Hand Sanitizer in Schools Helps Prevent Some Cases of Influenza

A hand and respiratory hygiene program including frequent use of alcohol-based hand sanitizer helps reduce illness caused by influenza A and missed school days in elementary school children, reports a study in the November issue of the Pediatric Infectious Disease Journal.

"Respiratory hygiene education and the regular use of hand sanitizer can be an important adjunct to influenza vaccination programs to reduce the number of influenza A infections among children," according to the study by Dr. Samuel Stebbins of the University of Pittsburgh and colleagues.

In the study, five Pittsburgh elementary schools were assigned to receive five-step training "cough etiquette and hand hygiene" program. In the program, called "WHACK the Flu," in which children were taught:
(W)ash or sanitize your hands often.
(H)ome is where you stay when you are sick.
(A)void touching your eyes, nose, and mouth.
(C)over your coughs and sneezes.
(K)eep your distance from sick people.

Another five schools received no special hygiene training. During the school year, children who developed a flu-like illness were tested to determine if they had influenza, and whether the cause was influenza A or B virus. In tests performed in 279 children with flu-like illness, 104 confirmed cases of influenza were identified.

The program was successful in getting kids to use hand sanitizer regularly. Average use was 2.4 times per day, compared to four recommended times (on arrival at school, before and after lunch, and when leaving school).

Schools assigned to "WHACK the Flu" had a significant 52 percent reduction in the rate of confirmed illness caused by influenza A. However, there was no significant difference in the overall rate of laboratory-confirmed influenza, or in the rate of illness caused by influenza B.

Along with the decrease in influenza A, there was a 26 percent reduction in total school absences. The hygiene program was also linked to possible improvements in other school attendance measures, including a lower rate of absences during flu season.

School-age children are an important source of influenza transmission, and were heavily affected by the 2009-10 influenza A H1N1 pandemic. Previous reports have suggested that using hand sanitizeralone or with other hygiene measurescan reduce absences and some causes of infectious diseases. (The new study was performed before the H1N1 pandemic.)

Although the "WHACK the Flu" program didn't lower the overall influenza rate, it did achieve approximately a one-half reduction in influenza A and a one-fourth reduction in school absences. The researchers aren't sure why there was no decrease in influenza Bpossibly because of "basic differences in the biology or epidemiology" of influenza B, or because it occurred later in the flu season and mainly in younger children.

The results show that a hygiene education program including hand sanitizer "can be implemented successfully on a large scale within urban schools to reduce absenteeism and the incidence of influenza A," Stebbins and coauthors write. They believe their study supports current recommendations for respiratory hygieneincluding hand sanitizerduring any type of flu outbreak, and as part of an overall influenza prevention strategy in schools.