Azor‐Martinez 2018.

Study characteristics
Methods	A cluster‐RCT, controlled, and open study of 911 children aged 0 to 3 years attending 24 DCCs in Almería, Spain, with an 8‐month follow‐up. 2 intervention groups of DCC families performed educational and hand hygiene measures, 1 with soap and water (n = 274), another with hand sanitiser (n = 339), and the control group followed usual hand‐washing procedures (n = 298). Respiratory infection (RI) episode rates were compared through multilevel Poisson regression models. The percentage of days missed were compared with Poisson exact tests.
Participants	A total of 911 children attending 24 DCCs in Almería (Spain). Inclusion criteria: children between 0 and 3 years old enrolled in DCCs and attending for at least 15 hours per week whose parents or guardians had signed an informed consent Exclusion criteria: children with chronic illness or medication that could affect their likelihood of contracting an infection Data were analysed for 911 participants: hand sanitiser group (n = 339), soap and water group (n = 274), and control group (n = 298).
Interventions	2 intervention groups. 1 group used soap and water, another used hand sanitiser, whilst the control group followed usual hand‐washing procedures. Groups received 1‐hour hand hygiene workshop. See Table 4 for details.
Outcomes	Primary: RI incidence rate Secondary: (1) the presence or absence of at least 1 antibiotic prescription for each new RI episode during the study period (topical antibiotics were excluded), and (2) the percentage of RI absenteeism days in the 3 groups calculated as the ratio of RI absenteeism days to all possible days of attendance DCC absenteeism episode was defined as when a child failed to attend a DCC because of an RI. Respiratory illness was defined as the presence of 2 of the following symptoms during 1 day or the presence of 1 of the symptoms for 2 consecutive days‍: (1) runny nose, (2) stuffy or blocked nose or noisy breathing, (3) cough, (4) feeling hot or feverish or having chills, (5) sore throat, or (6) sneezing. No safety outcomes reported.
Notes	Government funded. This work was supported by a grant from the Andalusia Department of Health.  Competing interests: the authors have indicated they have no potential conflicts of interest to disclose.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer randomisation using statistical software for the sequence
Allocation concealment (selection bias)	Low risk	Clusters assigned prior to recruitment.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Unblinded study
Blinding of outcome assessment (detection bias) All outcomes	High risk	Unblinded study
Incomplete outcome data (attrition bias) All outcomes	Low risk	Attrition minimal and similar in 3 groups
Selective reporting (reporting bias)	Unclear risk	No protocol available