1.3 masks per day and duration of use of 3.7 ± 2.7 hours/day |
| Jacobs 2009 | Face masks | Hospital healthcare providers (nurses, doctors, and co‐medical personnel) | Decrease risk of infection through limiting droplet spread through masks | Hospital‐standard disposable surgical Mask MA‐3 (Ozu Sangyo, Tokyo, Japan); quantity not specified | Provision of masks and instructions for use | Not described, presumably research team | Face‐to‐face | Tertiary care hospital in Tokyo, Japan Face masks worn whilst on hospital property. | 77 days | None described. | None described. | Self‐reported adherence | Self‐reported adherence for both groups reported as good, with full adherence by 84.3% and remainder complying 79.2% to 98.7%. |
| Loeb 2009 | 2 active interventions A. surgical masks B. N95 respirators | Healthcare workers (nurses) | Reduce transmission of influenza in healthcare settings through coughing or sneezing with protective masks | A. Surgical masks B. N95 respirators | Provision of masks or N95 respirators Instruction in use and proper placement of devices Fit‐testing and demonstration of positioning of N95 using standard protocol and procedure (details provided) Qualitative fit‐testing using saccharin or Bitrex protocol[7] | Provided by research team (not further described) Fit‐testing by technician for N95 | In‐person face‐to‐face | Tertiary hospitals in Ontario, Canada | 1 influenza season (12 weeks) Use of mask as required[8] when providing care to or within 1 m of patient with febrile respiratory illness, ≥ 38 °C, and new or worsening cough or shortness of breath Nurses to wear N95 when caring for patients with “febrile respiratory illness” | Fit‐testing of nurses not already fit‐tested | Ceased before end of season | Adherence audits during peak of season by trained auditor who stood short distance from patient isolation room | 18 episodes: N95: 6/7 participants (85.7%) wearing assigned device versus 100% for masks |
| MacIntyre 2009 | 2 active interventions in addition to infection control guidelines A. Surgical masks (SM) B. P2 masks (P2) | Householders with a child with fever and respiratory symptoms | Prevent or reduce respiratory virus transmission in the community through non‐pharmaceutical interventions | A. 3M surgical mask, catalogue no. 1820; St Paul, MN, USA for adults B. P2 masks (3M flat‐fold P2 mask, catalogue no. 9320; Bracknell, Berkshire, UK) A and B: health guidelines and pamphlets about infection control | Provision of masks and pamphlets and education about infection prevention and mask use Telephone calls and exit interviews to record adherence to mask use All groups: health guidelines, pamphlets about infection control were provided | Not described, presumably research team | Face‐to‐face and by telephone | Households in Sydney, Australia | 2 winter seasons (3 months and 6 months) 2 weeks of follow‐up Masks to be worn at all times when in same room as index child, regardless of distance from child | None described. | None described. | Daily telephone calls to record mask use throughout day Exit interviews about adherence | Reported mask use:
Day 1
SM: 36/94 (38%)
P2: 42/92 (46%) stated wearing “most or all” of the time. Other participants were wearing face masks rarely or never.
Day 5: SM: 29/94 (31%) P2: 23/92 (25%) |
| MacIntyre 2011 | 3 active interventions A. Medical masks B. N95 respirators fit‐tested C. N95 respirators non‐fit‐tested | Healthcare workers | Protect HCWs by preventing transmission of influenza and other respiratory viruses from patients through mask wearing | Daily supply of A. 3 medical masks (3M medical mask, catalogue number 1820, St Paul, MN, USA) 2 respirators: B. N95 fit‐tested mask (3M flat‐fold N95 respirator, catalogue number 9132) fit‐tested with 3M FT‐30 Bitrex Fit Test kit according to manufacturer's instructions (3M, St Paul, MN, USA) C. N95 non‐fit‐tested mask (3M flat‐fold N95 respirator, catalogue number 9132) Diary cards for usage recording | Supply of masks or respirators. Instruction in when to wear it, correct fitting, and storage (in paper bag in personal locker) Instruction in importance of hand hygiene before and after removal For fit‐tested group: fit‐testing procedure | Masks provided to hospitals. Training of staff provided by 1 member of research team. | Masks and training provided face‐to‐face, not described if training was individually or in groups. | Emergency departments and respiratory wards in hospitals in Beijing, China | Entire work shift for 4 weeks | Taken off for toilet and meal breaks and at end of shift | None described. | Mask ⁄ respirator use monitored by: (i) observed adherence by head ward nurse recorded daily; (ii) self‐report diary cards carried during day recording; (i) no. hours; (ii) usage. Exit interviews | Adherence for usage was high for all and not significantly different amongst arms. Medical mask: 76%, 5 hours N95 fit‐tested: 74%, 5.2 hours N95 non‐fit‐tested: 68%, 4.9 hours |
| MacIntyre 2013 | 3 active interventions A. N95 respirators at all times B. N95 respirators targeted use C. Medical masks | Healthcare workers (nurses and doctors) | Protect HCWs from respiratory infections from patients through mask use | Daily supply of: A. and B. 2 respirators (3M Health Care N95 Particulate Respirator; catalogue number 1860) 3M FT‐30 Bitrex Fit Test Kit C. 3 masks 3 masks (3M Standard Tie‐On Surgical Mask catalogue number mask 1817; 3M, St Paul, MN, USA) Pocket‐sized diary card with tick boxes for mask use | Supply of respirators Instructions in use including times and fit Fit‐testing procedure according to the manufacturer’s instructions (3M) For targeted N95: checklist of defined high‐risk procedures, including common aerosol‐generating procedures | 3M supplied respirators and masks. Provider of instructions not specified. | Masks and training provided face‐to‐face, not described if training was individually or in groups. | Emergency departments and respiratory wards of tertiary hospitals in Beijing, China | For 4 weeks, A and B worn at all times on shift; B. targeted (intermittent) use of N95 respirators only whilst performing high‐risk procedures or barrier. | None described. | None described. | Self‐reported daily record of number of hours worked, mask or respirator use, number of high‐risk procedures undertaken collected by study staff. | Adherence highest for targeted N95 (82%; 422/516) versus N95 (57%; 333/581) versus medical mask (66%; 380/572). |
| MacIntyre 2015 | 2 active interventions A. Cloth masks B. Medical masks | Hospital healthcare workers | Prevent respiratory infections in HCWs from patients through mask‐wearing | A. 5 cloth masks for study duration (2‐ layer, cotton) B. 2 medical masks daily for each 8‐hour shift for study duration (3 layers, non‐woven material) All masks locally manufactured. Written instructions on cleaning cloth masks | Cloth or medical masks to be worn at all times on shift. Cloth masks to be washed with soap and water daily after shifts, and the process of cleaning to be documented. Provision of written instructions for cloth mask cleaning | Researchers arranged supply of masks and instructions and any training of staff assisting the delivery. | Masks and written instructions provided face‐to‐face. | Hospital wards in Vietnam | 4 weeks (25 days) of face mask use | Masks not worn while in the toilet or during tea or lunch breaks. | None described. | Monitored adherence with mask use by self‐report diary card and exit survey and interviews with a sub‐sample (ACTRN12610000887077) | Mask‐wearing adherence: cloth mask: 56.8% medical mask: 56.6% Reported cloth mask washing: 23/25 days (92%) |
| MacIntyre 2016 | Medical mask use | Sick householders with ILI (index cases) and their well contacts of the same household | Protect well people in the community from transmission of respiratory pathogens by contacts with ILI through mask use | 21 medical masks (3M 1817 surgical mask) Diary cards for mask use | Supply of masks Instructions for mask wearing and hand‐washing protocol Provision of diary cards | Study staff member provided masks and instructions in use. | Masks and instructions provided face‐to‐face and individually. | Fever clinics of major hospitals in Beijing, China | 3 masks/day for 21 days Mask wearing: whenever in the same room as a household member or a visitor to the household Hand‐washing: before putting on and after taking off | Allowed to remove their masks during mealtimes and whilst asleep and to cease wearing once symptoms resolved | None reported. | Self‐reported daily record of mask use using diary card | Mask use: mask group: 4.4 hours; control group: 1.4 hours |
| Radonovich 2019 | 2 active interventions A. N95 respirators (N95) B. Medical masks (MM) | Healthcare personnel of outpatient sites within medical centres | Prevent HCP from acquiring workplace viral respiratory infections and transmitting them to others by effective respiratory protection by N95 respirators which reduce aerosol exposure and inhalation of small airborne particles, meet filtration requirements, and fit tightly | A. N95 respirators: 3M Corporation 1860, 1860S, and 1870 (St Paul, MN, USA) or Kimberly Clark Technol Fluidshield PFR95‐270, PFR95‐274 (Dallas, TX, USA) B. Medical mask Precept 15320 (Arden, NC, USA) or Kimberly Clark Technol Fluidshield 47107 (Dallas, TX, USA). Reminder signs posted at each site A portable computer equipped with data recording software (HandyAudit; Toronto, Canada) to document adherence (Radonovich 2016) | Participants instructed to wear assigned protective devices whenever they were positioned within 6 feet (1.83 m) of patients with suspected or confirmed respiratory illness and to don a new N95/MM with each patient interaction. Hand hygiene recommended to all participants in accordance with Centers for Disease Control and Prevention guidelines. Infection prevention policies were followed at each study site. Reminder signs posted at sites and emails sent. Annual fit‐testing conducted for all participants. Filtration testing performed on the device models in the study. Further details in protocol (Radonovich 2016). | Centres provided device supplied by study to HCP. Study personnel posted reminder signs and emails and conducted adherence observations. | Face‐to‐face individual provision of devices and adherence observations Onsite posting of signs Other reminders by email | Outpatient sites within medical centres in USA | As instructed, for each new patient interaction during 12‐week period of peak viral respiratory illness each year for 4 years (total of 48 weeks) | Fitting of N95 masks | None described. | Reminder signage posted at study sites, and emails sent by study personnel. Self‐reported daily device wearing of “always”, “sometimes”, “never”, or “did not recall" Observation of device‐wearing behaviours as participants entered and exited care rooms conducted during unannounced, inconspicuous visits to randomly selected sites documented on portable computer | Device wearing: N95: 89.4% reported “always” or “sometimes” versus MM: 90.2% “Never” N95: 10.2% MM: 9.5% |
| Hand hygiene | |||||||||||||
| Alzaher 2018 | Hand hygiene workshop | Primary school girls | Targeted school children to improve hand hygiene to reduce school absences due to upper respiratory infection and spread of infection in schools and to families | 6‐minute video‐clip of 2 siblings that attended school‐based health education about hand hygiene Short interactive lecture about: common infections in schools, methods of transmission, hand‐washing procedure using soap and water including when to wash hands Puzzle games related to hand hygiene Posters with cartoon princesses’ picture promoting hand‐washing |
Delivery of workshop and distribution of supporting materials (games and posters) to school and students | Study investigator delivered workshop. | Delivered face‐to‐face in group format for the workshop |
2 primary girls’ schools in Saudi Arabia | 1‐hour once‐off workshop; posters and games provided to school | Not described | Not described | Posters in restrooms as reminders of hand‐washing hygiene during 5‐week follow‐up period after workshop | Not reported |
| Arbogast 2016 | Multimodal hand hygiene intervention programme in addition to control of brief video | Office buildings and the employees of health insurance company | Reduce hand‐to‐mouth germ transmission from shared workspaces and workplace facilities and thereby healthcare claims and absenteeism through improved workplace hand hygiene | Alcohol‐based hand sanitiser (PURELL Advanced, GOJO Industries Inc, Akron, OH, USA) installed as wall‐mounted dispensers, stands, or free‐standing bottles One 8‐ounce bottle of hand sanitiser (PURELL Advanced) per cubicle One 100‐count canister of hand wipes (PURELL Wipes) per cubicle Replenishment products stored in supply room (in addition to existing foam hand wash (GOJO Green Certified Foam Handwash) and an alcohol‐based hand sanitiser foam wall‐mounted dispenser (PURELL, GOJO Industries) already provided near the restroom exits prior to intervention) Identical soap in all restrooms Intervention and control group: brief (< 1‐minute educational video) about proper hand hygiene technique, for both washing and sanitising hands ‘‘Wash Your Hands’’, signage promoting hand hygiene adherence, was already posted next to restroom exits at both the control and intervention sites. |
Hand hygiene supplies installed in offices. Replenishment product was made easily available to individual employees upon request via a simple process. Monitoring of product shipments into sites Physical collection and full replacement of soap, sanitiser, and wipes Intervention and control group: educational video embedded at end of baseline online knowledge survey |
Not described, presumably study investigators arranged installations | Hand hygiene supplies provided in office environments and individually at staff cubicles/offices. Video provided individually via email. |
High‐traffic common areas of 2 US health insurance company offices (e.g. near elevators, at entrances) and appropriate public spaces (e.g. coffee area, break rooms, conference rooms, training rooms, lobbies, reception areas); individual staff cubicles of mostly open plan offices (average 309 square feet). Office restrooms |
13.5 months overall One‐off email video 11 days before study hand hygiene supplies installed. 13 months of provision of supplies 2 times evening collection and full replacement of products |
Sanitiser installed in high‐use areas of the offices. | Not described | Employee survey at 4 months included questions about hand hygiene practice adherence. Monitoring of product shipments into the sites and physical collection of the soap, sanitiser, and wipes products 2 times in the study; collected samples were measured and usage rates were estimated |
Intervention group employees: reported 40% more cleaning of work area regularly; significantly more likely to keep the hand sanitiser with them and use it throughout the day; significant increases in hand sanitiser use for at‐risk activities[9] Estimated use by average employee from sample collection: sanitiser 1.8 to 3.0 times/day, soap 2.1 to 4.4 times/day, wipes at their desk 1.4 to 1.5 times/week |
| Azor‐Martinez 2016 | Hand‐washing programme | Primary school children and their parents and teachers | Prevent transmission of upper respiratory infections in schools and to families through non‐pharmaceutical intervention of hand‐washing programme in schools |
Brochure about hand‐washing awareness and habits Workshop content materials Stories, songs, and classroom posters about hand hygiene and infection transmission Hand sanitiser (ALCO ALOE GEL hand sanitiser by Americo Govantes Burguete, S.L. Madrid, Spain containing 0.2% chlorhexidine digluconate, 1% phenoxyethanol, 0.1% benzalkonium chloride, 5% aloe barbadensis, 70% denat ethyl alcohol, excipients quantity sufficient for 100 mL alcohol 70%, pH 7.0 to 7.5) Informational poster about when and how to wash hands Written and verbal guidance to teachers, parents, and students on properties, possible side effects, and precautionary measures for gel use and storage |
Brochure sent to parents by mail with study information sheet. Workshop provided for pupils and teachers: frequent infections in schools, transmission and prevention, instructions on correct hand‐washing (water and soap, soaping > 20 s, drying hands), use of hand sanitisers and possible side effects Classroom activities linked to hand hygiene and infection transmission Reinforcement of hand hygiene by teachers Hand sanitiser dispensers fixed to walls with an informational poster about hand‐washing Supervision of younger children when using hand sanitiser and administration of sanitiser if needed Instruction of children in hand‐washing procedures after toilet and when dirty and correct hand sanitiser use[10] |
Brochure sent by school administration. Workshop and verbal and written information presumably provided by the study research assistant. Classroom activities provided by research assistant and teachers. Supervision and administration of hand sanitiser for younger children by teachers |
Brochure sent by mail to individual parents. Workshops and classroom activities delivered in groups face‐to‐face. Teacher reinforcement of hand hygiene provided to class face‐to‐face. Hand sanitiser use supervision was provided individually and face‐to‐face. |
Primary school classes in Spain (details not provided) | 8 months overall One‐off brochure and installation of hand sanitiser dispensers 2‐hour workshop held 1 month before study commencement Fortnightly classroom activities As required, teacher supervision and administration of hand sanitiser Daily reinforcement of hand hygiene by teachers |
Supervision and administration of hand sanitiser as needed by teachers, especially for younger children | Not described | Daily reinforcement by teachers of hand hygiene Fortnightly support by research assistant promoting hand‐washing Self‐reported correct hand‐washing procedure (water and soap, soaping > than 20 s, drying hands) |
Self‐reported correct hand‐washing included in analysis but not separately reported. |
| Azor‐Martinez 2018 | Educational and hand hygiene programme 2 active interventions: A. soap and water B. hand sanitiser |
Day care centres and their attending children, their parents, and DCC staff | Prevent transmission of respiratory infections by improved hand hygiene of children, parents, and staff through hand‐washing practices and use of hand sanitiser due to its bactericide and virucide properties | A. Liquid soap (no specific antibacterial components (pH = 5.5)) OR B. Hand sanitiser (70% ethyl alcohol (pH = 7.0 to 7.5)) for home use and in dispensers for school classroom Workshop content handout Stories, songs, and posters about hand hygiene and infection transmission |
Installation of liquid soap or hand sanitiser dispensers in classrooms Supervision and administration of hand sanitiser if required 3 hand hygiene workshops for parents and DCC staff: 1. Hand‐washing practices, hand sanitiser use, possible side effects and precautionary measures (HSG only) 2. RIs and their treatments 3. Fever Instructions to children, parents, and DCC staff on usual hand‐washing practices and protocol[11] Classroom activities (stories and songs) about hand hygiene and infection transmission |
Workshop delivered by researchers. Research assistant provided hand hygiene materials to DCCs and parents. Parents and staff supervised and administered sanitiser where indicated. |
Workshops delivered face‐to‐face in groups to parents and staff. Workshop content emailed to attendees individually. Individual face‐to‐face supervision of hand sanitiser use, as indicated |
Classroom of DCCs (in Spain) for child interventions Workshops provided at DCCs. |
8 months overall Initial 1‐hour workshop 1 month before study commencement 3 further identical sessions/DCC provided again 1 month apart Fortnightly classrooms and DCC activities One‐off installation of dispensers As‐needed supervision of hand sanitiser use Dose of sanitiser: 1 to 2 mL/disinfection |
Administration of hand sanitiser in the case of young children DCC staff could attend training at other DCC if unable to attend at own DCC. |
Not described | Not described Reported that no monitoring of adherence through continuous observation of hand hygiene behaviours was done, but amount of hand sanitiser was measured |
Families or DCC staff, or both, used 1660 L of hand sanitiser, estimated use by each child of dose 6 to 8 times/day. |
