A Hand Hygiene Intervention to Decrease Hand, Foot and Mouth Disease and Absence Due to Sickness among Kindergarteners in China: A Cluster-Randomized Controlled Trial.

OBJECTIVES:To evaluate the effect of the "Clean Hands, Happy Life" intervention on the incidence of hand, food and mouth disease (HFMD) and on school absences due to sickness in kindergarten students.METHODS:The intervention consisted of four hand hygiene (HH) promotion components and was evaluated in a cluster-randomized controlled trial among 8275 children and 18 kindergartens from May to October, 2015 in Shenzhen, China. We compared two intervention arms - received the intervention in kindergartens only and in both kindergartens and families, respectively - to the control arm in multilevel analyses.RESULTS:During the follow-up, the incidence of HFMD in both intervention arms was significantly lower than in the control arm (IRR1: 0.39, 95%CI: 0.26-0.59; IRR2: 0.30, 95%CI: 0.19-0.49); the duration of absence due to sickness (in days) in both intervention arms was significantly shorter than in the control arm (β1 = 0.58, 95%CI: 0.41-0.74; β2 = 0.34, 95%CI: 0.17-0.50), controlling for the area type of kindergarten and grade level of children. Furthermore, during the follow-up we found that there were fewer episodes of absence due to respiratory, skin and eye infections (P < 0.05).CONCLUSIONS:Our intervention is effective at reducing HFMD infections and absence due to sickness in children attending kindergartens in China.