Can improved infection control in kindergartens and schools help to improve children’s and adolescent’s health and reduce illness and antibiotic use?

We included seven systematic reviews of high methodological quality. Four systematic reviews summarize nine unique infection control interventions. The best documentation exists for complex interventions, i.e. interventions that consist of a combination of initiatives to reduce the spread of infections.

The main findings are:

• Complex interventions that combine handwashing and hygiene education directed towards children and staff in kindergarten and primary school, significantly lower the insidence of respiratory infecions and diarrhoea with 10-50% compared to controls. Such interventions also improve hygiene behavior (compliance) among the children. The documentation is of moderate to low quality.
• Complex interventions that combine hand disinfection, handwashing, and hygiene education reduce absenteeism due to infections with 30- 50% in school children (age 5 to 12 years) compared to controls who receive education and practiced handwashing as usual or used a placebo hand rub. The documentation is of moderate to low quality.

Documentation of simple interventions with alcohol-based hand rub or handwashing in schools, have major methodological weaknesses. This does not mean that such interventions are ineffective, but it means that the evidence base is too weak to conclude on possible effects. We did not find evidence regarding the effects of physical interventions such as improvements in facilities, ventilation, person density, etc.

There were no evaluations of the intervention effects on secondary diseases, use of or resistance to antibiotics, adverse events from the intervention, costs or use of health services. There were no evaluations of the intervention effects on staff in kindergartens or schools.