| Biswas 2019 | Hand sanitiser and respiratory hygiene education | Primary schools and their students and staff | Reduce community‐wide influenza virus transmission by improving hand‐washing and respiratory hygiene and use of sanitiser in schoolchildren as contributors to community‐wide virus transmission | Hand sanitiser (63% ethyl alcohol) in colourless, transparent 1.5‐litre local plastic bottles (manufactured by a local pharmaceutical company and was available commercially in Bangladesh (price: USD 5.75/L)) Video clip on respiratory hygiene practices Behavioural change materials – 3 colour posters (see Appendix of paper) Curriculum materials for hygiene classes |
Installation of hand sanitiser in wall dispensers in all classrooms and outside all toilets, refilled by field staff as needed Encouragement of use of sanitiser at 5 key times during the day[12] Hand and respiratory hygiene education provided.[13] Integration of hygiene messages into school’s hygiene curriculum Delivery of video clip on respiratory hygiene practice Behaviour change materials distributed and placed around schools. Use of sanitiser by classroom teachers after training Training of selected teachers in consultation with head of school and management committee in key messages Communication of key messages by the selected teachers to other teachers |
Selected teachers responsible for dissemination of intervention messages throughout were trained over 2 days in these messages, behaviour change communication, sanitiser use, and practices for preventing spread of respiratory secretions. Classroom teachers conveyed intervention messages during regular hygiene classes. Field staff replaced supplies as needed. |
Hand sanitiser and education materials provided to schools. Education provided in classrooms in groups and face‐to‐face. |
Primary schools (in Bangladesh) Sanitiser in each classroom and outside toilets Education in classroom |
10 weeks Intervention messages conveyed in classrooms 3 times/week. |
Refills provided as needed. | Not described | Structured field observation by 2 field staff of 5 hours/school observing hand‐washing and respiratory hygiene behaviours of children at 2 different locations in a classroom or outside Every other day, field staff measured the level of hand sanitiser in the morning and in the afternoon to calculate amount of hand sanitiser used/day/school and enrolled children. |
Hand‐washing observed opportunities: IG 604/921 (66%) versus CG 171/802 (21%) Hand sanitiser used in 91% of observed hand‐washing events in intervention schools. Average consumption of hand sanitiser/child/day: 4.3 mL Observation of proper cough or sneeze etiquette: IG: 33% versus CG: 2% |
|
Correa 2012 |
Alcohol‐based hand rubs | Childcare centres and their staff and children | Reduce incidence and transmission of infection in children by improved hand hygiene where water is scarce including provision of ABH and training in hand hygiene teaching techniques | Dispensers of alcohol‐based hand rubs with ethanol 62.0% (PURELL, GOJO Industries, Akron, OH, USA) Workshop materials[14] Visual reminders on ABH techniques in bathrooms and next to dispensers |
ABH and training on proper use to staff and children Pre‐trial ABH use workshop to teachers that followed recommended HH teaching techniques and instructed teachers to add ABH to routine HH and give preference to hand‐washing with soap and water if hands visibly soiled Continuous refilling of ABH ABH technique refresher workshops (8/centre) Monitoring of safety, proper use of ABH, amount of ABH used |
Local representative of GOJO Industries Inc. provided dispensers and dispenser installations free of charge. Fieldwork team delivered other components. |
Face‐to‐face training and provision of materials; group training | Childcare centres in Colombia (centres or community homes) ABH in centres, classrooms, and common areas depending on size Visual reminders in bathrooms and next to dispensers Workshops and training presumably provided in centres. |
8 months overall 1 ABH dispenser per centre with < 14 children; 1 per classroom in larger centres; 1 per classroom + 1 for common areas in centres with > 28 children 1 workshop pre‐trial to staff Monthly 30‐minute ABH technique refresher training (8 per centre) Biweekly monitoring |
Refilled ABH as needed | Not described | Visual reminders and monthly refresher training Monitoring of safety, proper use of ABH, amount of ABH used Semi‐structured survey on completion of teachers' perceptions about changes in HH practices and use of HSW and ABH. Measurement of consumption of resources and costs related to ABH use and HSW |
Teachers at 7 intervention centres reported almost complete substitution of HSW with ABH, and HSW decreased from 3 times per day to 1 per day, and ABH rose to 6 per day. Teachers at remaining 14 centres reported partial substitution of HSW with ABH. Controls reported HSW 3 times per day. Median number of ABH applications per child rose from 3.5 to 4.5 in preschools and 3.5 to 5.5 in community centres. |
| DiVita 2011 | Household hand‐washing promotion | Householders with index patient with ILI | Prevent influenza transmission in households in resource‐poor settings through provision of hand‐washing facilities and use of them at critical times for pathogen transmission | Hand‐washing stations with soap |
Provision of hand‐washing stations Hand‐washing motivation to wash at critical times for pathogen transmission (e.g. after coughing or sneezing) |
Not specifically described, presumably the researchers | Face‐to‐face provision of facilities in households "Motivation" not described |
Household in Bangladesh | Over 2 influenza seasons One‐off provision of hand‐washing facilities Frequency of “motivation” not described |
Not described | Not described | Not described | Not described |
| Feldman 2016 | 2 active interventions
A. Hand disinfection with chlorhexidine gluconate + hygiene education B. Hygiene education |
Naval ships and their sailors | Reduced infection transmission and improved hand hygiene in sailors who are at increased risk due to closed environments, contact with shared surfaces, and poor HH culture | Septadine solution (Floris, Misgav, Israel) 70% alcohol and 0.5% CHG; inactive materials: purified water, glycerin, propylene glycol, and methylene blue |
Installation of CHG disinfection devices on ships alongside regular soap and water Supply and replenishment of CHG (sent to ships regardless of replenishment demands) Hygiene instruction by a naval physician (to both intervention groups and study control group) |
Provision of CHG presumably by study team and funds Hygiene instruction by naval physician |
CHG sent to ships directly. Mode of hygiene instruction not described. |
Navy fast missile boats and patrol boats of naval base in Israel Dispensers installed in key locations onboard (adjacent to heads (toilets), mess decks (dining rooms), common areas). |
4 months Unlimited supply of CHG replenished on demand for 4 to 5 months. Automatic amount dispensed: 3 mL |
CHG replenished on demand. | Not described | Total amount of CHG dispensed was tallied. | Mean volume CHG: 8.2 mL per sailor per day (projected yearly cost USD 45 per sailor) |
|
Gwaltney 1980 |
A. Virucidal hand preparation
B. Placebo (no control) |
Healthy young adults | Reduce infection rates by interrupting viral spread by hand or self‐inoculation route | A. Virucidal hand preparation: aqueous iodine (2% iodine and 4% potassium iodide) B. Placebo: aqueous solution of food colours (Kroger; Kroger Co., Cincinnati, OH, USA) mixed to resemble the colour of iodine with 0.01% iodine and 0.02% potassium iodide to give an odour of iodine Masks |
Immersion of each finger and thumb of both hands to proximal interphalangeal joint (interphalangeal joint of thumb) into designated preparation for 5 seconds then air‐dried for 5 to 6 min Exposure of recipients to donors either immediately after treatment or after 2‐hour delay by hand contact with donor stroking fingers for 10 s Masks worn by donors and recipients during procedure. Recipients placed in single isolation rooms after second exposure till end of experiment. |
Researchers | Face‐to‐face and individually | US university | Exposure to donors on 3 consecutive days (days 2, 3, and 4) after initial exposure | Not described | Not described | Reported knowledge of hand preparation use as active, placebo, or don't know | Active (n = 24): 6 active 2 placebo 16 don't know Placebo (n = 22): 6 active 7 placebo 9 don't know |
| Hubner 2010 | Alcoholic hand disinfection | Employees (administrative officers) | Reduce absenteeism and spread of infection in administration employees with frequent customer contact and work with paper documents through improved hand hygiene | 2 alcohol‐based hand rubs (500 mL bottles) for desktop use to ensure minimal effort for use: 1. Amphisept E (Bode Chemie, Hamburg, Germany) ethanol (80% w/w) based formula with antibacterial, antifungal, and limited virus inactivating activity. 2. For participants with skin problems: Sterillium (Bode Chemie, Hamburg, Germany) 2‐propanol (45% w/w), 1‐propanol (30% w/w), and mecetronium etilsulfate (0.2% w/w), with a refatting effect and has activity against bacteria, fungi and enveloped viruses. Hand cream: Baktolan balm, water‐in‐oil emulsion with no non‐antibacterial properties (Bode Chemie, Hamburg, Germany) |
Provision of hand rub and instruction on use as needed at work only and in accordance with prevailing standard[15]: at least 5 times per day, especially after toileting, blowing nose, before eating, and after contact with ill colleagues, customers, and archive material | Presumably provided or arranged by study team | In person to staff | Administration offices in Germany Hand rubs used at desk or work (not outside of work). |
12 months overall Hand rub used as much needed for complete wetting of the hands (at least 3 mL or a palmful)[16] at least 5 times per day. |
Hand rub use especially after toileting, blowing nose, before eating, and after contact with ill colleagues, customers, and archive material | Not described | Self‐reported adherence with hand hygiene measures | Reported mean hand disinfection frequency times per day: > 5: 19% 3 to 5: 59.8% 1 to 2: 20.5% < 1: 0.7% |
|
Ladegaard 1999 (translated from Danish) |
Hand hygiene programme | Daycare centres and their staff, children, and parents of children | Reduce risk of infection in child care through increased hygienic education of daycare professionals, motivation of daycare facilities for regular hand hygiene, and informing parents about hand hygiene | Personnel guide on recommendations for: hygiene, ventilation, out‐of‐stay care, stricter hygienic regulations in cases with selected diseases Fairy tale and poster “The Princess Who Won't Wash Hands” Colouring in drawings “Wash hands” song and rhymes T‐shirt for children with the inscription “Clean hands ‐ yes thank you” Diploma for children and book “The Princess Who Won't Wash Hands” to also be used by parents with their child Informational leaflet for parents in envelope |
Staff meeting in each DCC and training in microbiological cause of infection spread guided by National Board of Health and Hygiene Education of children in hand‐washing (about bacteria and why and when to wash hands) Practical hand‐washing classes with 4 to 5 children at a time Provision of t‐shirt, book, and diploma to children Provision of leaflet for parents |
Research team presumably provided training. |
Face‐to‐face with training and activities by group with staff and children Information sent home to parents via children. |
Onsite in DCCs |
2‐month intervention period 1‐hour training of children |
None described. | None described. | None described. | None reported. |
| Little 2015 | Web‐based hand‐washing intervention | Householders (over 18) who were general practice patients | Prevent transmission of respiratory tract infections through improved hand hygiene to reduce spread via close contact (via droplets) and hand‐to‐face contact | Website‐based programme: provided information about the importance of influenza and role of hand‐washing; developed a plan to maximise intention formation for hand‐washing; reinforced helpful attitudes and norms; addressed negative beliefs (URL provided for demonstration version no longer active; see www.lifeguideonline.org) |
Provision of link to website for direct log in Automated emails prompted participants to use sessions and complete monthly questionnaires and maintain hand‐washing. |
Researchers delivered web‐based programme and emails. | Online individually | Households in England | 4 months overall 4 weekly web‐based sessions Monthly email questions to maintain hand‐washing over 4 months |
Tailored feedback provided within web programme | None described. | Emailed questions monthly to maintain hand‐washing | None reported. |
| Luby 2005 | Hand‐washing promotion at neighbourhood level with 2 interventions at household level A. Antibacterial soap B. Plain soap |
Neighbourhoods and their households | Improve hand‐washing and bathing with soap in settings where communicable diseases are leading causes of childhood morbidity and mortality | Slide shows, videotapes, and pamphlets illustrating health problems from contaminated hands and specific hand‐washing instructions Soaps: 90‐gram white bars without brand names or symbols, same smell with identical generic white wrappers with serial numbers matched to households A. Households: 2 to 4 white bars of 90‐gram antibacterial soap containing 1.2% triclocarban (Safeguard Bar Soap: Procter & Gamble Company (Cincinnati, OH, USA) B. Households: plain soap (no triclocarban) Soap packets |
Hand‐washing promotion to neighbourhoods: Neighbourhood meetings of 10 to 15 householders (mothers) from nearby homes and monthly meetings for men Soap to households Fieldworker home visits: discussed importance of and correct hand‐washing (wet hands, lather them completely with soap, rub them together for 45 seconds, and rinse off completely) technique and promote regular hand‐washing habits[17] Encouragement of daily bathing with soap and water |
Research team in collaboration with Health Oriented Preventive Education (HOPE)[18] Fieldworkers were trained in interviewing and hand‐washing promotion. |
Face‐to‐face in small groups and individually | Neighbourhoods and homes in Karachi, Pakistan | 1‐year weekly household visits 30‐ to 45‐minute neighbourhood meetings 2 to 3 times/week first 2 months then weekly for months 2 to 9, then monthly Monthly men’s meetings first 3 months Weekly household visits |
Soap replaced regularly. | None described. | None described, though soap use measured. | Households' mean use of study soap per week: 3.3 bars Average use per resident per day: 4.4 g |
| Millar 2016 additional details from Ellis 2010 | Skin and soft‐tissue infection prevention intervention in addition to SSTI brief on entry also provided to control
A. Enhanced standard B. Chlorhexidine |
Military trainees | Improve personal hygiene practices to prevent infection, especially acute respiratory infection in military trainees who are at increased risk |
A. Enhanced standard: supplemental materials (a pocket card and posters in the barracks) B. CHG: CHG‐based body wash (Hibiclens, Mölnlycke Heath Care, Norcross, GA, USA) |
Provision of education and hygiene‐based measures in addition to standard SSTI prevention brief upon entry: Enhanced standard: supplemental materials CHG: as for enhanced standard group, plus a CHG‐based body wash and instructions for use |
Not described, presumably the researchers | Face‐to‐face and individually for body wash and pocket card Mode of education not described. |
US military training base | One‐off education on entry to training CHG: use of wash 1 per week for entire training period (14 weeks) |
None described. | None described. | None described. | None described. |
|
Morton 2004 |
Healthy hands (alcohol gel as hand‐washing adjunct) |
Elementary schools and their children and staff | Prevent infections in elementary school‐age children who are particularly vulnerable through adjunct use of alcohol gel and education based on Health Belief Model (HBM) (Kirscht 1974) | Alcohol gel and dispensers: AlcoSCRUB (60% ethyl alcohol) supplied by Erie Scientific Company, Portsmouth, NH, USA ‘‘Healthy Hands Rules’’ protocol[19] (Figure 3 in paper) Healthy Hand Resource Manual for school nurse, available for parents Monthly newsletters to parents ‘‘Healthy Hands’’ refrigerator magnet for families (see Figure 2 in paper) Informational letter to local primary care providers, paediatricians, family practitioners, and advanced practice nurses “Germ Unit” curriculum and materials including Germ models and Glo Germ |
Healthy hands protocol introduced after "Germ unit" education in classes Daily reminders to children on public address system (in first week) then weekly reminders Review of protocol in each classroom after vacation by school nurse 2 classroom visits from school nurse “Healthy Hands” magnet provided to parents and guardians. “Hand Checks on Wednesdays” to identify adverse effects of gel |
Gel provided by suppliers. Research team provided educational aspects. Classroom teachers responsible for encouraging use of gel and reinforcing protocol School nurse assisted in monitoring and hand checks for adverse effects. |
Face‐to‐face training in classes and individual information giving and monitoring | Elementary schools in USA Wall‐mounted near door entrance of each classroom at age‐appropriate height |
46 days 0.5 mL dispensed per application. Use of “special soap” according to “Healthy Hands Protocol” (Figure 3 in paper) |
Reinforcement teaching provided if gel usage indicated that it was needed. Germ unit education tailored for each grade level. |
1 student was concerned gel was making her sick, so school nurse provided additional classroom visit to allay concerns. | Usage of gel calculated. | 5 gel applications per day 1 dispenser lasted 1 month. |
| Nicholson 2014 | Hand‐washing with soap |
Households with 5‐year‐olds and their mothers | Targeted 5‐year‐old children and their mothers as change agents to reduce incidence of respiratory infections (and diarrhoeal disease) through hand‐washing using behaviour change principles (Claessen 2008), including social norms for child and mother (Perkins 2003), using fear of contamination and disgust (Curtis 2001), peer pressure (Sidibe 2003), morale boosting, and networking support | Initial supply of 5 bars of free soap (90‐gram Lifebuoy bars) replenished on submission of empty wrappers. Environmental cue reminders (wall hangers, danglers) Rewards (e.g. stickers, coins, toy animals) |
Provision of soap and social marketing programme (Sidibe 2009) (Lifebuoy branding) to educate, motivate, and reward children for HWWS at key times Weeks 1 to 17: hand‐washing occasions, germ education, soap’s importance in germ removal Week 18 onward: encouragement of HWWS on 5 key occasions supported by environmental cues "Classrooms" for children Home visits for mothers Parents’ evenings to boost morale, build networks, and run competition for adherence, assignment completion, and folder decoration Establishment of a "Good Mums" club for sharing HWWS tips Rewards provided by mothers. Children encouraged to advocate HWWS within families before meals. Establishment of social norms for child and mother with pledges in front of peers |
Dedicated team of "promoters" delivered education and home visits. Mothers provided supplied rewards. |
Face‐to‐face in groups Individually by mother to child |
"Classrooms" held in community buildings Home visits of households in Mumbai, India |
41 weeks Weekly "classrooms" after school and home visits HWWS encouraged 5 key occasions: after defecation, before each of 3 meals, and during bathing. Week 18 onward: hand‐washing on 5 occasions for 10 consecutive days 6 weekly parents’ meetings |
Mothers were asked to provide and share hand‐washing tips with other mothers, competitions held for mothers. | Technical difficulties with "soap acceleration sensors" to measure HWWS behaviours prevented successful use. | Registers for "classrooms" and home visits where 3‐week gaps in attendance triggered supervisors to ask participants to resume or be withdrawn Monitoring of soap resale on open market by use of unique identifiers on soap wrappers and twice weekly checks in local shops Collection of used soap wrappers as soap consumption measure |
Soap consumption: IG versus CG: 235 g versus 45 g |
| Pandejpong 2012 | 3 active interventions (no control) different time‐interval applications of alcohol hand gel A. Every 60 min B. Every 120 min C. Once before lunch |
Preschool classes (students and teachers) and their parents | Targeted preschool children who can have high infection rates in ILI; have close interaction so at risk of airborne, droplet, and contact transmission; and are of increasingly younger ages through hand gel as a single strategy of convenient and effective disinfection |
