Table 1

Characteristics of included studies

Study author (study name)Year of studyPopulationIntervention (product details provided where reported)Control (not all authors defined standard practice)Study design (cluster RCTs)
ParticipantsAge in years (school grade)SettingLocationClusterNumber of clusters
School-based studies
Azor Martínez et al27 282009–2010School children (n=1640)4–12 yearsPrimary school (n=5)Spain (Almeria)Handwashing with soap followed by hand sanitiser (ALCO ALOE GEL)Standard practiceSchool and classroom4 schools, 29 classes from another school
Bowen et al33 (Safeguard Promotion Program)2003–2004School children (n=3962)Median
7.53 years (1st grade)
Primary school (n=90)China (3 counties in Fujian Province)(1) Standard programme (teacher training to encourage handwashing with soap, student take home pack) (2) Enhanced programme (standard programme plus supply of safeguard soap, student peer mentors)Standard practice (Annual statement about Handwashing before eating and after toilet)School90
30 intervention (1),
30 intervention (2),
30 controls
Freeman et al (WASH programme)34 352007School children (n=5989 supplied absence data)6–16 years; median 13 years (4th–8th grade)Public primary school (n=135)Kenya (4 districts in Nyanza Province)(1) Hygiene promotion (HP) and water treatment (WT) (3 days teacher training, follow-up sessions) (2) HP and WT plus up to 7 new latrines per schoolStandard practiceSchool135
45 intervention (1)
45 intervention (2)
45 controls
Graves et al36 (substudy of NICHE: Nyando Integrated Child Health and Education)2008–2009School children (precise number not reported)Age not reported (Students in NICHE study were in 4th–8th grade)Primary school (n=21)Kenya (rural western area)NICHE intervention (multiple components including health promotion by teachers, installation of drinking water, handwashing stations) plus a visual aid poster designed by students in intervention schoolsNICHE intervention onlySchool21 schools
10 intervention
11 control
(14 included in analysis)
Morton and Schultz (Healthy hands)222000–2001School children (n=253)Age not reported (Kindergarten–3rd grade)Elementary school (n=1)USA (New England)Handwashing with soap and AlcoSCRUB alcohol gel use (45 min session for students)Standard practice (handwashing with soap)Classroom17 (cross-over design)
Pandejpong et al242009–2010School children (n=1437)2–3, 3–4, 4–5, 5–6 yearsPrivate school (n=1)Thailand (suburban Bangkok)Application of alcohol hand gel: Two intervention groups (1) every 60 min; (2) every 120 minStandard practice (alcohol gel application once, before lunch)Classroom68 (not clear how many classes in each arm)
Pickering et al37UnclearSchool children (n=1364)5–10 years (preunit to P5). 1 included a nursery (2–4 years), 4 included 10–13-year-olds (P6-8 grades)Primary school (n=6)Kenya (Kibera urban community in Nairobi)(1) Handwashing with soap. Two soap dispensers installed by toilets, eating area (plus water tank with a spigot). (2) Alcohol-based hand sanitiser use (Purell). Two dispensers installed by toilets, eating areaNo intervention (standard practice)School6
2 intervention (1)
2 intervention (2)
2 controls
Priest et al38–402009School children (n=16 245)5–11 years (school years 1–6)Primary school (n=68)New Zealand (Dunedin, Christchurch, Invercargill)30 min inclass hand hygiene education session, instruction on hand sanitiser use, ‘no touch’ dispensers installed in classrooms30 min inclass hand hygiene education session only (no instruction on hand sanitiser use)School68 schools
34 intervention
34 controls
Sandora et al252006School children (n=285)Age not reported (3rd–5th grade)Elementary school (n=1)USA (Avon, Ohio)Handwashing with soap, Aerofirst hand sanitiser use, plus Clorox disinfectant wipes (Student instruction, teachers wiped students’ desks once a day, after lunch)Standard practice (handwashing with soap)Team6 teams in 15 classrooms
Stebbins et al (Pittsburgh Influenza Prevention Project)41–442007–2008School children (n=3360)Age not reported (Kindergarten—5th grade)Elementary school (n=10)USA (Pittsburgh, Pennsylvania)Handwashing and Purell hand sanitiser use (45 min presentation for students, educational materials for parents)Standard practiceSchool10
5 intervention
5 controls
Talaat et al452008School children (n=44 451)Median 8 years (1st–3rd grade)Elementary school (n=60)Egypt (Cairo)Handwashing with soap (school-specific activities, coordinated by teachers, school nurse; pupils provided soap, drying materials)Standard practiceSchool60
30 intervention
30 controls
Vessey et al23Not knownSchool children (n=383)Age not reported (2nd and 3rd grades)Elementary school (n=4)USA (Butte, Montana)Hand sanitiser use (one educational session for students)Handwashing with soapClassroom18 (cross-over design)
White et al261999School children (n=769)5–12 years (Kindergarten—6th grade)Elementary school (n=3)USA (California)Handwashing and alcohol-free hand sanitiser use (all students attended 22-min assembly)Handwashing and placebo sanitiser use (all students had 22-min assembly)Classroom72 32 retained for analysis: 16 intervention, 16 controls
Non-school based studies
Correa et al462008Children (n=1727)1–5-yearsChild care centre (n=42)Colombia (6 urban settings)Purell alcohol-based hand sanitiser use (training workshop for staff and children, monthly refresher workshops)Standard practice (handwashing with soap)Child care centre42 (32 community, 10 preschool)
Ladegaard and Stage19Not knownChildren (n=399 aged 3–6 years)0–2 years and 3–6 yearsNursery (n=8)Denmark (Borough of Odense)Handwashing with soap (staff training, take home book, 1 h education session for children)Standard practiceNursery8
4 intervention, 4 controls
Lennell et al472004–2005Children (n=1477)0–5 years. Mean: 3.2 years (intervention), 3.1 years (control). Circa 30% <3 yearsDay care centre (n=60)Sweden (10 counties, south and mid-Sweden)Handwashing with soap and alcohol-based oily disinfectant gel use (instruction, demonstration to staff and children)Standard practice (handwashing with soap)Day care centre60
30 intervention, 30 controls (matched pairs)
Rosen et al (Jerusalem handwashing study)48–522001Children (n=1029)3 years and 4 yearsPreschool (n=40)Israel (Jerusalem)Handwashing with soap (2 3-h staff training sessions, child education programme, take home pack)Standard practice and alternative take-home pack (about oral hygiene)Preschool40
20 intervention
20 controls
Uhari and Möttönen531991–1992Children (n=1522)861 >3 years
661 <3 years
Mean: 3.6 years (intervention), 3.5 years (control)
Child day care centre (n=20)Finland (Oulu city)Handwashing with soap and alcohol-based oily disinfectant use, plus cleaning environment (staff lecture on infection prevention; cleaning toys; staff encouraged to take sick leave at first sign of symptoms)Standard practiceDay care centre20
10 intervention
10 controls
(matched pairs)
  • RCT, randomised controlled trial; WASH, Water, Sanitation and Hygiene.