Published online August 31, 2005
PEDIATRICS Vol. 116 No. 3 September 2005, pp. 587-594 (doi:10.1542/peds.2005-0199)

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A Randomized, Controlled Trial of a Multifaceted Intervention Including Alcohol-Based Hand Sanitizer and Hand-Hygiene Education to Reduce Illness Transmission in the Home

Thomas J. Sandora, MD, MPH^*, Elsie M. Taveras, MD, MPH, Mei-Chiung Shih, PhD, Elissa A. Resnick, BS^*, Grace M. Lee, MD, MPH^*,, Dennis Ross-Degnan, ScD and Donald A. Goldmann, MD^*

^* Division of Infectious Diseases, Children's Hospital Boston, Harvard Medical School
Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School
Clinical Research Program, Children's Hospital Boston, Boston, Massachusetts

Objective.Good hand hygiene may reduce the spread of infections in families with children who are in out-of-home child care. Alcohol-based hand sanitizers rapidly kill viruses that are commonly associated with respiratory and gastrointestinal (GI) infections. The objective of this study was to determine whether a multifactorial campaign centered on increasing alcohol-based hand sanitizer use and hand-hygiene education reduces illness transmission in the home.

Methods.A cluster randomized, controlled trial was conducted of homes of 292 families with children who were enrolled in out-of-home child care in 26 child care centers. Eligible families had 1 child who was 6 months to 5 years of age and in child care for 10 hours/week. Intervention families received a supply of hand sanitizer and biweekly hand-hygiene educational materials for 5 months; control families received only materials promoting good nutrition. Primary caregivers were phoned biweekly and reported respiratory and GI illnesses in family members. Respiratory and GI-illness–transmission rates (measured as secondary illnesses per susceptible person-month) were compared between groups, adjusting for demographic variables, hand-hygiene practices, and previous experience using hand sanitizers.

Results.Baseline demographics were similar in the 2 groups. A total of 1802 respiratory illnesses occurred during the study; 443 (25%) were secondary illnesses. A total of 252 GI illnesses occurred during the study; 28 (11%) were secondary illnesses. The secondary GI-illness rate was significantly lower in intervention families compared with control families (incidence rate ratio [IRR]: 0.41; 95% confidence interval [CI]: 0.19–0.90). The overall rate of secondary respiratory illness was not significantly different between groups (IRR: 0.97; 95% CI: 0.72-1.30). However, families with higher sanitizer usage had a marginally lower secondary respiratory illness rate than those with less usage (IRR: 0.81; 95% CI: 0.65-1.09).

Conclusions.A multifactorial intervention emphasizing alcohol-based hand sanitizer use in the home reduced transmission of GI illnesses within families with children in child care. Hand sanitizers and multifaceted educational messages may have a role in improving hand-hygiene practices within the home setting.

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Key Words: hand hygiene • hand sanitizer • child care • illness transmission • randomized controlled trial

Abbreviations: GI, gastrointestinal • IRR, incidence rate ratio • CI, confidence interval

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Accepted May 2, 2005.

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