1 container of alcohol hand gel per classroom (active ingredients: ethyl alcohol, 70%; chlorhexidine gluconate,1%; Irgasan (triclosan), 0.3%) Cost of hand gel every 60 minutes was USD 6.39 per child per 12‐week period Leaflet describing risk factors for ILI for each family |
Teachers instructed to: assist each child with dispensing hand gel at required time interval, store hand gel properly, and refill gel as needed. Monitoring of hand gel use at specified times |
Teachers supervised, stored, and refilled hand gel. Instructions to teachers presumably provided by researchers. Leaflets distributed through school. Monitoring of use by 2 research assistants |
Face‐to‐face to schools, teachers and children Individual assistance to children with hand gel Leaflets given to each family. |
Kindergarten school in Bangkok, Thailand | 12 weeks overall 1 pump of gel per child per disinfection round at 1 of 3 time intervals of school day: A. every 60 min B. every 120 min C. once only before lunch, the school standard for hand hygiene |
None described. | Students whose families declined to participate were not asked to use alcohol hand gel. These students remained in their classrooms and continued to follow the school standard for hand hygiene. |
2 research assistants monitored hand gel use every 60 or 120 minutes for the duration of study. Classroom teachers were required to co‐sign after each disinfection round. |
Reported that adherence was ensured for each intervention group Cost of hand gel every 60 minutes was USD 6.39 per child per 12‐week period. |
| Priest 2014 | Hand sanitiser provision (in addition to hand hygiene education session also provided to control group) | Primary schools and their students, teachers, and administrative staff | Reduce person‐to‐person community transmission of infectious disease by targeting improved and additional hand hygiene of school children through supervised hand sanitiser provision as an alternative to improving and maintaining bathroom facilities |
‘‘No touch’’ dispensers (> 60% ethanol) for each classroom that dispensed dose when hands were placed under an infrared sensor Supply of top‐up sanitiser as needed |
Dispensers installed into each classroom. Teachers asked to ensure that the children used sanitiser at particular times and to oversee general use (McKenzie 2010). Weekly classroom visits to top‐up of sanitiser and measure quantity used 30‐minute in‐class hand hygiene education session provided (also to control group) plus instruction in hand sanitiser use. |
School liaison research assistants topped‐up sanitiser. Teachers |
Installation of dispensers to classrooms Supervision of children by teachers delivered face‐to‐face individually and as a class. |
City schools in New Zealand | 20 weeks (2 school terms) Sanitiser to be used by students at least after coughing/sneezing, blowing their nose, and as they leave for morning break and for lunch break. Approximately 0.45 mL of sanitiser dispensed per wash. Weekly top‐up of sanitiser |
Children were able to use the sanitiser at any time they wished as well as at key times (McKenzie 2010). | Change of sanitiser after week 10 to flavourless type of the same % ethanol in 41 of 396 classrooms (10%) (in 9 of 34 schools) due to children tasting it when eating, affecting use. |
Weekly classroom visits by school liaison research assistants who recorded quantity of sanitiser used Total amount of sanitiser per classroom was measured. adherence defined as dispensing a volume equivalent to at least 45 mL per child of hand sanitiser solution over the trial period. |
100% dispensing 45 mL per child Average hand sanitiser dispensed/child for 34 schools: 94 mL Median classroom difference in sanitiser usage between first 10 weeks and second 10 weeks amongst classes that switched products was 220 mL. |
| Ram 2015 | Soap and intensive hand‐washing promotion | Household compounds and its householders (adults and children) that had a householder with ILI | Reduce household transmission of ILI and influenza by promoting hand‐washing in households with householder with ILI as other householders who are well are at highest risk of exposure due to crowded and poorly ventilated homes. Followed constructs of Social Cognitive Theory and the Health Belief Model (Glanz 2008) and behaviour change communication using social marketing concepts |
Hand‐washing station in central location of each compound using: large water container with a tap; plastic case for soap; bar of soap. Cue cards depicting critical times for hand‐washing: after coughing or sneezing; after cleaning one’s nose or child’s nose, after defecation; after clearing a child who has defecated; before food preparation or serving; before eating. |
Hand‐washing station in each compound Didactic and interactive group‐level education and skills training describing influenza symptoms, transmission, and prevention, promoting health and non‐health benefits of hand‐washing with soap and identification of barriers and proposed solutions to hand‐washing with soap Daily surveillance including weighing of soap and replacing if ≥ 20 g and resupply of water in container if needed Posting of cue cards Asking householders to demonstrate hand‐washing with soap technique |
Intervention staff arranged provision of hand‐washing station and presumably provided education. Intervention staff conducted daily surveillance and reinforcement visits. |
All elements delivered face‐to‐face but at compound (facilities), group (education), and individual levels (reinforcement). | Household compounds in a rural area of Bangladesh consisting of several households with common courtyard, shared latrine, water source, and cooking facilities | Initiation of intervention within 18 hours of study enrolment, then daily visits until 10 days following resolution of index case patient’s symptoms Day 1 set up of hand‐washing station |
Daily surveillance included observation of individual hand‐washing reinforcement and modelling as needed. | None described. | Daily surveillance of facilities and reinforcement and modelling of hand‐washing behaviours including observed hand‐washing Cue cards in common areas of courtyard Presence or absence of soap during each of first 10 days of surveillance from 180 household compounds Patterns and amount of soap use measured.[20] |
Soap present for at least 7 days in all compounds and on all 10 days in 133 compounds (74%). Soap and water together were present 7 or more of first 10 days in 99% of compounds, with water and soap observed together on all 10 days in 99 compounds (55%) Soap consumption per capita: median: 2.3 g maximal: 5 g (on Day 7) |
|
Roberts 2000 |
Education about infection control measures, hand‐washing, and aseptic nose wiping | Childcare centres and their staff and children | Reduce transmission of respiratory infections in childcare centres through improved infection control procedures | GloGerm (GloGerm, Moab, UT, USA) Newsletters to staff Songs and rhymes on hand‐washing Plastic bags (sandwich bags available at supermarkets) to cover hand for nose wiping |
Staff training in good health (developed by Kendrick 1994) and practical exercise of hand‐washing with GloGerm Fortnightly visits and newsletter to reinforce training and to communicate techniques Recommended hand‐washing technique as per guidelines of the time[21] and after toileting, before eating, after changing diaper (staff and child), and after wiping nose unless barrier used Teaching of technique to children and wash hands for infants |
Training and reinforcement activities provided by 1 of the researchers. Teachers delivered training to children based on their training. |
Face‐to‐face in groups for training and classes and individually as needed to children or staff | Childcare centres in Canberra, Australia |
8 months overall 3‐hour training in evening or 1‐hour during lunch for new staff after study start Duration of hand‐washing: “count to 10” to wash and “count to 10” to rinse |
Training for new staff provided as needed. | None described. | 6‐weekly adherence measured by recorded observation of recommended practice for 3 hours in the morning in each centre, graded by quantiles of frequency of recommended hand‐washing by children. | Adherence was reported only in relation to analysis of outcomes. High adherence reported for nose wiping and child hand‐washing. |
|
Sandora 2005 |
Healthy Hands Healthy Families | Families with an index child in out‐of‐home childcare | Reduce illness transmission in the home through multifactorial campaign centred on hand hygiene education and hand sanitiser | Alcohol‐based hand sanitiser: active ingredient: 62% ethyl alcohol (PURELL Instant Hand Sanitiser; GOJO Industries, Inc, Akron, OH, USA) Hand hygiene educational materials at home (fact sheets, toys, games) |
Supply of hand sanitiser and hand hygiene materials Biweekly telephone calls Biweekly educational materials |
Study investigator | Not stated whether materials mailed or delivered in person | Homes in USA Sanitiser use in home |
5 months overall Biweekly educational materials Sanitiser dispensed 1 mL each pump. |
None described. | None described. | Recorded amount of hand sanitiser used (as reported by the primary caregiver) | Median frequency of reported times of hand sanitiser use: 5.2 per day 38% used > 2 ounces of hand sanitiser per fortnight = 4 to 5 uses per day |
|
Savolainen‐Kopra 2012 further details from Savolainen‐Kopra 2010 |
STOPFLU Enhanced hygiene 2 active interventions IR1. Soap and water wash IR2. Alcohol‐based hand rub |
Office workers of office work units | Prevent transmission of respiratory infections in workplaces through enhanced hand hygiene with behavioural recommendations to reduce transmission by droplets during coughing or sneezing | IR1: Liquid hand soap (“Erisan Nonsid” by Farmos Inc., Turku, Finland) IR2: in addition: Alcohol‐based hand rub, 80% ethanol (“LV” by Berner Inc., Helsinki, Finland) Bottles of hand hygiene product (free of charge) to be used at home and in the office (IR2). Written instructions on hygiene for further reference |
Toilets equipped with liquid hand soap (all groups) or alcohol‐based hand rub (IR2). Guidance on other ways to limit transmission of infections, e.g. frequent hand‐washing in office and at home, coughing, sneezing into disposable handkerchief or sleeve, avoiding hand‐shaking Visits to work clusters and monitoring of materials availability Monthly electronic “information spot” about viral diseases for motivation to maintain hygiene habits Adherence activities |
In collaboration with occupational health clinics servicing the corporation Specially trained research nurse provided guidance and visited worker clusters throughout intervention period. |
In‐person provision of soap or hand rub Guidance and written instructions given personally. Face‐to‐face visits by study nurse |
Office work units in corporations in Helsinki, Finland | 15 to 16 months overall Monthly visits by nurse throughout |
Nurses assisted with any practical problems with intervention as they arose. New employees received guidance on hand hygiene and habits. |
None described. | Adherence assessed by an electronic self‐report survey of transmission‐limiting habits 3 times (more details in protocol). Use of soap (IR1) and alcohol‐based disinfectant (IR2) for personal use was recorded. Study nurse checked availability of soap and alcohol rub. |
Avoiding hand‐shaking became more common and remained high in both groups. Recorded use for personal use smaller than predicted use based on hand hygiene instructions. Soap or disinfectant usage per participant: IR1: 6.1 IR2: 6.9 |
| Stebbins 2011 | “WHACK the Flu” (hand sanitiser and training in hand and respiratory hygiene) |
Elementary schools and their students and homeroom teachers | Targeted school‐aged children as important sources of influenza transmission through improved cough etiquette and hand hygiene in schools including sanitiser as potential inexpensive non‐pharmaceutical interventions |
Hand sanitiser dispensers with 62% alcohol‐based hand sanitiser from PURELL (GOJO Industries, Inc, Akron, OH, USA) automatically dispensing 1 dose |
Delivery of grade‐specific presentations on “WHACK the Flu” concepts and proper hand‐washing technique and sanitiser use: (W)ash or sanitise your hands often; (H)ome is where you stay when you are sick; (A)void touching your eyes, nose and mouth; (C)over your coughs and sneezes; and (Keep your distance from sick people (provided URL no longer active) Desired frequency of hand wash use taught to student (see When and how much) Installation of hand sanitiser dispensers Refresher training at each school Reinforcement of message and monitoring of sanitiser |
Project staff provided education. Home room teachers reinforced message and monitored proper use of sanitiser. |
Face‐to‐face at schools, presumably as a group in classes | Elementary schools (Pittsburgh, USA) Dispensers installed in each classroom and all major common areas. |
Whole intervention over 1 influenza season One‐off installation of hand sanitiser dispensers One‐off 45‐minute education presentation and one‐off refresher training at onset of influenza season Goal of use of 1 dose (0.6 mL) of sanitiser 4 times per day[22] |
Encouraged to wash hands or use additional doses of hand sanitiser, or both, as needed | None reported. | Monthly teacher surveys of observed NPI‐related behaviour in their students before, during, and after influenza season Measurement of hand sanitiser use at 2‐week intervals throughout the intervention period |
Teacher surveys of observed classroom NPI behaviour indicated successful adoption and maintenance of behaviours throughout influenza season. Average sanitiser use: 2.4 times per day |
| Talaat 2011 | Intensive hand hygiene campaign | Schools and their students, teachers, and parents | Reduce or prevent transmission of influenza viruses amongst children through intensive hand hygiene intervention campaign | Soap supplied as needed. Grade‐specific student booklets each including a set of 12 games and fun activities that promoted hand‐washing Hand hygiene activities materials including: games (e.g. how to escape from the germs); puzzles; soap activities (e.g. soap drawing); song specially developed to promote hand hygiene Teachers’ guidebook including detailed description of the students’ activities and methods to encourage students to practice these activities. Posters with messages to wash hands with soap and water upon arriving at school, before and after meals, after using the bathroom, and after coughing or sneezing. Informational flyers for parents reinforcing the messages delivered at the schools. |
Establishment of a hand hygiene team in each school Provision of hand hygiene activities: weekly exercises (e.g. games, aerobics, songs, experiments); school activities, (e.g. obligatory hand‐washing under supervision, morning broadcast, parent meetings, students‐parents information transfer); specific school initiatives: (e.g. competitions and awards, hand‐washing committee, school trips to soap factory and water purification plant) More details in Table 1 of paper Song played regularly. Social worker weekly visits Distribution of flyers to parents |
Hand hygiene team (3 teachers from social studies, arts, and sports and the school nurse) ensured that all pre‐designed activities for the hand hygiene campaign were implemented. 6 independent social workers visited the schools. |
Delivered face‐to‐face in groups and individually | Elementary schools (grades 1 to 3) in Cairo, Egypt In school environment and classrooms Poster near sinks in classrooms and on playground |
12 weeks overall Weekly hand hygiene campaign activities Weekly visits by social workers Twice‐daily obligatory supervised hand‐washing required by students for about 45 seconds, followed by proper rinsing and drying with a clean cloth towel. |
Soap and hand‐drying material provided by school administration if children did not bring their own as was the custom or families could not afford it. Schools could create own motivating activities such as selecting a weekly hand hygiene champion, developing theatre plays, and launching school contests for drawings and songs. |
None described. | Observation by social workers of hand hygiene activities, availability of soap and drying material, and students’ hand‐washing during the day Schools created own activities to improve adherence. |
About 93% of the students had soap and drying material available. All but 2 intervention schools “had a rigorous system of ensuring that schoolchildren were washing their hands at least twice daily”. |
|
Teesing 2021 (additional sources: Teesing 2020a and Teesing 2020b) |
HANDSOME multimodal nursing home HH adherence intervention | NH management staff and nurses and nursing students (with or of 3 or 4‐year nursing degree) and residents | Change hygiene policy and individual HH behaviour of nurses through multimodal intervention designed specifically for nursing homes based on literature, interviews at nursing homes and intervention mapping principles, the principle of repetition and informal discussions with members of over 20 nursing home organisations in an iterative process See protocol for more details of intervention mapping process using determinants and methods to develop strategies for intervention components |
Materials for lessons about WHO‐defined 5 moments for HH[23] using HANDSOME novel method: ‘Room In’ (moment 1), ‘Room Out’ (moments 4 and 5 combined), ‘Before Clean’ (moment 2), and ‘After Dirty’ (moment 3)[24] Nurse’s watches and certificates earned on completion of e‐learning Paint for washing hands exercise 28 stickers representing barriers to HH in 4 themes (facilities, forgetting, choosing not to do HH, and the telephone) E‐learning materials including videos modelling knowledge, guided practice and promotion of active learning 10 posters (multiple copies, new one each month) Prize for photo competition NH certificate of good HH Small bottle of hand sanitiser for lesson participants See website (www.zorgvoorbeter.nl/hygiene/handhygiene-verbeteren-verpleeghuis) for materials (in Dutch) used for intervention:[25] ‐ Manual (84p) ‐ E‐learning module ‐ PowerPoint presentation and script ‐ Assignments ‐ Awareness activities ‐ Audit materials ‐ Policy materials ‐ Posters Adherence recording application and computer table Adherence observer training materials using method adapted from a study in Dutch hospital[26]: videos and case studies and examination using videos from Hand Hygiene Australia[27] [1] World Health Organization. (2012). Hand hygiene in outpatient and home‐based care and long‐term care facilities: a guide to the application of the WHO multimodal hand hygiene improvement strategy and the “My Five Moments For Hand Hygiene” approach. World Health Organization. apps.who.int/iris/handle/10665/78060 (accessed 15 June 2022) [2] Moment 1 (before touching a resident) = Room In; Moment 4 (after touching a resident) and Moment 5 (after touching a resident’s surroundings) = Room Out; Moment 2 (before a clean/antiseptic procedure) = Before Clean; Moment 3 (after body fluid exposure risk) – After Dirty [3] Handsome: handhygiëne in verpleeghuizen.: Zorg voor beter; 2019 May 03. URL: www.zorgvoorbeter.nl/handsome (accessed 7 June 2022) [4] Veiligheid en Kwaliteit: Project Handen uit de Mouwen.: Stichting Samenwerkende Rijnmond Ziekenhuizen [5] Auditor training.: Hand Hygiene Australia URL: www.hha.org.au/audits/auditor-training (accessed 7 June 2022) |
See Table 1 of Teesing 2020a and Teesing 2020b for more details 1. Policy change: ‐ management meeting (with senior nursing home manager, infection prevention specialist, and facilities manager), ‐ personal hygiene rules ‐ HH materials audit 2. Nursing staff interventions (The New Way of Working) i) 3 live lessons: a. introduction of HANDSOME/WHO HH moments; teaching and discussion re HH when handling medication, food, laundry; when to use hand sanitiser/soap/gloves. Team HH goal‐setting; b. make inventory and solutions for barriers to HH adherence; and c. exercise washing hands with paint to see where missed; teaching how to disinfect hands ii) e‐learning: introduction and 7 lessons showing: ‐ correct/incorrect HH behaviour ‐ common HH actions ‐ when to use gloves ‐ food and medication preparation Quizzes: iii) reminder posters hung throughout NH showing large picture of hands and text: “Did you remember to wash your hands?” (in Dutch’) iv) photo competition: prize for best photo of hands 3. Arts and craft project for residents involving hands that NH displays Adherence recording procedures Provision of hand sanitiser to lesson participants Provision of good HH certificate to NH if higher than average adherence Provision of nurse’s watch on completion of e‐learning Provision of adherence observers training |
