A hand hygiene intervention to decrease infections among children attending day care centers: design of a cluster randomized controlled trial
Open Access
- 3 June 2013
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Infectious Diseases
- Vol. 13 (1), 259-7
- https://doi.org/10.1186/1471-2334-13-259
Abstract
Day care center attendance has been recognized as a risk factor for acquiring gastrointestinal and respiratory infections, which can be prevented with adequate hand hygiene (HH). Based on previous studies on environmental and sociocognitive determinants of caregivers’ compliance with HH guidelines in day care centers (DCCs), an intervention has been developed aiming to improve caregivers’ and children’s HH compliance and decrease infections among children attending DCCs. The aim of this paper is to describe the design of a cluster randomized controlled trial to evaluate the effectiveness of this intervention. The intervention will be evaluated in a two-arm cluster randomized controlled trial among 71 DCCs in the Netherlands. In total, 36 DCCs will receive the intervention consisting of four components: 1) HH products (dispensers and refills for paper towels, soap, alcohol-based hand sanitizer, and hand cream); 2) training to educate about the Dutch national HH guidelines; 3) two team training sessions aimed at goal setting and formulating specific HH improvement activities; and 4) reminders and cues to action (posters/stickers). Intervention DCCs will be compared to 35 control DCCs continuing usual practice. The primary outcome measure will be observed HH compliance of caregivers and children, measured at baseline and one, three, and six months after start of the intervention. The secondary outcome measure will be the incidence of gastrointestinal and respiratory infections in 600 children attending DCCs, monitored over six months by parents using a calendar to mark the days their child has diarrhea and/or a cold. Multilevel logistic regression will be performed to assess the effect of the intervention on HH compliance. Multilevel poisson regression will be performed to assess the incidence of gastrointestinal and respiratory infections in children attending DCCs. This is one of the first DCC intervention studies to assess HH compliance of both caregivers and children, as well as the incidence of gastrointestinal and respiratory infections in children, as outcome measures. When an effect of the intervention on improving HH compliance and/or reducing incidence of infections is shown, (inter)national dissemination of the intervention in other DCCs may be considered. Netherlands trial registry: NTR3000Keywords
This publication has 26 references indexed in Scilit:
- Compliance of Health Care Workers with Hand Hygiene Practices: Independent Advantages of Overt and Covert ObserversPLOS ONE, 2013
- A systematic review of hand hygiene improvement strategies: a behavioural approachImplementation Science, 2012
- The ACCOMPLISH study. A cluster randomised trial on the cost-effectiveness of a multicomponent intervention to improve hand hygiene compliance and reduce healthcare associated infectionsBMC Public Health, 2011
- The World Health Organization hand hygiene observation methodAmerican Journal of Infection Control, 2009
- Effect of Hand Hygiene on Infectious Disease Risk in the Community Setting: A Meta-AnalysisAmerican Journal of Public Health, 2008
- Day care in relation to respiratory‐tract and gastrointestinal infections in a German birth cohort studyActa Paediatrica, 2007
- Hand-Washing and Diapering Equipment Reduces Disease Among Children in Out-of-Home Child Care CentersPEDIATRICS, 2007
- Can a handwashing intervention make a difference? Results from a randomized controlled trial in Jerusalem preschoolsPreventive Medicine, 2006
- Effect of Infection Control Measures on the Frequency of Diarrheal Episodes in Child Care: A Randomized, Controlled TrialPEDIATRICS, 2000
- Effect of Infection Control Measures on the Frequency of Upper Respiratory Infection in Child Care: A Randomized, Controlled TrialPEDIATRICS, 2000