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.