Meeting and materials provided by researcher Study team member delivered 3 live lessons with involvement of senior NH manager Senior NH managers involved in delivery of aspects, including a lesson on NH personal hygiene policy between lessons 1 and 2 Nurses and doctors in training provided adherence observation and assessment |
Face to face in groups (management and nursing staff) Lessons in groups of maximums of 18/session Online individual e‐learning |
In residents’ rooms or other areas of 2 units each of 33 Dutch nursing homes with ≥ 3 nurses providing intense psychogeriatric and/ or somatic care to geriatric residents Meetings on‐site Lessons on‐site and online Posters throughout NH |
4 months (Jan to Apr 2017) Management meeting (45 to 60 min) Personal hygiene policy presentation (10 min) Live lessons: 1 (20 min) 2 (30 min) 3 (40 min) given multiple times on 1 day E‐learning: 5 to 10 min each Adherence observer training: 2 to 3 days Adherence observation: during observation hours (8 am to 1.30 pm, weekdays) |
Persuasive communication used to encourage continuing when NH wanted to stop When < 3 nurses working at the unit, either the observers continued observations at an additional ward (who also received the intervention) or they stopped observing HH needed to happen in the same room as action occurred, except if a nurse brought a resident to another room, they carried something soiled or no door needed to be opened before leaving the room; for these instances, HH should take place at the end of action |
None described, except that the process was iterative in response to feedback from individual nursing homes | Unobtrusive HH direct observation disguised as registering of frequency of health care activities recorded on computer tablet (see Figure 2 in Teesing 2020a and Table 3 of Teesing 2020b) Compliance registered if HH occurred immediately before (moments 1 and 2) or after (moments 3, 4 and 5) a HH opportunity without touching another object (e.g. door handle) and only if hand sanitiser or soap, water and paper towel used Hand‐related personal hygiene[28] for each nurse according to Dutch guidelines[29]1 / every nurse / day Attendance at live lessons and e‐learning was recorded Participants asked if HH policy information received and if posters seen |
HH compliance (12 m f/u) IG: 36% CG: 21% (OR 2.28, CI 1.67 to 3.11) HH compliance increased more for IG than CG for each WHO‐defined moment, except for moment 2 Estimated attendance at lessons: varied per unit: 23% had < 50% attending at least 1 lesson, 18% had 50% to 74% attendance at at least 1 lesson and 59% had > 75% attendance at least 1 lesson (n = 22). |
| Temime 2018 | Multifaceted hand hygiene programme (including alcohol‐based hand rub) | Nursing home staff, residents, visitors, and outside care providers | Nursing homes and their residents, staff, and visitors and external providers have an increased risk of person‐to‐person transmission of pathogens, and HH is a simple and cost‐effective tool for infection control; however, compliance with HH is poor in nursing homes. | Dispensers and pocket‐sized containers of hand rub solution Posters promoting hand hygiene Developed local HH guidelines eLearning module on infection control and HH training with online quizzes requiring sufficient performance |
Facilitated access to hand rub solution Campaign to promote HH with posters and event organisation Formation of local work groups in each NH Development of local HH guidelines Staff education using eLearning Monitoring of quantity of hand rub solution used |
Same nurse provided HH training for all NHs. Provision of hand rub by NH Local work group developed guideline. eLearning module and posters presumably developed by research team. |
Provision of materials face‐to‐face Education and quizzes via eLearning |
Nursing homes in France | 1 year overall One‐off provision of hand rub One‐off eLearning repeated if unsatisfactory performance. |
If staff did not score sufficiently on online quiz, they were invited to repeat the eLearning. |
None described. | Estimated mean amount of hand rub solution used per resident per day assessed as proxy for HH frequency, based on quantity of hand rub solution bought by NH (which was routinely monitored in all the NHs). | Hand rub solution used: baseline quantity of consumed hand rub solution was 4.5 mL per resident per day. Over the 1 year, mean quantity consumed was significantly higher in intervention NH (7.9 mL per resident per day) than control (5.7 per resident per day). |
|
Turner 2004a Clinical trial 1 |
3 active interventions (no control) Product: A. Ethanol B. Salicylic acid C. Salicylic acid with pyroglutamic acid |
Healthy volunteers | Assess the residual virucidal activity of organic acids used in currently available over‐the‐counter skin products for the prevention of experimental rhinovirus colds | 1.7 mL of hand products: A. 62% ethanol, 1% ammonium lauryl sulphate, and 1% Klucel) B. 3.5% salicylic acid, or vehicle containing C. 1% salicylic acid and 3.5% pyroglutamic acid |
Disinfection of hands then application of test product then allowed to dry. 15 min later, fingertips of each hand contaminated with 155 TCID50 of rhinovirus type 39 in a volume of 100 μL. Hands air‐dried for 10 min. Intentional attempted inoculation with virus by contact with fingers, conjunctiva, and nasal mucosa with fingers of right hand. Left hand eluted in 2 mL of virus‐collecting broth. |
Researchers | Face‐to‐face individually | Communities in Manitoba, Canada | 1.7 mL of product applied. See What for timing |
Not described | Not described | Not described | Not described |
|
Turner 2004b Clinical trial 2 |
2 active interventions (no control) Skin cleaner wipe product: A. Pyroglutamic acid B. Ethanol |
Healthy volunteers | Assess the residual virucidal activity of organic acids used in currently available over‐the‐counter skin products for the prevention of experimental rhinovirus colds | Skin cleanser wipe containing: A. 4% pyroglutamic acid formulated with 0.1% benzalkonium chloride B. 62% ethanol |
Application of product to hands with towelette then allowed to dry. 15 min later, fingertips of each hand contaminated with 106 TCID50 of rhinovirus type 39 in a volume of 100 μL. Intentional attempted inoculation with virus by contact with fingers, conjunctiva, and nasal mucosa with fingers of right hand. Left hand eluted in 2 mL of virus‐collecting broth. |
Researchers | Face‐to‐face individually | Communities in Manitoba, Canada | Dose not reported; see What for timing Additional group challenged 1 h after application; final group challenged 3 h after application (remained at study site and not allowed to use or wash hands between). |
Not described | Not described | Not described | Not described |
| Turner 2012 | Antiviral hand lotion | Healthy adults | Reduce rhinovirus infection and illness through hand disinfection with ethanol and organic acid sanitiser | Lotion containing 62% ethanol, 2% citric acid, and 2% malic acid Daily diary |
Provision of lotion and instructions for use Meetings with participants to check compliance |
Staff of study site presumably supplied lotion. Study site staff met with participants. |
Face‐to‐face and presumably individually, but not specified | Study site at university community in the USA | 9 weeks Every 3 hours whilst awake and after hand‐washing for 9 weeks Compliance meetings twice weekly for first 5 weeks then weekly meetings with participants |
None reported. | None reported. | Self‐reported daily diary of time of each product application Twice weekly for 5 weeks then weekly meetings with participants to reinforce compliance with treatment |
“All subjects … applied at least 90% of the expected amount of hand treatment” (p. 1424) |
| Yeung 2011 | Multifaceted hand hygiene programme (including alcohol‐based hand rub) | Long‐term care facilities and their healthcare workers | Promote use of alcohol‐based hand rub by staff in LTCFs as an effective, timely, and low‐irritant method of hand hygiene in a high‐risk environment | Free supply of pocket‐sized containers of alcohol‐based antiseptic hand rub (either WHO formulation I (80% ethanol) or II (80% propanol) carried by each HCW (supplier: Vickmans Laboratories) Replacement hand rub as required Hand hygiene seminar content Reminder materials (3 to 5 posters and specially designed ballpoint pens) |
Provision of materials Provision of hand hygiene seminars to HCWs covering: indications, proper method, and importance of antiseptic hand rubbing and washing according to WHO 2006a) guidelines Provision of feedback session Direct, unobtrusive observation of hand hygiene adherence Training of observation staff |
Study team delivered the materials, seminars, and observer training. Administrative staff of LTCF provided replacement hand rub and communicated with HCWs. 6 registered nurses conducted direct observation of adherence after 2‐hour training (100% interrater reliability). |
Delivered face‐to‐face and individually for hand rub and pens; not described if education was individually or by group, but seminar implies as a group | LTCFs in Hong Kong Posters posted in common areas. Adherence observations occurred in common rooms and resident rooms but not bathing or toilet areas. |
7 months overall Initial 2‐week intervention period, then 7 months of hand rub provision and reminders 3 identical seminars at start of intervention; each staff member to attend once Feedback session 3 months after start of intervention 2‐hour training of observers Adherence observations either 9 am to 12 pm or 3 pm to 6 pm, 1 LTCF at a time |
Replacement of hand rub as required | As adherence dropped off in the middle months, the feedback session was delivered. | Direct observation of HCW adherence to hand‐washing and antiseptic hand rubbing (recorded separately and anonymously) during bedside procedures or physical contact with residents 3300 hand hygiene opportunities during 248.5 hours of observation on 92 days |
90% attendance of seminars Hand rubbing with gel increased significantly from 1.5% to 15.9%. Hand‐washing decreased significantly from 24.3% to 17.4%. Control: 30% Overall hand‐washing adherence increased from 25.8% to 33.3%. |
| Zomer 2015 | Hand hygiene products and training |
Daycare centres and their caregivers (staff) | Reduce infections in children attending DCCs through improved access to HH materials (Zomer 2013a) and compliance of their DCC caregivers to hand hygiene guidelines based on socio‐cognitive and environmental determinants of caregivers’ HH behaviour[30] (Zomer 2013b) | HH products: dispensers for paper towels, soap, alcohol‐based hand sanitiser, and hand cream, with refills for 6 months Reminder posters and stickers for children and DCC caregivers Training materials including booklet |
Provision of free HH products sponsored by SCA Hygiene Products, Sweden. Provision of posters and stickers for children and staff Provision of training about RIVM 2011 for mandatory HH[31] Distribution of training booklet Team training sessions aimed at goal‐setting and formulating HH improvement activities (Erasmus 2011; Huis 2013) |
Study team arranged supply of HH products and presumably provided training. | Products provided to DCCs in person for staff use. Mode of training not specified. |
DCCs in regions of the Netherlands | 6 months overall Initial one‐off supply of products 3 training sessions with 1‐month interval 2 team training sessions |
Replacement hand hygiene provided as required. | None described. | 6‐month follow‐up observation of whether intervention dispensers and posters/stickers in use Survey of DCC caregivers HH guidelines compliance observed at 1, 3, and 6 months' follow‐up: no. of HH actions/no. of opportunities |
2 DCCs did not use any HH products. Sanitiser products used in at least 1 of 2 groups in 94%, 89%, 86%, and 45% of intervention DCCs. Posters used in 86%, stickers in 74%. DCC survey results: 79% attended at least 1 training session; 77% received HH guidelines booklet. HH compliance at 6 months: IG: 59% vs CG: 44% (Zomer TP, et al, unpublished data) All intervention DCCs received guidelines training; all but 2 received at least 1 team training. |
| Hand hygiene and masks | |||||||||||||
| Aelami 2015 | Hygienic education and package | Religious pilgrims | Prevent influenza‐like illness by reduced infection transmission through personal hygiene measures | Hygiene package of: alcohol‐based hand rub (gel or spray) surgical masks soap paper handkerchiefs user instructions |
Not clearly described, but it appears that packages may have been distributed by trained physicians before departure to or on site of country of pilgrimage | Not specifically described | Not described, but it appears that packages were distributed face‐to‐face and individually | Not described if before departure (from Iran) or on site (in Saudi Arabia) | One‐off during Hajj season | Not described | Not described | Not described | None described |
|
Aiello 2010 |
2 active interventions: A. Face mask (FM) B. Face mask and hand hygiene (FM + HH) |
Students living in university residences | Reduce the incidence of and mitigate ILI by use of non‐pharmaceutical interventions of personal protection measures | 7 face masks (standard medical procedure masks with ear loops TECNOL procedure masks; Kimberly‐Clark) 7 re‐sealable plastic bags for mask storage when not in use (e.g. eating) and for disposal Alcohol‐based hand sanitiser (62% ethyl alcohol in a gel base, portable 2‐ounce squeeze bottle, 8‐ounce pump) Hand hygiene education (proper hand hygiene practices and cough etiquette) via emailed video, study website, written materials detailing appropriate hand sanitiser and mask use |
Weekly supply of masks through student mailboxes Provision of basic hand hygiene education through an email video link, the study website, and written materials; instruction to wear mask as much as possible; education in correct mask use, change of masks daily, use of provided re‐sealable bags for mask storage and disposal Provision of replacement supplies which students signed for upon receipt |
Not described, except education provided via study website (URL not provided) “Trained staff” for compliance monitoring Study‐affiliated residence hall staff provided replacement supplies. |
Education via email and study website; provision of masks and sanitiser in person to residences | University residence halls in the USA | One‐off education, 6 weeks (excluding spring break) of face mask and/or hand hygiene measures which commenced at “the beginning of the influenza season just after identification of the first case of influenza on campus” (p.496). Replacement supplies provided as needed. |
Mask wearing during sleep optional and encouraged outside of residence. |
University spring break occurred during weeks 4 and 5 of the study, with most students leaving campus and travelling; they were not required to continue protective measures at that time. | Weekly web‐based student survey included: self‐reported average number of times hands washed/day and average duration of hand‐washing to obtain composite "optimal handwashing” score (at least 20 s ≥ 5/day); average no. of mask hours/day/week; average hand sanitiser use/day/week and amount used. Trained staff in residence hall common areas observed silently and anonymously improper mask use, instances of hand sanitiser use. |
Average mask use hours/day: FM + HH 2.99 versus FM 3.92 Average hand‐washing times/day: FM + HH 6.11 versus FM 8.18 vs control group 8.75 Daily washing seconds/day: FM + HH 20.65 versus FM 23.15 vs control 22.35 Hand sanitiser use times/day: FM + HH: 5.2 versus FM 2.31 vs control 2.02 No. of proper mask wearing participants/hour of observation: FM + HH 2.26 versus FM 1.94 |
| Aiello 2012 | 2 interventions: A. Face mask (FM) B. Face mask and hand sanitiser (FM + HH) |
Students living in university residences | Prevent ILI and laboratory‐confirmed influenza by use of non‐pharmaceutical interventions of personal protection measures (e.g. face masks and hand hygiene) | Packets of 7 standard medical procedure masks with ear loops (TECNOL procedure masks, Kimberly‐Clark, Roswell, GA, USA) and plastic bags for storage during interruptions in mask use (e.g. whilst eating, sleeping) and for daily disposal Hand sanitiser (2‐ounce squeeze bottle, 8‐ounce pump bottle with 62% ethyl alcohol in a gel base) Replacement face masks and hand sanitiser Educational video: proper hand hygiene and use of standard medical procedure face masks |
Intervention materials and educational video provided. Supply of masks and instructions on wearing Provision of replacement masks or sanitisers as needed on site |
Trained study staff available at tables in each residence hall for surplus masks and sanitiser and for observing compliance | Hygiene packs delivered to student mailboxes; face‐to‐face supply also available | University residence halls in the USA | One‐off educational video at start Weekly supply of hygiene packs Masks to be worn at least 6 hours/day Study staff available onsite with replacement supplies as needed for duration of intervention (6 weeks, excluding spring break) |
Students encouraged but not obliged to wear masks outside of residence hall. | 1‐week university spring break during the study when majority of students left campus | Weekly student survey including compliance (e.g. masks hours/day, frequency and amount of sanitiser use, number of hand washes/day, duration of hand‐washing (seconds) Observed compliance completed by trained study staff who daily and anonymously observed mask wearing in public areas of residences. |
Self‐reported mask wearing: no significant difference Sanitiser use: significantly more in FM + HH than FM or control groups More results in S1 of paper. Staff observed an average of 0.0007 participants properly wearing a mask for each hour of observation. |
|
Cowling 2009 |
2 active interventions in addition to control of lifestyle education:
A. Enhanced hand hygiene (HH) B. Face masks and enhanced hygiene (FM + HH) |
Householders with index patient with influenza | Reduce transmission of influenza in households through personal protective measures | A. and B. Liquid soap for each kitchen and bathroom: 221 mL Ivory liquid hand soap (Proctor & Gamble, Cincinnati, OH, USA) Alcohol hand rub in individual small bottles (100 mL) WHO recommended formulation I, 80% ethanol, 1.45% glycerol, and 0.125% hydrogen peroxide (Vickmans Laboratories, Hong Kong, China) B. Adults: box of 50 surgical face masks (Tecnol–The Lite One (Kimberly‐Clark, Roswell, GA, USA) to each household member or C. Children 3 to 7: box of 75 paediatric masks |
Home visits Provision of soap, hand rub, and masks as applicable and when to use them HH: education about efficacy of hand hygiene Demonstration of proper hand‐washing and antisepsis techniques + FM: education about efficacy of surgical face masks in reducing disease spread to household contacts if all parties wear masks Demonstration of proper wearing and hygienic disposal All groups: provision of education about the importance of a healthy diet and lifestyle, both in terms of illness prevention (for household contacts) and symptom alleviation (for the index case) |
Trained study nurse provided interventions. | Face‐to‐face to householders | Households in Hong Kong | Initial home visit scheduled within 2 days (ideally 12 h) of index case identification. Further home visits day 3 and 6, 7‐day follow‐up HH: use of liquid soap after every washroom visit, sneezing or coughing, when their hands were soiled. Use rub when first returning home and immediately after touching any potentially contaminated surfaces FM: masks worn as often as possible at home (except eating or sleeping) and when the index patient was with the household members outside of the household |
Not described | Not described | Monitoring of adherence during home visits Evaluation of adherence on final visit by interview or self‐reported practices and counting of amount of soap and rub left in bottles and remaining masks for FM group |
Most initial visits completed within 12 h. Intervention groups “reported higher adherence … than the control group. Self‐reported data were consistent with measurements of amount of soap, alcohol hand rub, and face masks used” (p.443) (see Table 6 in paper). “Adherence to the hand hygiene intervention was slightly higher in the hand hygiene group than the face mask plus hand hygiene group.” Median masks used: Index: 9 Contact: 4 More details in paper and Appendices |
|
Larson 2010 |
