Does use of an instant hand sanitizer reduce elementary school illness absenteeism?

Author and Disclosure Information

Dyer DL, Shinder A, Shinder F. Alcohol-free instant hand sanitizer reduces elementary school illness absenteeism. Fam Med 2000; 32:633-68.


BACKGROUND: Hand washing is generally considered to be beneficial in fighting the plethora of viral and bacterial pathogens in school settings. Many antimicrobial rinse-free hand-sanitizing formulas are available. The one chosen for this study (CleanHands) contains surfactants, allantoin, and benzalkonium chloride. Unlike alcohol- or triclosan-based products, this one has persistent antiviral and antimicrobial properties and does not irritate or dry the skin.

POPULATION STUDIED: All 420 students from a private elementary school were included. Their ages ranged from 5 to 12 years (all grades from kindergarten through sixth grade).

STUDY DESIGN AND VALIDITY: This was a 10-week crossover study of hand sanitizer use in conjunction with at-will soap and water hand washing. The subjects were not formally randomized; they were grouped by school class into 2 similar groups. There was no blinding. All of the students received education on the importance of hand washing before the study started. Seven classes then received instant hand sanitizer, and 7 were assigned to the control group. In addition to at-will hand washing with soap and water, children in the study group used the hand cleaner under teacher supervision immediately after entering the classroom, before eating, after sneezing or coughing, and after using the restroom. Children in the control group were only told to wash before eating and after going to the restroom but were not monitored for hand washing. The initial study group was evaluated for 4 weeks. After a 2-week washout period the 2 groups switched roles.

OUTCOMES MEASURED: The teachers recorded days absent, and parents provided the reasons for the absence, which if due to illness were then broken down into gastrointestinal (GI) illness versus respiratory illness.

RESULTS: During the study period the number of absences caused by a communicable acute illness was reduced by 33.6% (P=.001) in the first group and 55.7% (P=.001) in the second group compared with their respective control groups. Absences for all causes were reduced by 48% (P=.001) and 43% (P=.05) in the 2 groups. GI illnesses in the 2 groups were significantly reduced by 37.5% (P=.001) in the first group but not in the second group. Absences for respiratory illnesses were reduced 30.9% (P=.02) and 76% (P=.001) during the 2 time periods. During the 2-week washout period the absences were statistically similar between the 2 groups. No adverse events were reported.


This study demonstrated something mothers have always known: the benefit of clean hands. Clearly, having the teacher frequently tell children to clean their hands (and watching them do so) is more efficacious than giving them hall passes to go to the restroom unsupervised. Problems with this intervention include adding more responsibilities to teachers, adding training to institute this practice in public schools, and losing teaching time. This inexpensive, easy-to-use intervention could have an astounding impact, however, since the diverse effects of school absenteeism include effects on funding of public schools, remediation for absent students, and parents’ loss of work to stay home and care for sick children. As primary care providers, we should educate our young patients and their parents about the importance of clean hands.

Next Article: