Side benefit: less absenteeism from school
by Michael Smith, North American Correspondent, MedPage Today October 05, 2017

Action Points
• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Note that an experiment in an elementary school wherein second-graders compared microbial hand colonization before and after hand washing found that absentee rates improved after the experiment.
• The study lacked adequate experimental controls, but suggests that adequate hand washing may decrease absenteeism in school-children.

SAN DIEGO — Kids do the darndest experiments.
In second-grade classrooms in Virginia Beach, Virginia, children tested the efficacy of washing in reducing the presence of microbes on their hands, according to Kavita Imrit-Thomas, DO, of LifeNet Health there.
Not surprisingly, the children found that cleaner hands were less likely to harbor micro-organisms, Imrit-Thomas told reporters here at the annual IDWeek meeting, sponsored jointly by the Infectious Diseases Society of American (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).
But the experiment also showed that regular hand-washing was associated with a reduction in the number of days off school, she said — something that is important for both children and their families.
The science that makes headlines from this meeting is typically “huge outbreaks that are very scary” or high-tech treatment and prevention methods, commented Andy Pavia, MD, of the University of Utah, a member of the meeting’s program committee, who moderated the media briefing.
But, he said, “kids get a lot of infections and they transmit a lot of infections” so the meeting’s organizers decided to highlight this “very simple but important study done with school-children.”
“Hand-washing, as old and simple as it is, is one of our greatest tools,” Pavia continued. “But it’s fairly rare that we get good scientific data that looks at hand-washing, our ability to get people to do a better job of hand-washing, and whether or not it makes a difference.”
The study arose, Imrit-Thomas said, after she was asked to talk to students on a career day. She wondered if such young children could undertake an experiment on hand-washing and what effect it might have.
To find out, she and her colleagues worked with 90 students in five second-grade classes.
The children were shown how to take samples for culture from their hands and how to wash their hands properly, following Centers for Disease Control and Prevention (CDC) protocols. The children then took samples before and after hand-washing and cultured them for 5 days in Petri dishes.
The students were divided into two groups — one using soap and water, and the other an alcohol-based sanitizer.
The key questions, Imrit-Thomas said, were whether students would observe a difference in the culture outcomes, whether they would change their behavior afterward, and whether soap and water or hand sanitizer would be more effective.
The investigators also looked at absenteeism rates before and after the January experiment, to see what larger effect, if any, it might have had.
In fact, they found, 91% of the students reported that they saw reduced microbial growth in the cultures taken after they cleaned their hands, with a range of 89% to 100% in the five classes.
And 89% of the students reported they had changed their hand hygiene — in the right direction — with a range of 68% to 100%.
Hand sanitizer appeared to be more effective than soap and water, Imrit-Thomas said.
Importantly, however, the absenteeism rates changed significantly after the experiment. In the 30 days before the experiment, children missed 126 days owing to illness, while in the 30 days afterward they missed only 37.
The 71% decrease was more than expected — Imrit-Thomas said she and colleagues would have been happy to see a 50% drop — and was highly statistically significant. But, she said, there are “a lot of variables” in play and it’s possible the difference was driven, for instance, by changing rates of immunity over time as more children were exposed to and recovered from illness.
The CDC estimates that 160 million school days are lost annually owing to infectious diseases, she said, so the issue is important.
Pavia noted that studies have shown that blocking infection in children has a knock-on — i.e., secondary — effect, leaving their parents and grandparents healthier.
But he added that making behavioral changes last is hard, even among highly educated medical professionals: “The minute you stop the intervention, behavior tends to slide a bit,” he said. “Hopefully [children] are at least as good or better as healthcare workers, but we need to test that.”

Imrit-Thomas said there was no external support for the study.
Pavia said he had no disclosures to make.
• Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner
• Primary Source
IDWeek 2017
Source Reference: Imrit-Thomas K, et al “An appeal to incorporate hand hygiene education into standard elementary school curriculum 1332” IDWeek 2017; abstract 1332.