2 active interventions in addition to control of URI education: A. Alcohol‐based hand sanitiser (HS) B. Face masks and hand sanitiser (FM + HS) |
Hispanic householders with at least 1 preschool or elementary school child | Reduce incidence and secondary transmission of URIs and influenza through non‐pharmaceutical household level interventions | A. and B. 2‐month supply of hand sanitiser in 8‐, 4‐, and 1‐ounce containers: PURELL (Johnson & Johnson, Morris Plains, NJ, USA) B. 2‐month supply of masks: Procedure Face Masks for adults and children (Kimberly‐Clark, Roswell, GA, USA) Replacement supplies at least once every 2 months Disposable thermometers Educational materials about URI prevention, treatment, and vaccination (written in Spanish or English language) |
Provision of materials and instructions for when to use including demonstration of use and observation of return demonstration by householder A. Mask worn when householder had: “temperature of ≥37.8°C and cough and/or sore throat in the absence of a known cause other than influenza” (CDC definition of influenza‐like illness at the time). Home visits to reinforce adherence, replenish supplies and record use, answer questions B. Telephone calls to reinforce mask use All groups received URI educational materials. |
4 trained bilingual research assistants (RAs) with minimum baccalaureate degree and experience in community‐based research; procedures were practised with each other until demonstrated proficiency |
Face‐to‐face to householders | Households in New York, USA | 19‐month follow‐up Initial home visit, then at least every 2 months Sanitiser for use at home, work, and school B. Telephone calls days 1, 3, 6 Masks worn for 7 days when within 3 feet of person with ILL or no symptoms. |
Change masks between interactions with person with ILL Householders' questions and misconceptions addressed on home visits. |
None described. | RA home visits for adherence with random accompaniment by project manager, who also made random calls to householders Telephone calls to reinforce mask use Used bottles or face masks, or both, monitored for usage. |
Sanitiser use (mean ounces/month) HH: 12.1 FM + HH: 11.6 Mask compliance was “poor”: 22/44 (50%) used within 48 hours of onset. Mask users reported mean mask use of 2. |
| Simmerman 2011 | 2 active interventions: A. Hand‐washing education and hand‐washing kit (HW) B. Hand‐washing education, hand‐washing kit, and face masks (HW + FM) |
Households with a febrile, influenza‐positive child | Decrease influenza virus transmission in household with a febrile influenza‐positive child through promoted use of hand‐washing or hand‐washing with face mask use | A. and B. Hand‐washing kit per household including graduated dispenser with standard unscented liquid hand soap (Teepol brand. Active ingredients: linear alkyl benzene sulfonate, potassium salt, and sodium lauryl ether sulphate) Replacement soap as needed Written materials from education including pamphlets and posters attached near sinks in household. B. Box of 50 standard paper surgical face masks and 20 paediatric face masks (Med‐con company, Thailand #14IN‐20AMB‐30IN) |
A. and B. Provision of intensive hand‐washing education on initial home visit to household members with 5 approaches: discussion, individual hand‐washing training, self‐monitoring diary, provision of soap, and provision of written materials (Kaewchana 2012) Individual hand‐washing training ("why to wash", "when to wash", and "how to wash" in 7 hand‐washing steps described in Thailand Ministry of Public Health guidelines) B. Provision of education of benefits of and appropriate face mask wearing Soap replaced as needed. More details (Kaewchana 2012) |
Study nurse conducted home visits, provided education and monitoring activities. | Education provided face‐to‐face as a group to household member and individually for hand‐washing training. | In homes (in Bangkok, Thailand) | One‐off provision of kits at initial home visit conducted within 24 hours of enrolment Subsequent home visits on days 3, 7, and 21 90‐day supply of hand‐washing supplies 30‐minute education provided at initial home visit |
B. No face masks whilst eating or sleeping as impractical and could hinder breathing in ill child Impromptu education and training provided by nurses as questions arose. |
None described. | Self‐monitoring diary recording hand‐washing frequency > 20 s and face mask use for that group Reinforcement of messages by nurses on subsequent home visits Amount of household liquid soap and number of face masks used |
Reported average hand‐washing episodes/day: HW: 4.7 HW + FM: 4.9 Parents had highest frequency (5.7), others (4.8), siblings (4.3), index cases (4.1). Average soap used/week: HW: 54 mL/person HW + FM: 58.1 mL/person B. Mask use: 12/person/week Mask wearing median minutes/day: 211 Parents 153, other relations 59, index patients 35, siblings 17 |
| Suess 2012 | 2 active interventions in addition to written information: A. Mask/hygiene (MH) B. Mask (M) |
Households with an influenza‐positive index case in the absence of further respiratory illness within the preceding 14 days |
Prevent influenza transmission in households through easily applicable and accessible non‐pharmaceutical interventions such as face masks or hand hygiene measures |
A. Alcohol‐based hand rub (Sterilium, Bode Chemie, Germany) A. and B. Surgical face masks in 2 different sizes: children < 14 years (Child’s Face Mask, Kimberly‐Clark, USA) and adults (Aérokyn Masques, LCH Medical Products, France) Written information provided on correct use of intervention and on infection prevention (Suess 2011) (tips and information on the new flu A/H1N1) (URL provided is no longer active) Digital tympanic thermometer General written information on infection prevention |
A. Provision of hand rub and masks A. and B. Provision of masks only Provision of thermometer and how to use it Mask fit assessed (at first household visit) Information provided by telephone and written instructions at home visit on proper use of interventions and recommendations to sleep in a different room than the index patient, not to take meals with the index patient, etc. (Suess 2011) In‐person demonstration of interventions at first home visit All participating households received general written information on infection prevention. |
Study personnel arranged provision of materials, rang the participants, visited the homes, demonstrated and assessed fit of masks. |
Provision of materials in person to households Initial telephone delivery of information Face‐to‐face home visits |
Households in Berlin, Germany | Over 2 consecutive flu seasons Day 1 households received all necessary material instructions. Household visits no later than 2 days after symptom onset of the index case, then days 2, 3, 4, 6, 8 (5 times) or on days 3, 4, 6, 8 (4 times) depending on the day of recruitment Hand rub use: after direct contact with the index patient (or other symptomatic household members), after at‐risk activities or contact[31] Mask use: at all times when index patient and/or any other household member with respiratory symptoms were together in 1 room Regular change of face masks, not worn during the night or outside the household |
Adult masks worn if masks for under 14‐year‐olds did not fit properly. If other household members developed fever (> 38.0 °C), cough, or sore throat, they were asked to adopt the same preventive behaviour as the index patient. |
In the season 2010/11 participants also recorded number of masks used per day. | Self‐reported daily adherence with face masks, i.e. if they wore masks “always”, “mostly”, “sometimes”, or “never” as instructed. Participants of the MH households additionally noted the number of hand disinfections per day. Exit questionnaire about (preventive) behaviour during the past 8 days, general attitudes towards NPI, the actual amount of used intervention materials, and, if applicable, problems with wearing face masks. Used intervention material per household member was calculated by dividing the amount used per household by the number of household members. See paper and Suess 2011 for more details. |
Face mask use (median/individual): MH: 12.6 M: 12.9 Daily adherence was good, reaching a plateau of over 50% in nearly all groups from the third day on. MH hand rub use (median): 87 mL (Suess 2011) MH mean frequency of daily hand disinfection: 7.6 (SD 6.4) times per day See paper and Suess 2011 for more results. |
| Hand hygiene and surface/object disinfection | |||||||||||||
|
Ban 2015 |
Hand hygiene and surface cleaning or disinfection | Kindergartens and the families of their students | Reduce transmission of infection in young children from contaminated surfaces or hands through hand hygiene and surface cleaning or disinfection | Antibacterial products for hand hygiene and surface cleaning or disinfection: liquid antimicrobial soap for hand‐washing (0.2% to 0.3% parachlorometaxylenol). Instant hand sanitiser for hand disinfecting (72% to 75% ethanol), antiseptic germicide (4.5% to 5.5% parachlorometaxylenol, diluting before use). Bleach (4.5% to 5.0% sodium hypochlorite, diluting before use) for surface disinfecting. Produced by Whealthfields Lohmann (Guangzhou) Company Ltd. |
Provision of products to kindergartens and families Instruction of parents or guardians and teachers in hand hygiene techniques and use of antibacterial products Daily cleaning of kindergartens with products At least twice/week cleaning of homes and weekly cleaning or disinfecting of items such as children’s toys, house furnishings, frequently touched objects (doorknobs, tables or desks), kitchen surfaces (utensils, cutlery, countertops, chopping boards, sinks, floors, etc.), bathroom surfaces (toilet, sink, floor, etc.) Monitoring activities |
Research team provided products and instructions and monitoring. |
Materials provided to kindergartens and families in person and presumably instructions in person to families and staff. |
In kindergartens (hard surfaces) and families’ homes (Xiantao, China) | 1 year overall Daily hand‐washing with soap before eating, after using bathroom, nose blowing, and outdoor activities Hand sanitiser carried daily. Kindergarten cleaning daily Home cleaning at least twice/week |
Families and teachers could contact study management at any time as needed. Exchange of empty bottles for new ones at any time |
Not described | Close contact with teachers and families for monitoring, e.g. unscheduled parents’ meetings, quarterly home visits, phone interviews, and monthly cell phone messages Monthly survey of consumption of products by volume, total usage, person usage |
Consumption of products by person (mL/person/day). Liquid soap: 7.7 Sanitiser: 1.4 Bleach: 25.0 Antiseptic‐germicide: 12.5 |
| Carabin 1999 | Hygiene programme | Daycare centres and their staff and children | Reduce infections in at‐risk children (under 3 years old) in DCCs with inexpensive, easily implementable and practical interventions | Hygiene materials and documents, e.g. colouring books, hand‐washing posters, hygiene videotapes Materials for training Reimbursement of equivalent of 1 full‐time educator’s salary Bleach (diluted 1:10) for toy and play area cleaning |
Provision of comprehensive hygiene training session to entire DCC staff, especially the educators of participating classrooms Training in recommendations for hygiene practices: i. toy cleaning ii. hand‐washing technique and schedule iii. use of creative reminder cues for hand‐washing iv. open window for daily period v. sandbox and play area cleaning Payment of salary of educator for the day to encourage participation DCC meetings to discuss training session with all staff |
Training appears to have been provided by study team. | Appears staff trained as a group, i.e. “entire DCC staff” |
Daycare centres in Canada Location of training not described, except may have been off‐site from DCCs since 1 DCC did not “send” staff to training. |
15‐month trial One‐off 1‐day training Toy cleaning at least every 2 days Hand‐washing at least after DCC arrival, after outside play, after bathroom, before lunch Open windows at least 30 min/day Biweekly cleaning of sandbox/play area |
Teachers to use creative reminder cues for hand‐washing with children | Not described | Follow‐up telephone questionnaire for DCC directors about following training recommendations | Use of materials: colouring book: 22/24 poster: 23/24 videotapes: 18/24 staff meetings: 19/24 Increased frequency of toy cleaning: 6/24 Use of rake and shovel for sandpit: 17/24 Frequency of cleaning sandbox: 14/24 |
|
Kotch 1994 |
Hygiene | Caregivers at child daycare centres (CDCCs) | Develop feasible, multi component hygienic intervention to reduce infections in children at CDCCs who are at increased risk | Hygiene curriculum for caregivers Availability of soap, running water, and disposable towels Waterless disinfectant scrub (Cal Stat) used only if alternative was not washing at all. Handouts posted in CDCC. |
Delivery of hygiene curriculum to caregivers through initial training session which required demonstration of participants’ hand‐washing and diapering skills Local procedures: Hand‐washing of children and staff Disinfection of toilet and diapering areas Physical separation of diapering areas from food preparation and serving areas Hygienic diaper disposal Daily washing and disinfection of toys, sinks, kitchen and bathroom floors Daily laundering of blankets, sheets, dress‐up clothes Hygienic preparation, serving, and clean up of food Separate training of food handlers As‐required induction training for new staff Onsite follow‐up training reinforcing adaptations, demonstrations and discussion of hygiene techniques, responding to questions, and review of handouts Monthly meeting with centre directors to encourage leadership and support |
Research team delivered training. Scrub donated by Calgon Vetal Laboratories. |
Face‐to‐face training and follow‐up group and individually | Classrooms of child daycare centres in the USA | 8 months overall 3‐hour initial training session Cleaning schedules as described in column What (procedures) Onsite follow‐up training 1 week and 5 weeks later |
Follow‐up sessions addressed questions and local adaptations to procedures. As‐required induction training |
During intervention, research team encouraged directors to address physical barrier to hygiene practice, such as distance between sink and diapering areas and sink access in rooms. | Follow‐up sessions reinforced training. Meeting with directors 5 weekly unobtrusive recorded observation by training staff |
Rate of compliance to barrier modification was better in younger centres, which were more likely to have written guidelines. |
|
McConeghy 2017 |
Multifaceted hand‐washing and surface‐cleaning intervention | Nursing homes and their staff | Reduce exposure to pathogens and person‐person transmission in high‐risk facility of close environment and potentially contaminated surfaces through multifaceted intervention equipping staff to protect residents from infection within the “culture” of care |
Education and launch materials Online module for certified nursing assistants about: infection prevention, product, and monitoring "Essential bundle" of hygiene products supplied at no cost: ‐ hand sanitiser gel and foam ‐ antiviral facial tissues ‐ disinfecting spray ‐ hand and face wipes Plus additional: ‐ 4 skin cream and wipe products iPads for compliance audits Newsletters for support during intervention |
Pre‐intervention: NH administrators required to: ‐ identify a "Heroes In Prevention" champion and team ‐ allow all staff participation in education ‐ iPad use for staff in each floor or community ‐ ask staff to incorporate intervention into workflow Delivery of 3 components: ‐ education ‐ cleaning products ‐ compliance audit and feedback Education: Launch event for all staff to publicise programme and explain roles Intensive training of "hygiene monitors" for data collection and compliance audit and feedback tool Training of site champion Training of select group of certified nursing assistants (online module) Audit and feedback activities Ongoing support during intervention: ‐ newsletter with best practices ‐ teleconferences with each NH ‐ "onboarding" education of new staff |
Study personnel equipped staff with knowledge and tools and support. NH staff (e.g. champion, hygiene monitors, nursing assistants) delivered aspects of interventions after specific training. |
Face‐to‐face interaction with staff for planning and some aspects and delivery of products Some aspects delivered online (e.g. nursing modules, compliance auditing) |
Nursing homes in the USA Onsite and at unit/team levels Online training |
6 months overall: training period: 3 months 1‐hour launch event 1 or 2 hygiene monitors/site 1 champion/site 1‐hour online module for selected nursing assistants iPads for each community or floor Weekly teleconferences initially decreased in frequency over time. Weekly measurement of product consumption |
Sites could use existing comparable products from another vendor and fill in any gaps with study products. New staff provided with education, as needed and came onboard. Retraining of sites with low training participation rates |
2 sites retrained due to low training participation rate. | Cloud‐based audit and feedback system via secure login to web browsers on NHs’ existing computers or via iPads included weekly product consumption to get measure: weekly count of product units consumed x no. of hand hygiene occasions |
Online training participation rates: > 90% for 3/5 sites, 13% and 23% for 2/5 Administrators demonstrated high fidelity in reporting measures of hand‐washing (> 80% of time). Hand‐washing rates in Figure 1B in paper reported as “relatively constant” and “not ideal in the first few months”, but improved significantly over time. |
|
Sandora 2008 |
Multifactorial intervention, including alcohol‐based hand sanitiser and surface disinfection | Elementary school and its students | Reduce transmission of infections in schoolchildren through improved hand hygiene and environmental disinfection | 1 container of disinfecting wipes (Clorox Disinfecting Wipes (The Clorox Company, Oakland, CA, USA); active ingredient, 0.29% quaternary ammonium chloride compound) Pre‐labeled 1.7‐ounce containers of alcohol‐based hand sanitiser (AeroFirst non‐aerosol alcohol‐based foaming hand sanitiser (DEB SBS Inc, Stanley, NC, USA, for The Clorox Company); active ingredient, 70% ethyl alcohol) Receptacle in classrooms for empty containers |
Sanitiser and wipes provided to classroom/teacher with instructions for use. Teachers disinfected desks once daily. Hand sanitiser to be used: before and after lunch, after use of the restroom (on return to the classroom; hand hygiene with soap and water occurred in the restroom, because sanitisers were not placed there), after any contact with potentially infectious secretions (e.g. after exposure to other ill children or shared toys that had been mouthed) |
Research team arranged supply of materials and instructed teachers on use. Teachers instructed in use of materials and in collecting empty containers and distributing new product. |
Products provided to schools. Instruction provided face‐to‐face to teachers and children. |
Elementary schools and their classrooms in the USA | 8‐week period Desks disinfected once a day. |
Products replenished as needed. | None described. | Individually labelled containers collected every 3 weeks from the classroom to assess adherence. |
Product usage: average wipes used/week: 897 (128 wipes/classroom/week) Average bottles of hand sanitiser used per week: 8.75 (1.25 bottles/classroom/week) |
| Quarantine/Physical distancing | |||||||||||||
| Helsingen 2021 | Rapid‐Cycle Re‐Implementation of TRAining Facilities in Norway (TRAiN) hygiene and physical distancing measures | Members of health and fitness training facilities aged 18 to 64 years not at increased risk for severe COVID‐19 |
Enable safe re‐opening of fitness training facilities to maintain health and fitness by reducing the risk of SARS‐CoV2 transmission | Infection mitigation measures described by “Norwegian guidelines for Hygiene and Social Distancing in Training Facilities during the COVID‐19 Pandemic” (in Norwegian t-i.no/wp-content/uploads/2020/04/Bransjestandard-for-sentre.pdf) See Supplementary Appendix for “Standard for COVID‐19 infection prevention measures in fitness centers during the TRAiN‐study” Disinfectant readily available at workstations and strategic places (reception, booking station, changing rooms, toilets, water taps used for drinking or refilling bottles) Rubbish cans without lids Washbasin with soap or hand disinfection Personal microphones for instructors (i.e. not shared) Infection preventive measures reminders online and via posters in facilities |
