Study: Hand sanitizer use in schools reduces flu illness, absenteeism

PHILADELPHIA — A hand and respiratory hygiene program including frequent use of alcohol-based hand sanitizer helped reduce illness caused by influenza A, and reduced the number of missed school days in elementary school children, according to 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," stated Samuel Stebbins of the University of Pittsburgh, author of the study.

In the study, five Pittsburgh elementary schools were assigned to receive a five-step training "cough etiquette and hand hygiene" program. In the program, called "WHACK the Flu," 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; and


• (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 with 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% 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% reduction in total school absences. The hygiene program also was linked to possible improvements in other school attendance measures, including a lower rate of absences during flu season.

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 B — possibly 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 showed 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 noted. He believed the study supports current recommendations for respiratory hygiene — including hand sanitizer — during any type of flu outbreak, and as part of an overall influenza prevention strategy in schools.

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