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Am J Infect Control. 2009 Dec;37(10):820-6. doi: 10.1016/j.ajic.2009.06.012. Epub 2009 Dec.

Mandatory handwashing in elementary schools reduces absenteeism due to infectious illness among pupils: a pilot intervention study.

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The objective of this study was to determine the effect of mandatory, scheduled handwashing on actual absenteeism due to infectious illness in elementary school pupils in Denmark.


A 3-month pilot intervention study, randomized between 2 schools, was performed on 652 pupils age 5 to 15 years. The pupils at the intervention school (IS; n=290) were required to wash their hands before the first lesson, before lunch, and before going home. Those at the control school (CS; n=362) continued their usual handwashing practices. All absences due to illness were recorded, and data were analyzed statistically.


Multivariate analysis demonstrated a significantly reduced rate of absenteeism for the IS compared with the CS (P=.002). For girls, the rate was 1.05 periods (95% confidence interval [CI]=0.90 to 1.22) for the IS versus 1.35 (95% CI=1.26 to 1.44) for the CS. For boys, these rates were 0.87 (95% CI=0.72 to 1.05) and 1.12 (95% CI=0.92 to 1.36). An alternative approach demonstrated that the odds ratio for absence was 0.69 (95% CI=0.52 to 0.92) for the IS compared with the CS.


This study suggests that handwashing could be an effective tool to reduce absences due to infectious illness in elementary school pupils. A school policy regarding hand hygiene and teaching of hand hygiene is warranted.

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