Implementation of the following during regular floor training facilities and group classes: ‐ avoidance of body contact ‐ 1 metre distance between individuals, ‐ 2 metre distance for high intensity activities Provision of disinfectants at all workstations Requirement of HW and cleaning of all equipment by members before and after use with utensils provided No physical contact between participants or participants and instructors Regular cleaning of facilities by facility employees Create lists of what should be cleaned and how often Disinfection of instructor microphones Extra cleaning of frequently touched surfaces (e.g. door handles, card readers, washbasin batteries) Frequent refilling at all hygiene stations Avoid queuing by making sure group classes do not start and stop at same time and keep 15 min minimum between group classes Access control by facility employees Closure of showers and sauna but changing rooms open Staff presence during all opening hours Removal of lids on trash cans Reminders of infection preventive measures Communication to members about changes to training for social distancing Advice to members to stay home if any COVID‐19 related symptoms Advice to members to avoid touching eyes, nose and mouth Closure of childcare facilities |
Facility employees controlled access and enforced implementation of guidelines and procedures at all times Staff present during all opening hours Not reported if training needed for facility staff |
Face‐to‐face individually and as a group | 5 health and fitness training facilities in Oslo, Norway | 3 weeks May 22nd to June 15th, 2020 Hours of access not reported; presumably the participants had unlimited access to training facility within the procedures for distancing |
Masks not required, so were optional Change rooms available Access controlled to avoid overcrowding Staff monitored that distance measures were ensured Number of people attending depended on size of gym and associated changing rooms, showers and toilets. Facility to calculate the maximum number who could train at the same time while maintaining 1 to 2 m distance, as well as toilet, shower and change room capacity |
None described | Staff monitored access and distancing No apparent measures of fidelity |
None described |
| Miyaki 2011 | Quarantine from work (stay‐at‐home order) | Employees | Prevent spread of influenza in workplaces by quarantining workers who had a co‐habiting family member with an ILI | Full wages to employee | Non‐compulsory asking of workers whose family members developed an ILI to stay at home voluntarily on full wages. Daily measuring of temperature before leaving work. Where symptoms were doubtful, industrial physician made judgement. Company doctors provided input on cancelling of stay‐at‐home orders as required. |
Health management department oversaw the procedures and decisions. |
Mode of advice to employees not described. | Car industries in Japan | Stay‐at‐home order for 5 days after resolution of ILI symptoms or 2 days after alleviation of fever over 7.5 months | Strict standard for cancelling of stay‐at‐home orders described. | None described. | Recording of compliance with stay‐at‐home request | 100% compliance to stay at home reported. |
|
Young 2021 (additional source: Denford 2022) |
Daily contact testing (DCT) with Lateral Flow Device (LFD) for contacts of COVID‐19 cases | Students and staff from secondary schools and further education colleges | Provide a quicker, more convenient and alternative testing option and policy for COVID‐19 close contact testing in schools, as an alternative to self‐isolation | SARS‐CoV‐2 Lateral Flow Device (LFD) (Orient Gene, Huzhou, China)[47] |
In addition to twice weekly asymptomatic testing with LFD according to national policy: students and staff who were close contacts[48] of students or staff members who had a positive LFD or PCR were identified and offered daily LFD testing on arrival at school or college each morning (if asymptomatic and no household member isolating due to testing positive for COVID‐19) Participants swabbed own nose (anterior nares), supervised by trained staff. Swabs tested by school staff using LFC Contacts with negative LFC attended education but were asked to self‐isolate at home after school and on weekends/holidays Contacts with 5 negative tests (tests done over 7 consecutive days) including one on or after the 7th day of testing were released from self‐isolation Contacts with positive test were required to self‐isolate for 10 days, along with their contacts. Their school‐based contacts were identified and process repeated |
A study worker was funded at each school but role not specified School staff tested the swabs that were taken by students Study staff trained according to national NHS Test and Trace standard process supervised LFD testing |
Individually and face to face | 172 secondary government funded, residential, special and independent day schools and further education colleges in England | March to May 2021 Daily contact testing was performed at arrival at school each morning Day 1 of testing began the day after a case was identified Testing was done over 7 consecutive days (allowing for no testing on weekends) Schools actively participate between 19 April 2021 to 27 June 2021 (considered periods of low to moderate COVID‐19 incidence) |
When testing could not start immediately following identification of a case (e.g. due to a weekend), testing could start within 3 days of case identification | None reported | Daily participation rates in IG measured per day and per participant Compliance was calculated / school / week, and participant type, (= sum of all study school days of individuals eligible for DCT returning a test result or already having completed follow up each day, divided by the sum of individuals eligible for DCT. Qualitative interviews conducted to understand reasons for participation and not (reported separately in Denford 2022) |
Testing did not occur on 15.8% of person‐school‐days due to school or public health agency directives IG participation rate: 42.4% with marked variation between schools (range 0% to 100%). See Figure 2 for non‐participation reasons breakdown (e.g. testing kit unavailable, whole cohort moved to isolation). Staff more likely to participate than students. See Figure 2 for participation by school type breakdown “Although contacts at government‐funded schools with students 11–16 years old with a low proportion of free school meals were most likely to participate, other school types were similar, such that differences in participation related to factors other than school type.” (p. 1227) Qualitative analysis of interviews indicated daily testing may be feasible and acceptable but needs improved communication to students and parents about rationale, test interpretation and actions (Denford 2022) |
| Other (miscellaneous/multimodal) interventions | |||||||||||||
|
Ashraf 2020 (additional sources: Arnold 2013, Luby 2018, Parvez 2018, Rahman 2018, Unicomb 2018) |
6 active interventions of Water, sanitation, hygiene (WASH) and nutrition components: A. Water (W) B. Sanitation (S) C. Handwashing (H) D. Water + sanitation + handwashing (WSH) E. Nutrition F. Nutrition + WSH (WSHN |
Residents of households of village compounds and for some interventions, particularly pregnant women and their infants and children < 5 years | Improve environmental conditions to interrupt transmission of respiratory pathogens and improve child malnutrition thereby reducing childhood respiratory illness and improving childhood morbidity based on the Integrated Behavioural Model for Water Sanitation and Hygiene[33] and 2 years of iterative testing and revision. Intervention specific behavioural objectives: W: drink treated and safely stored water S: safe faeces disposal H: HW with soap at key times N: age‐appropriate nutrition birth to 24 months |
Free technologies and supplies: W: chlorine (sodium dichloroisocyanurate) tablets (Aquatabs, Medentech, Wexford, Ireland) ‐ 10 L insulated safe storage vessel (Lion Star Plastics, Sri Lanka) with a lid and tap for drinking water per household S: Dual‐pit pour flush latrines with water seals for all compound households. Each pit had 5 concrete rings 0.3 m high; ‐ Potties[34] (RFL, Bangladesh) ‐ Sani‐scoops[35] (locally developed hand‐tool made for the trial for removal of faeces from compound) for households with index children H: 2 HW stations, 1 water reservoir near kitchen (16 L) and 1 near latrine (40 L), each with basins for rinsing with a soapy water bottle (RFL, Bangladesh) and detergent sachets for index households[36] N: supply of lipid‐based nutrient supplements (LNS, Nutriset; Malaunay, France) (for 6 to 24 months olds) 2 10g sachets per day per child; (118 kcal, 9.6g fat, 2.6g protein, 12 vitamins and 10 minerals) Cost: USD 0.08/day 18‐month shelf life Stipends for CHWs (USD 20/month for 24 months) delivered through mobile phone network to ensure timely payments Promoter’s guide for visits for each relevant intervention including: ‐ visit objective, ‐ target audience ‐ steps and materials to be used CHW ID badges Cell phones for CHW supervisors Training Plan and Manual for CHW supervisors covering: i) basic training ‐ introduction of project, CHW roles and responsibilities, introduction to behaviour‐change principles based on the IBM‐WASH theoretical framework and interpersonal and counselling communication skills. ii) Intervention‐specific training iii) classroom practice / role playing |
Provision and delivery of supplies or installations as described in Materials column according to intervention type or combination. Interventions deployed so that they were in place before index children were born In combined intervention arms, the sanitation measures were delivered first, followed by handwashing, then water treatment. Household visits and community discussions based on behaviour change strategy by CHWs (paid a monthly stipend), including interactive sessions for developing solutions to improve practice. Key recommendations per IG: W: children drink treated, safely stored water from vessel (filled vessel with added 1 33 mg tablet, wait 30 min before drinking) S: family use double pit latrines, potty train children and how to safely dispose of faeces and clean and maintain latrines H: family wash hands with soap after defecation, after cleaning a child who has defecated, before eating or before feeding a child, and before food preparation N: recommendations for exclusive breastfeeding up to 180 days and maternal and infant nutrition to mothers and index children; introduce diverse complementary food at 6 months; feed LNS from 6 to 24 months, mixed into the child’s food (not intended as a replacement for breastfeeding or complementary foods). Messages adapted from the Alive & Thrive programme[37] On household visits, following a structured plan, CHWs greeted targeted household members, checked presence and functionality of relevant hardware and signs of use, observed recommended practice using a guide. CHWs used discussions, video dramas, storytelling, games and songs and provided training on hardware maintenance, where applicable Adherence observed and measured by separate team Supervision meetings of CHWs and periodic internal monitoring of their performance Intervention Delivery Team managed delivery through regular team phone calls, field meetings, field reports and liaison with relevant government and other stakeholders. It co‐ordinated CHWs to ensure rapid identification of issues with delivery. Including a dedicated training officer, it also trained the CHW supervisors who then trained the CHWs under their supervision (“train the trainer” approach) |
540 CHW or ‘promoters’ who were local women and residents of study villages recruited through transparent merit‐based selection methods and consultation with community leaders CHWs had completed minimum of 8 years formal education, lived within walking distance of IG cluster and passed a written and oral examination. They attended multiple training sessions and quarterly refreshers. Training covered active listening, strategies for developing collaborative solutions and technical aspects of interventions (see Table 1 of Luby 2018 for more details) CHWs were trained by 47 CHW supervisors who received direct training on intervention delivery Hardware installation team (n = 18) 9 field research officers The Intervention Delivery Team[38] co‐ordinated delivery including CHWs, overseen by Principal Investigators with consultation from Technical Advisory Group (see Unicomb, 2018) Dedicated Training Officer and Communication Development officer Adherence observed by separate team who received formal 21 day training |
Mostly face to face in groups and individually with some activities by phone | Households and compounds (n = 5551) of rural villages in Gazipur, Kishoreganj, Mymensingh and Tangail Districts in Bangladesh Households spread across 0.2 to 2.2 km radius |
2 years from May 2012 6 to 8 households / CHW 1:12 supervisor to CHW ratio CHWs visited households 1 / week for first 6 months, then at least 1 / fortnight Promoter training: Initial: W, S, HW: 4 days; N, WSH: 5 days; WSHN: 9 days Refresher training: 1 day each 21 day training of adherence team Monthly CHW supervisor meetings |
CHWs identified and addressed any barriers that arose through ongoing dialogue with caregivers CHWs met with supervisors monthly to adapt technology and behaviour‐change approaches to meet evolving conditions CHW supervisors available by cell phone as needed Training of promoter varied in content and length depending on intervention type Potties provided if children < 3 years |
S: latrine pits adapted when insufficient space (2% of cases) Functional water seals count was low (< 80% benchmark) in initial months which triggered a rapid response which improved uptake (Rahman 2018); households were using own latrines with broken water seals in parallel with trial latrines so pre‐existing latrines were closed, visits by CHWs were increased and water‐seal removal or breakage was discouraged Initial professional trainer for CHW training did not engage trainees enough so replaced with internal training resource group Due to observation of intervention fatigue reported by CHWs and sub‐optimal practices observed, new behaviour change activities were developed (e.g. further technology use, increasing self‐efficacy and roles for men) |
Measured by a separate trained team (university graduates) at regular intervals using a priori benchmarks: a) surveys and spot checks in 30 to 35 households / IG / per month, over 20‐month period; b) 5‐hours of structured observations in 324 IG and 108 control households, approximately 15 months after interventions commenced. Measured: W: Presence of stored drinking water with detectable free chlorine (> 0.1 mg/L) S: a latrine with functional water seal, sani‐scoop accessibility H: presence of soap at primary HW stations N: reported consumption of LNS sachets See Rahman 2018 for more details (Table 1) Continuous oversight and periodic monitoring of CHWs performance (CHW replaced within 1 month of attrition or critically low performance |
CHWs visited more than planned (5 to 7 / month) which researchers suggest may have affected uptake Reported “high adherence to all interventions” with “marked differences in promoted behaviors from the control group at both year 1 and year 2,” with over 75% adherence in the single IG and combined IGs. Similar adherence in single W, S, H and N IGs compared with WSH and WSHN S: observed use of latrines: 94% to 97%; child sanitation practices (37% to 54%) H: HW with soap in IG more common after toilet use (67% to 74%) versus 18% to 40% in non‐IGs and after cleaning child’s anus (61% to 72%) but low before food handling W: > 65% mothers and children observed drinking chlorine‐treated water from safe container N: LNS feeding > 80% 33 low performing CHWs discontinued See Luby 2018, Parvez 2018, Arnold 2013, Unicomb 2018 for more details |
|
Farr 1988a
trial 1 |
2 active interventions in addition to control of no tissues: A. Virucidal nasal tissues B. Placebo tissues |
Families | Reduce transmission of viruses from hand contamination via hand‐to‐hand contact or large‐particle aerosol through tissues for nose blowing and coughs and sneezes | 3‐ply tissues with: A. 5.1 mg/inch2 (2.54 cm2) of the virucidal mixture (58.8% citric acid, 29.4% malic acid, 11.8% sodium lauryl sulphate) B. 3 mg/inch2 (2.54 cm2) of saccharin applied uniformly to all 3 plies of the tissue Tissues prepared by Kimberly‐Clark Corporation, Neenah, WI, USA. |
Family visits to distribute tissues Weekly contact of mother Families instructed to only use supplied tissues. |
Nurse epidemiologist visited families. | Face‐to‐face visits to families and individuals in families (especially mothers) | Communities in the USA | 6 months overall Monthly family visits Weekly contact with mother |
Not described | Not described | Family visits and weekly contact with mother to encourage compliance | Not described |
| Farr 1988b trial 2 | 2 active interventions (no control): A. Virucidal nasal tissues B. Placebo tissues |
Families | Reduce transmission of viruses from hand contamination via hand‐to‐hand contact or large‐particle aerosol through tissues for nose blowing and coughs and sneezes | 2‐ply tissues containing: A. 4.0 mg/inch2 (2.54 cm2) of antiviral mixture (53.3% citric acid, 26.7% malic acid, 20% sodium lauryl sulphate) B. 3 mg/inch2 (2.54 cm2) of succinic acid, malic acid, sodium hydroxide, and polyethylene glycol Tissues prepared by Kimberly‐Clark Corporation, Neenah, WI, USA. |
Family visits to distribute tissues and encourage compliance Weekly contact of mother Families instructed to only use supplied tissues. |
Nurse epidemiologist visited families monthly. Study monitor visited bimonthly. |
Face‐to‐face visits to families and individuals in families (especially mothers) | Communities in the USA | 6 months overall Monthly family visits Weekly contact with mother Bimonthly study monitor visit |
None described. | None described. | Bimonthly study monitor visits to encourage compliance as well as monthly and weekly contact by nurse | In 124/222 families, 1 or more family members reported not using the tissues regularly and/or reported having side effects from the tissues. |
| Fretheim 2022a (additional source: Fretheim 2022b (protocol) | GLASSY (GLasses Against transmission of SARS‐CoV‐2 in the communitY | Adult members of the public who did not regularly wear glasses and who owned or could borrow glasses to use (e.g. sunglasses) | Provide a simple, readily available, environmentally friendly, safe and sustainable means of personal protection from infection with respiratory viruses including SARS‐CoV‐2 | Instructions via online portal Regular eyewear, e.g. sunglasses owned by participant or that could be borrowed by participant |
Request to wear sunglasses or other types of glasses when outside home and close to others in public spaces for 14 days | Research team | Individually Instructions provided via email and online portal (Nettskjema‐platform)accessed via web‐page hosted by the Norwegian Institute of Public Health |
Outside the home, e.g. on public transport, in shopping malls (in Norway) |
14 days when outside and close to others in public spaces Over 11 to 12 week period (February – April 2022) |
Could borrow glasses if did not own any | None reported. | No contact was made with participants between enrolment and data collection. | Reported use of glasses often, almost always, or always: IG: 71% CG: 11% Negative experiences (especially fogging with mask use): IG: 21/76 |
|
Longini 1988 |
2 active interventions (no control): A. Virucidal nasal tissues B. Placebo tissues |
Households and their families | Prevent intrafamilial transmission of viral agents in a community setting | Treated tissues of 3‐ply material identified with no specific identifiers (Kimberly‐Clark Corporation) with inside layer containing: A. citric and malic acid plus sodium lauryl sulphate; B. succinic acid. |
Tissues delivered to households with specific instructions on use (all purposes, when blowing nose, coughing or sneezing) and to discard after use and to help young children use tissues if develop a cold. | Tissues assigned by study sponsor (Kimberly‐Clark Corporation). | Supply of tissues throughout 5‐month trial period | Households in the USA | 5 months' overall supply | Resupply of tissues as required | None described. | Reported use of tissues “not at all, some of the time, most of the time, or all of the time” | Reported use “all of the time”: A. versus B. 82% versus 71% |
|
Chard 2019 (additional details from Chard 2018) |
Water, Sanitation, and Hygiene for Health and Education in Laotian Primary Schools (WASH HELPS) | Primary schools and their students | Prevent the spread of pathogens within schools through improved water supply and hygiene facilities and improved WASH habits in children at home and throughout the life course |
For each school: Water supply for school compound: (borehole, protected dug well with pump, or gravity‐fed system) Water tank to supply toilet and hand‐washing station School sanitation facilities (3 toilet compartments) Hand‐washing facilities: 2 sinks with tapped water and supply of soap available (1 bar of soap/pupil) 3 group hand‐washing tables with soap and water At least 1 drinking water filter per classroom Schedules of daily group hand‐washing, compound and toilet cleaning Cost per school: USD 13,000 to 17,500 |
Provision of school: Water supply, sanitation facilities, hand‐washing facilities (individual and group), drinking water filters Behaviour change education and promotion including daily group hygiene activities Daily hand‐washing and cleaning schedules |
UNICEF paid for materials. School and teachers conducted daily hand‐washing activities with children. Students participated in daily group cleaning activities. |
Facilities provided within schools. Children participated in group hand‐washing and cleaning. |
Primary schools and their classrooms (in Laos) |
One‐off provision of water and hygiene facilities Daily hand‐washing activities and cleaning for 1 school year Cleaning schedules posted in at least 1 classroom near toilet. |
Water supply tailored to the school requirements/environment. Sanitation facilities provided as needed and designated for boys, girls, and students with disabilities. |
Rain water tank provision affected by rain water supply, so changed to tanks with motorised hand pumps or gravity‐fed water supply systems. Theft and animal consumption of supplied soap reduced supply. |
Unannounced visits every 6 to 8 weeks for structured observations to measure fidelity and adherence Fidelity Index score (0 to 20): for hardware provided see Table 1 in paper and protocol Adherence index: student report of behavioural outcomes index score (0 to 4) |
Fidelity: 30.9% across all schools and visits Adherence: 29.4% Hardware provision: 87.8% of schools School‐level adherence: 61.4% Group compound cleaning: 94.8%, toilet use: 75.5%, group toilet cleaning: 68.3%, group hand‐washing: 48.7%, individual hand‐washing with soap after toilet use: 23.9%. Further details (Chard 2018) |
|
Hartinger 2016 |
Integrated environmental home‐based intervention package (IHIP) | Households and their householders including children | Reduce infections and improve child growth in households in rural communities with limited facilities through a multi component, low‐cost environmental intervention to improve drinking water, sanitation, personal hygiene, and household air quality developed in pilot (Hartinger 2011; Hartinger 2012) using a participatory approach that addressed local beliefs and cultural views | Per household: "OPTIMA‐improved stove": improved ventilated solid‐fuel stove Kitchen sink with in‐kitchen water connection providing piped water Point‐of‐use water quality intervention applying solar disinfection to drinking water |
Community engagement with local and regional stakeholders in design and development Provision of stoves, kitchen sinks, and plastic bottles for solar water treatment, and hygiene education Training of mothers/caretakers in: ‐ solar drinking‐water disinfection (SODIS)[39] according to standard procedures ‐ hand hygiene (washing own and children’s hands with soap at critical times[40]) ‐ advice to separate animals and their excreta from the kitchen environment Project‐initiated repairs |
Health promoters hired local elementary school teachers and implemented and promoted the interventions. 4 teams of field staff conducted spot‐check observations. |
Face‐to‐face and to individual households; mode of delivery of training as individual or group not described | Households in rural communities in Peru | Stoves and sinks installed over initial 3 months. Monthly reinforcement over 12 months of SODIS, child and kitchen hygiene Weekly spot checks of compliance Repairs after 9 months Environmental samples test middle and end of 12‐month surveillance. |
Tailored to particular household facilities and environments as needed and to local beliefs and cultural customs Repairs to stoves as needed and checked at 9 months |
Not described | Weekly spot‐check observations of household hygiene and environmental health conditions (e.g. presence of SODIS bottles on the roof or kitchen) using a checklist Monthly self‐report by mothers of stove and sink use |
SODIS use: 60% initially and 10% at end of study Self‐reported use by mothers: 90% with slight decrease at end Self‐reported stove use: 90% daily Sink use: 66% daily 35% of stoves needed minor repairs, 1% needed major repairs. Best‐functioning stoves achieved mean 45% and 27% reduction of PM2.5 and CO, respectively, in mothers’ personal exposure. |
| Huda 2012 | Sanitation Hygiene Education and Water Supply in Bangladesh (SHEWA‐B) | Villages and their households with a child < 5 years old | Reduce illness in children < 5 years by improving hygiene practices, sanitation and water supply and treatment in their household | Materials for training of community hygiene promoters and promotion activities including flip charts and flash cards with messages alerting participants to presence of unobservable “germs” and practices to minimise germs See Box 1 in paper for 11 key messages.[41] |
Engaging local residents under guidance of local NGOs to develop community action plans addressing: Latrine coverage and usage Access to and use of arsenic‐free water Improved hygiene practices, especially hand‐washing with soap Recruitment and appointment of community hygiene promoters Household visits, courtyard meetings, and social mobilisation activities (e.g. water, sanitation and hygiene fairs, village theatre, group discussions in tea stalls (the social meeting point for village men)) by community promoters Structured observation in households |
Community hygiene promoters (local residents with at least 10 years' schooling trained for 10 days on behaviour change communication in water, sanitation, and hygiene) | Face‐to‐face delivery to groups (villages and households) and individuals | Villages and households in districts of Bangladesh Community activities held in villages. Meetings held in courtyards of groups of households. Household visits |
18 months overall Expected household visit and courtyard meeting every 2 months Hand‐washing opportunities: after own or child’s defecation, prior to preparing and serving food, prior to eating and feeding a child |
Community action plans developed for and by local residents. | Not described | Structured observation of hand‐washing and child faeces disposal behaviour in households and spot checks of type of household water and sanitation facilities | HW: Food‐related: No significant difference from baseline to 18 months; IG versus CG After anus cleaning: 36% versus 27% Defecation: 30% versus 23% No access to latrine decreased from 10.3% to 6.8%. No significant improvement in access to improved latrines, solid waste disposal, drainage systems, and covered containers for water storage |
|
Ibfelt 2015 |
Disinfection of toys | Daycare nurseries | Reduce transmission of pathogens via shared toys in daycare environment through regular disinfection treatment | Disinfectants: Turbo Oxysan (Ecolab, Valby, Denmark) for washing machines Sirafan M, Ecolab (1% to 3% benzalkonium chloride, 1% to 3% didecyldimethylammonium chloride, and 5% to 7% alcohol ethoxylates) for immersion or wiping |
Collection and commercial cleaning of toys from nurseries:
‐ linen and toys suitable for washing machines were washed at 46 °C and subsequently disinfected ‐ toys not suitable for washing machines immersed in disinfectant or wiped with microfibre cloth |
Commercial cleaning company: Berendsen A/S, Søborg, Denmark | Cleaning companies collected the toys and linen and cleaned them offsite, then returned them. | Daycare nurseries in Denmark Commercial industrial cleaning facility |
2 to 3 months overall Cleaning every 2 weeks |
Staggered cleaning to ensure children had toys to play with whilst others were being cleaned | None described. | None described. | None described. |
| Najnin 2019 (see also Qadri 2015 for further details) | 2 active interventions: A. Combined cholera vaccine and 'behaviour change communication' intervention B. Cholera vaccine‐alone group |
Low‐income households and compounds | Prevent or reduce transmission of respiratory illness based on the Integrated Behavioural Model for Water Sanitation and Hygiene (IBM‐WASH) theoretical framework (Dreibelbis 2013; Hulland 2013) | A. and B. Cholera vaccine ShanChol™ (Shantha Biotechnics‐Sanofi, India) A. Following hardware per compound: a. Hand‐washing hardware: (i) Bucket with a tap (provided free of charge) (ii) Soapy water bottle (mixture of a commercially available sachet of powdered detergent (∼USD 0.03) with 1.5 L of water in a plastic bottle with a hole punched in the cap) supplied by participating compounds (iii) Bowl to collect rinse water after washing hands (see photo in text or in Najnin 2017 doi.org/10.1093/ije/dyx187) b. Water treatment hardware: Dispenser containing liquid sodium hypochlorite See Figure 2 in Najnin 2017 for photos of both doi.org/10.1093/ije/dyx187 and more details. Participants own water vessels for water treatment Print materials for behaviour change to compounds and households |
A. and B. Provision of cholera vaccine (2 doses at least 14 days apart) Provision of hand‐washing hardware and behaviour change communication activities Encouragement of hand‐washing after defecation, after cleaning child’s anus, and before preparing food Encouragement to add chlorine to own water vessels Benefits were again explained. Follow‐up visits by health promoters |
Dushtha Shasthya Kendra (DSK), an NGO, delivered the hardware and behavioural intervention (through community health promoters). Separate data collectors observed soap availability. |
Hand‐washing and water treatment hardware mostly delivered at the compound level in person. Behaviour change communication messages were delivered both at compound and household levels. |
Households and compounds (where several households share a common water source, kitchen, and toilets) in Bangladesh |
Behaviour change communication messages delivered first (within 3 months of cholera vaccination). Point‐of‐use water hardware provided 3 months later. Follow‐up health promoter visits 3 times in 2 months after hardware installation, then 2 times/month (over nearly 2 years). |
Hardware‐related problems (breakage/leakage) were addressed on health promoter follow‐up visits. | None described. | Unannounced home visits by data collectors who observed presence of soap/soapy water and water in most convenient place for hand‐washing (either reserved in a container or available at the tap) Residual chlorine was measured indicating uptake of chlorine dispenser. |
Presence of soap / soapy water and water: A. Handwashing group compounds: 45% (1729 / 3886); B. Vaccine‐only group compound: 22% (438 / 1965); C. Control: 28% (556 / 1991) Residual chlorine present in stored drinking water of 4% (160/3886) of households in the vaccine‐plus‐behaviour‐ change compound and none in the other 2 compounds. |
| Swarthout 2020 (additional sources: Arnold 2013, Christensen 2015, Dentz 2017, Null 2018, Pickering 2019) | 6 active interventions of water, sanitation, and handwashing (WASH), and nutrition components: A. Water (W) B. Sanitation (S) C. Handwashing (H) D. Combined (WSH) E. Nutrition (N) F. Combined (WSHN) |
Residents of households of villages and for some interventions, particularly pregnant women (Mamas) and their infants and children < 5 years; Landowners of communal water sources and compound heads for latrine upgrades and construction | Improve environmental conditions to interrupt transmission of respiratory pathogens and improve child malnutrition thereby reducing childhood respiratory illness and improving childhood morbidity based on a literature review, a theory‐based approach (health belief, social cognitive theory and persuasion theory),[42],[43],[44] formative research and the WASH Benefits pilot RCT (Christensen 2015) | Free technologies as appropriate to IG: W: water treated with sodium hypochlorite (1.25% solution / 2 mg/L) using chlorine dispensers installed at communal water source collection points or bottled chlorine (1L for 333 20‐l jerry‐cans worth)[45] provided to households in compounds Chlorine strips to test chlorine levels S: installation of new or improvement of existing latrines with plastic slab latrines with tight‐fitting lids; plastic potties and sani‐scoops H: 2 HW stations (2‐foot pedal‐operated jerry‐cans that dispensed soapy and rinse water), 1 near food preparation, 1 near latrine. Rinse water provided by households; bar soap for soapy water container N: 2 x 10 g sachets / day / child of lipid‐based nutrient supplementation (LNS) “Mwanzobora”, (Nutriset, Malaunay, France) (118 kcal/day and 12 essential vitamins and 10 minerals) See Figure 2 of Christensen 2015 for photos of examples of some of the materials Community meeting and household visit summary sheets (in Kiswahili and English) and list of materials provided as PDFs at osf.io/7j9sk/ Key messages and visual aids provided at osf.io/7j9sk/ Including ~6 primary key messages per intervention, each with a series of specific topics, visual aids, and engagement activities (e.g. storytelling, mottos, etc.). Visual aids included: ‐ cue card reminders ‐ picture sheets for use by promoters ‐ calendars for households with key messages ‐ stickers for LNS box depicting appropriate feeding and storage Promoter Training Materials for trainers and trainees for each intervention for initial training and for refresher training including detailed PDF training manuals available at osf.io/7j9sk/ focusing on key hygiene messages, visitation scripts and visual aids and hardware for each intervention[46] Promoters’ supplies: Branded t‐shirt, mobile phone, job aids and intervention materials, payment ($US15/month for first 6 months, then $9/month thereafter), detailed plans for every visit (key messages, scripts for visual aids, instructions for activities) |
Provision and delivery of supplies or installations as described in Materials column according to intervention type or combination Provision of study materials to promoters Community meetings Household and community visits by promoters who: ‐ delivered intervention‐specific behaviour change messaging focusing on themes of nurture, aspiration and self‐efficacy, considering convenience and cultural norms to improve adherence using scripts and visual aids; ‐ provided instructions on hardware use and consumable supplies where applicable ‐ advocated: W: drinking water treatment with sodium hypochlorite S: use of improved latrines for defecation and safe disposal of children’s and animals’ faeces and use of plastic potties by children < 3 years and sani‐scoops for faeces removal H: HW with soap before food preparation and after defecating (including assisting child); helped participants identify compound members to refill taps and manage barriers to use such as running out of soap N: early initiation of breastfeeding, exclusive breastfeeding 0 to 6 months and continued till 24 months; at 6 months, introduction of appropriate and diverse complementary foods; feeding frequency and during illness; supply of LNS to children 6 to 24 months and instruction to mix it was foods twice/day Promoters used visual aids to promote messages: ‐ cue cards provided to Mamas at initial visits to hang on walls for reminders ‐ picture sheets used by promoter to explain key concepts or messages ‐ calendars provided to households during first compound visit ‐ stickers attached to LNS box Adherence checking unannounced visits Initial training on intervention‐specific behaviour change messages and materials Refresher training Periodic observation and supportive supervision by study staff |
Community‐based health promoters nominated by their local communities and trained in the relevant intervention to be implemented Field enumerators assessed adherence in compounds Study staff trained promoters, provided periodic observation and supervision and monthly phone calls |
Face to face in groups (e.g. households or compounds) or individuals (mothers and their children) | 8246 households and 7960 compounds of rural villages in Bungoma, Kakamega, and Vihiga counties in western Kenya | Installation and supply of materials before community meetings Community meeting 6 weeks after enrolment Monthly visits (45 to 60 min in 1st year) by promoters over 2 years (2012 to 2014) Timing of visits detailed in procedures provided at osf.io/7j9sk/ W: 1 L bottle of chlorine / 6 months H: bar soap provided every 3 months N: LNS introduced at 6 months of age of child Promoter training: 6 days single IGs. 7 days combined IGs. Refresher training at 6, 12 and 18 months after initial training Supervision and observation of promoter by study staff at 2, 4, 9, 14 and 21 months and monthly phone calls |
Training tailored for different interventions Troubleshooting of solutions to barriers to adherence by promoter and participants as needed Nutrition messaging was tailored to be age‐appropriate Materials provided in both in Kiswahili and English Chlorine dispensers located based on list of sources participants reported (at baseline) using for water collection Sani‐scoops and potties were to be washed by caregivers with soap and water after use and tools kept out of reach of children (see the visual aids provided to participants: osf.io/9r4kg/ for potties and osf.io/mz2c6/ for sani‐scoops) |
None described | Participant reports of visits by promoters in past month Unannounced visits by staff to a random sample of at least 20% of participants in IGs at 2, 6, 10, and 19 months after the interventions began to confirm delivery of materials and monitor availability of intervention materials and recommended behaviours after the interventions began (Null 2018) W: monthly tests of chlorine concentration in stored water; negative results prompted discussions to address chlorination barriers S: participant report of access to improved latrine; field enumerators observed if latrine had plastic or cement slab or ventilation pipe; caregiver report that child faeces safely disposed H: field enumerator observed if water and soap available N: report of LNS sachets consumed by child in last week / 14 |
All interventions delivered within 3 months of enrolment Increased adherence indicators of ≥ 30% higher in all IGs relative to the control in the first year Adherence was comparable between the Individual IGs compared with combined IGs. W: 5 chlorine dispensers installed / cluster Year 1: 74% Year 2: 37% households were visited by a promoter in previous month W: Year 1: 42% Year 2: 21% had detectable total chlorine CG: 3% S: Year 1 and 2: > 80% had latrine access CG: 20% HW: Year 1: 77% Year 2: 21% had HW materials CG: 9% N: Year 1: 95% Year 2: 115% of expected sachets consumed See Null 2018 for more details |
| Oral and/or nasal applications | |||||||||||||
| Almanza‐Reyes 2021 | Mouthwash and nose rinse with ARGOVIT silver nanoparticles (AgNPs) |
Healthcare personnel (doctors, nurses, administrative staff) of a metropolitan hospital caring for patients diagnosed with atypical pneumonia and/or COVID‐19 | Reduce morbidity in healthcare professionals exposed to SARS‐Co V‐2 by inhibiting virus replication | Per participant: ‐ 50 ml bottle of RGOVIT® AgNPs mouthwash and nasal rinse [Investigation and Production Center Vector‐Vita Ltd., Novosibirsk, Russia] (metallic silver 0.06%, polyvinylpyrrolidone 0.63%, hydrolyzed collagen 0.31%, distilled water 99% wt.) ‐ water ‐ cotton swabs |
Individuals provided with spray bottle containing AgNPs solution with 1 wt% concentration (0.6 mg/mL metallic silver) and instructed to do 1 of the following or a combination: a) mix 4 to 6 spray shots (~ 0.5 mL) with 20 mL of water and gargle solution for 15 to 30 seconds at least 3 times/day (gargle) or b) do not dilute with water and cover the oral cavity evenly with 1 to 2 direct spray shots (spray) c) apply the same solution to the inner part of the nasal alae and nasal passage with cotton swab twice a day (nasal rinse) |
Researchers supplied materials and instructions Participants self‐applied the mouthwash and nasal rinse materials |
Individually and face to face | General hospital in Tijuana, Mexico | Over a 9 week period (April to June 2020) 4 to 6 spray shots of AgNP solution (0.5 mL) with 20 mL of water or 1 to 2 spray shots of solution without water for 15 to 30 seconds ≥ 3 times / day and 1 nasal lavage 2 times / day |
Participants could choose application method | None described | Weekly self‐report of number of: daily gargles; mouthwashes with spray; mouthwashes by gargle + spray; and nasal rinses |
Mean applications/ day: Gargle only: IG: 2 (n = 28) CG: 2.14 Spray only: IG: 2 (n = 34). Both gargle and spray: IG: 2 gargles, 4 sprays (n = 52) Nasal rinse: IG: 0.70 (n = 64) CG: 0.25 |
| Gutiérrez‐García 2022 | Nasopharyngeal and oropharyngeal rinses with a neutral electrolyzed water (SES) | COVID‐19 front‐line medical staff (nurses and physicians, males or females) | Reduce risk of COVID‐19 in frontline unvaccinated medical staff | SES (pH 6.5 to 7.5; REDOX potential 750‑950 mV; 0.0015% of active species of chlorine and oxygen) provided by Esteripharma S.A. de C.V Per participant: ‐ 4 plastic flasks of 240 mL oral SES (ESTERICIDE® Bucofaríngeo, COFEPRIS registration no. 1003C2013 SSA) with a graduated cap and ‐ 4 plastic flasks of 30 mL nasal rinse (EsteriFlu®, COFEPRIS registration no. 308C2015 SSA), with a valve for spraying |
Written instructions provided to follow a prophylactic rinse protocol with SES 3 times/day for 4 weeks with advice on correct way to use the mouthwashes and sprays and the need to report possible side effects immediately: a) nasal cavity: 4 vertical sprays in each nostril, inhaled deeply at the time of each spray b) oral cavity: mouthwash and gargle 10 mL for 60 seconds, then spit out In addition to standard COVID‐19 safety protocols requiring wearing of adequate personal protection equipment at all times,[49] frequent handwashing[50] and disinfection of secondary uniform and footwear[51] and bath at end of working day |
Not clearly specified; leaders of nursing and other relevant healthcare department distributed the study information and were the point of contact and monitored the protocol so they may have distributed intervention materials | Individually and face to face | Mexican COVID‐19 hospital | 4 nasal sprays (~ 0.4 mL) and 10 mL mouthwash gargle for 60 seconds 3 times / day for 4 weeks (September to November 2020) | None described | None described | None described | None described |
| Goodall 2014 | 2 active interventions: A. Vitamin D3 supplementation B. Gargling water | University students | Decrease the incidence of URTI through increased vitamin D levels (associated with greater frequency and severity of URTI) and gargling (as preventative measure against URTI) | A. Vitamin D3: container of 8 capsules of 10,000 IU (purchased from Euro‐Pharm International Canada Inc.) Weekly email reminder B. Gargling: 30 mL of tap water 2/day | A. Vitamin D: instructed to take 1 pill weekly
B. Gargling: instructed to gargle twice daily for 30 seconds All participants received general lifestyle and health advice on sleep, nutrition, hand hygiene, and exercise. |
Not specified, presumably the researchers, including a study pharmacist | Vitamin D3 supplied individually, but no further details. Method of lifestyle and health advice provision also not described. | In university student housing (in residences or off‐campus) in Canada | 2 months overall Vitamin D3: weekly supplementation and email reminder Gargling: 30 mL of water for 30 seconds twice daily | None described. | None described. | None described. | None described. |
| Ide 2014 | 2 active interventions (no control): A. Green tea gargling B. Water gargling | High school students | Prevent influenza spread and infection in high school students who are at increased risk from close interaction through gargling as a non‐pharmaceutical intervention, specifically green tea containing highly bioactive catechin (‐)‐epigallocatechin gallate, with possible anti‐influenza virus properties | A. Bottled green tea (500 mL) containing a catechin concentration of 37 ± 0.2 mg/dL, including approximately 18% (‐)‐epigallocatechin gallate (manufactured by the Kakegawa Tea Merchants Association). Concentration measured by high‐performance liquid chromatography based on the average concentration in 10 bottles from the same production lot (September 2011) used for gargling in the study. B. Tap water | A. Provision of green tea B. Advice to gargle with tap water and not to gargle green tea during study A. and B. Advice to gargle at least 3 times/day (after arriving at school, after lunch, and after school) Consumption of green tea and other tea was not restricted for either group. Safety monitoring carried out throughout the study (not further described). | Materials supplied by researchers. High schools’ vice principals and head teachers assisted with safety monitoring. | Green tea supplied individually to students. Mode of gargling advice not described. | High schools in Japan | Gargling 3 times/day for 90 days | None described. | None described. | Daily questionnaire included questions about daily adherence to gargling regimen. Adherence rate of gargling at or above 75%, and absence of green tea gargling when in the water gargling group. | Gargling adherence rate: green tea group: 73.7%; water group: 67.2% |
| Satomura 2005 | 2 active interventions: A. Water gargling B. Povidone‐iodine gargling |
Healthy adults | Prevent URTIs through gargling water alone, which may wash out pathogens from the pharynx and oral cavity through whirling water or through chlorine, or povidone‐iodine for its perceived virucidal properties | A. Water B. 15 to 30 times diluted 7% povidone‐iodine (as indicated by manufacturer) | Local administrators instructed participants to: ‐ gargle dose of water or povidone‐iodine 3 times/day; ‐ maintain hand‐washing routine; ‐ not change other hygiene habits; ‐ not take any cold remedies; ‐ complete gargling diary. Weekly monitoring of hygienic actions and encouragement to keep up assigned intervention every week | Local project administrators (18 healthcare professionals) provided instructions and monitoring and encouragement. | Not specified, but likely to have been face‐to‐face and individually, at least initially for instructions | 18 healthcare sites in Japan (4 in northern region, 9 in central region, 5 in western region) | 60 days overall 1. Water gargling: 20 mL for 15 s at least 3 times/day 2. Povidone‐iodine gargling: 20 mL of dilution 3 times/day | If diluted povidone‐iodine caused serious discomfort or was not available, participants were allowed to gargle with water instead. | 3 participants assigned to povidone‐iodine gargled with water instead as the povidone‐iodine “did not agree with them”. | Completion of gargling diary: frequency of gargling and hand‐washing Weekly monitoring and encouragement by local administrators | 9 participants did not complete diary. Average frequency of gargling / person / day: With water: A: 3.6 B: 0.8 Control: 0.9 With povidone‐iodine: A.: < 0.1 B: 2.9 Control: 0.2 |
ABH: alcohol‐based rub AGNPs: ARGOVIT silver nanoparticles ARI: acute respiratory infection CDC: Centers for Disease Control and Prevention CG: control group CHG: chlorhexidine gluconate CHW: community health worker CO: carbon monoxide DCCs: daycare centres DCT: daily contact testing FM: face masks H: handwashing HCP: healthcare personnel HCW: healthcare worker HH: hand hygiene HSG: hand sanitiser group HSW: hand‐washing with soap and water HW: hand‐washing HWWS: hand‐washing with soap IG: intervention group IHIP: integrated environmental home‐based intervention package ILI: influenza‐like illness IU: international units LFD: lateral flow device LNS: lipid‐based nutrient supplements LTCFs: long‐term care facilities m: metre min: minute N: nutrition NGOs: non‐governmental organisations NH: nursing home NHS: National Health Service no.: number NPIs: non‐pharmaceutical interventions PCR: polymerase chain reaction PM2.5: particulate matter of less than 2.5 microns RAs: research assistants RIs: respiratory infections RTIs: respiratory tract infections S: sanitation SD: standard deviation SES: electrolysed water SSTI: skin and soft‐tissue infection SWG: soap‐and‐water group TCID: tissue‐culture infectious dose URTI: upper respiratory tract infection W: water WHO: World Health Organization wk: week WSH: combined water, sanitation and handwashing WSHN: combined water, sanitation, handwashing and nutrition w/w: weight for weight
[1] Filtration efficiency testing was conducted using a Fluke 985 particle counter (volumetric sampling rate of 2.83 litres/ minute. The measurement was taken of particles 0.3–0.5 μm in diameter flowing through the material with a face velocity of 8.5 cm/s. Internal testing found that cloth masks with an external layer made of Pellon 931 polyester fusible interface ironed onto interlocking knit with a middle layer of interlocking knit could achieve a 60% filtration efficiency. Upon discussions with the manufacturers, the researchers learned that those materials could not be procured. Using materials that were available, the highest filtration efficiency possible was 37%. [2] “the exterior and interiors were spunbond and the middle layer was meltblown” [3] 10 times with bar soap and water [4] Featured the Honorable Prime Minister of Bangladesh Sheikh Hasina, the head of the Imam Training Academy, and the national cricket star Shakib Al Hasan. [5] A grassroots organization with a network of volunteers across the country [6] “consistent with the WHO guideline that defines physical distancing as one meter of separation.” www.who.int/westernpacific/emergencies/covid-19/information/physical-distancing (accessed 13 June 2022). [7] Occupational Safety and Health Administration (OSHA). OSHA technical manual: section VIII: chapter 2: respiratory protection. US Department of Labor. www.osha.gov/dts/osta/otm/otm_viii/otm_viii_2.html (accessed 21 April 2020). [8] Ministry of Health and Long‐Term Care, Public Health Division, Provincial Infectious Diseases Advisory Committee. Preventing respiratory illnesses: protecting patient and staff: infection control and surveillance standards for febrile respiratory illness (FRI) in non‐outbreak conditions in acute care hospitals [September 2005] http://www.health.gov.on.ca/english/providers/program/infectious/diseases/best_prac/bp_fri_080406.pdf (accessed September 11 2009). [URL inactive] [9] Before eating, after sneezing, coughing, handling money, using restroom, returning to desk and interacting with others who may be sick [10] after coming into classroom, before and after lunch, after break, after physical education, when they went home and after coughing, sneezing or blowing their noses [11] after toileting and when visibly dirty plus a protocol for particular circumstances: after coming into the classroom; before and after lunch; after playing outside; when they went home; after coughing, sneezing, or blowing their noses; and after diapering [12] 1) when entering into the classroom; 2) after sneezing, coughing, or blowing their nose; 3) after using the toilet/washroom; 4) before eating any food; and 5) when leaving the school at the end of the day [13] what to do if hands were dirty, why students should wash their hands, benefits of washing hands and using hand sanitiser, procedure for washing hands using hand sanitiser, to cover mouth and nose with upper part of sleeve while coughing and/or sneezing [14] Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, HICPAC/ SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in healthcare settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/ IDSA Hand Hygiene Task Force. MMWR Recommendations and Reports 2002;51(RR‐16):1–45. www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm (accessed 21 April 2020). International Bank for Reconstruction and Development/ World Bank, Bank‐Netherlands Water Partnership, Water and Sanitation Program. Hand washing manual: a guide for developing a hygiene promotion program to increase handwashing with soap. http://go.worldbank.org/PJTS4A53C0 (Accessed 16 May 2007). [URL inactive] California State Department of Education. Techniques for Preventing the Spread of Infectious Diseases. Sacramento (CA): California State Department of Education, 1983. Geiger BF, Artz L, Petri CJ, Winnail SD, Mason JW. Fun with Handwashing Education. Birmingham (AL): University of Alabama, 2000. Roberts A, Pareja R, Shaw W, Boyd B, Booth E, Mata JI. A tool box for building health communication capacity. www.globalhealthcommunication.org/tools/29 (Accessed 10 October 2007). [URL inactive] Stark P. Handwashing Technique. Instructor’s Packet. Learning Activity Package. Sacramento (CA): California State Department of Education, 1982. [15] DIN EN 1500: Chemische Desinfektionsmittel und Antiseptika, Hygienische Händedesinfektion, Prüfverfahren und Anforderungen (Phase 2/Stufe 2). Brüssel (Belgium): CEN, European Comittee for Standardization 1997;1‐20. [16] DIN EN 12791: Chemische Desinfektionsmittel und Antiseptika, Chirugische Händedesinfektionsmittel ‐ Prüfverfahren und Anforderungen (Phase 2/Stufe 2). Brüssel (Belgium): CEN, European Comittee for Standardization 2005;1‐31. [17] after defaecation, after cleaning an infant who had defaecated, before preparing food, before eating, and before feeding infants [18] non‐governmental organisation that supports community‐based health and development initiatives [19] “Healthy Hands” Rules (from Figure 3 in paper): Do use “special soap” when arrive to school, before lunch, after go to bathroom (only if soap and water not available), if rub nose or eyes or if fingers in mouth, if teacher asks. Do not: use “special soap” if hand dirt on them, put “special soap” on another student, play with ‘special soap”, put hands near eyes after using “special soap”. [20] Calculated by subtracting each day’s soap weight from the previous day’s weight. Maximum number of grams of soap consumed for each compound was identified and the day on which the maximum soap consumption was recorded. A per capita estimate of daily soap consumption was calculated [21] National Health and Medical Research Council. Staying Healthy in Child Care. Canberra (Australia): Australian Government Publishing Service, 1994 [22] upon arrival, before and after lunch, and prior to departure [23] World Health Organization. (2012). Hand hygiene in outpatient and home‐based care and long‐term care facilities: a guide to the application of the WHO multimodal hand hygiene improvement strategy and the “My Five Moments For Hand Hygiene” approach. World Health Organization. apps.who.int/iris/handle/10665/78060 (accessed 15 June 2022) [24] Moment 1 (before touching a resident) = Room In; Moment 4 (after touching a resident) and Moment 5 (after touching a resident’s surroundings) = Room Out; Moment 2 (before a clean/antiseptic procedure) = Before Clean; Moment 3 (after body fluid exposure risk) – After Dirty [25] Handsome: handhygiëne in verpleeghuizen.: Zorg voor beter; 2019 May 03. URL: www.zorgvoorbeter.nl/handsome (accessed 7 June 2022) [26] Veiligheid en Kwaliteit: Project Handen uit de Mouwen.: Stichting Samenwerkende Rijnmond Ziekenhuizen [27] Auditor training.: Hand Hygiene Australia URL: www.hha.org.au/audits/auditor-training (accessed 7 June 2022) [28] no long nails, acrylic nails, or polished nails and not wearing a ring, bracelet, wristwatch, brace, or long sleeves. [29] Persoonlijke hygiëne: Verpleeghuizen, woonzorgcentra, voorzieningen voor kleinschalig wonen voor ouderen.: Werkgroep Infectie Preventie; 2014. URL: tinyurl.com/wpfqr8p (accessed 7 June 2022) [30] knowledge and awareness of HH guidelines, perceived importance of performing HH, perceived behavioural control (i.e. perceived ease or difficulty of performing the behaviour), and habit [31] “According to the Dutch national guidelines, HH is mandatory for caregivers before touching/preparing food, before caregivers themselves ate or assisted children with eating, and before wound care; and after diapering, after toilet use/wiping buttocks, after caregivers themselves coughed/sneezed/wiped their own nose, after contact with body fluids (e.g. saliva, vomit, urine, blood, or mucus when wiping children’s noses), after wound care, and after hands were visibly soiled.” (p. 2495) [32] Having touched household items being used by the index patients and/or other symptomatic household contacts, and after coughing/sneezing, before meals, before preparing meals and when returning home [33] Which addresses “contextual, psychosocial, and technological factors at the societal, community, interpersonal, individual, and habitual levels”. (Luby 2018) [34] Hussain F, Luby SP, Unicomb L, Leontsini E, Naushin T, Buckland AJ, et al. Assessment of the acceptability and feasibility of child potties for safe child feces disposal in rural Bangladesh. The American Journal of Tropical Medicine and Hygiene. 2017;97: 469–76. [35] Sultana R, Mondal UK, Rimi NA, Unicomb L, Winch PJ, Nahar N, et al. An improved tool for household faeces management in rural Bangladeshi communities. Tropical Medicine & International health 2013;18: 854–60. [36] Hulland KR, Leontsini E, Dreibelbis R, Unicomb L, Afroz A, Dutta NC, et al. Designing a handwashing station for infrastructure‐restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM‐WASH). BMC Public Health 2013; 13: 877. [37] Menon P, Nguyen PH, Saha KK, Khaled A, Sanghvi T, Baker J, et al. Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: results of a cluster‐randomized program evaluation in Bangladesh. The Journal of Nutrition 2016;146:2075–84. [38] comprised of: senior program manager‐intervention delivery, senior program manager‐operations, Sanitation Intervention Team leader, senior field research officer, training officer, field research officers, CHW supervisors and CHWs [39] SODIS: www.sodis.ch/index_EN.html [40] after defecation, after changing diapers, before food preparation and before eating [41] 1. Wash both hands with water and soap before eating/ handling food 2. Wash both hands with water and soap/ash after defecation 3. Wash both hands with water and soap/ash after cleaning baby’s bottom 4. Use hygienic latrine by all family members including Children 5. Dispose of children’s faeces into hygienic latrines 6. Clean and maintain latrine 7. Construct a new latrine if the existing one is full and fill the pit with soil/ash. 8. Safe collection and storage of drinking water 9. Draw drinking water from arsenic safe water point 10. Wash raw fruits and vegetables with safe water before eating and cover food properly 11. Manage menstruation period safely (p.605) [42] Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the Health Belief Model. Health Education Quarterly 1988;15:175–83. [43] Glanz K, Rimer BK, 2005. Theory at a Glance: A Guide for Health Promotion Practice. Washington, DC:US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute. [44] Hovland CI, Janis IL, Kelley HH, 1953. Communication and Persuasion; Psychological Studies of Opinion Change. New Haven, CT: Yale University Press. [45] Based on family of five, consuming 2L of water per person per day, the bottle would last almost a year [46] W: key concepts for water treatment and contamination, procedures for refilling dispenser and distributing bottled chlorine, chlorine testing and reporting; H: HW with soap at critical times and creating supportive environment; S: contamination pathways; N: early initiation and exclusive breastfeeding, complementary and supplementary feeding, LNS procedures for collection from health facility and delivery tracking, teaching mamas how to feed Mwanzobora to the child, cooking demonstration, age‐specific messaging about nutrition [47] Department of Health and Social Care. Lateral flow device performance data. July 7, 2021. www.gov.uk/government/publications/lateral-flow-device-performance-data (accessed 15 June 2022). [48] “applicable to schools as defined in national guidelines were, face to face contact (within 1 metre for any length of time) or skin to skin contact or someone the case coughed on; or within 1 metre for ≥1 minute; or within 1‐2 metres for >15 minutes.” P.2 of Supplementary appendix [49] i.e., surgical uniform, N95 mask, eye‑sealing glasses and plastic wallet, disposable cap, latex gloves, rubber footwear for hospital use and disposable shoe covers, while working. Additionally, third level care health professionals wore a full protective mask, Dermacare®, overalls with zipper, and an integrated hood with elastic hand and ankle cuffs, double disposable boot covers and double latex gloves. [50] With liquid soap (2% chlorhexidine gluconate) and hand disinfection (0.05% chlorhexidine gluconate and 60‑80% ethyl alcohol). [51] With 80% ethyl alcohol