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School hand hygiene programs in an era of Coronavirus

One possible reason that children may abstain from using sanitiser is due to the effect it has on their skin. A recent study of school children in Denmark has shown that 42.4% of children studied who had no prior symptoms of dermatitis were experiencing it since more stringent hand hygiene measures came into place. Interestingly, this was more strongly linked to increased hand washing as opposed to sanitiser usage (Borch et al., 2020).

Perhaps then it is in schools’ best interest to place emphasis on hand sanitising as opposed to washing with soap and water.

HEPA filter and covid 19

There are certain factors that massively contribute to the success of sanitiser programs, one of the most obvious being user compliance. Interestingly, there seems to be a particular demographic most commonly associated with hand sanitiser use. A 2009 study in New Zealand  found that significantly more females than males used a hand sanitiser at the entrance of a hospital, and perhaps even more interestingly, it was often children leading the way, with adults following them to the sanitising station (Manning et al., 2009).

Many studies exist now that have set out to directly investigate the real-world impact of hand sanitisers in controlling pandemics, reducing work/ school absence and their ease of use.

One of the most commonly used ways to assess the success of hand sanitiser programs is to observe the impact they have on absences due to illness in schools (Stebbins et al., 2011; Nandrup-Bus, 2009; White et al., 2001). The effect of hand washing and hand sanitiser in schools has been shown time and time again to be beneficial. The impact of hand hygiene in schools is more far reaching that one would first imagine, as children that miss school generally need a member of the family to stay back from work in order to care for them (Neuzil, Hohlbein , Zhu 2002). Furthermore, children’s education is set back and they may transmit this virus to other members of the family (Fox et al., 1982).

Now, the question is, how does this impact transmission of Covid-19?

There’s no empirical data yet directly studying Covid-19 transmission in schools, but what we do know is that the clinical manifestation of Coronavirus in children has been reported to range from asymptomatic to mild (Kam et al., 2020). What we do know is that in previous coronavirus outbreaks (different strains of the virus we now face), evidence suggests that actual transmission in schools was very low (Wong, Li, Ng and Fok, 2003).

A more recent study conducted by a team at London Imperial College found that school closure by itself was insufficient to mitigate, let alone suppress, coronavirus outbreaks (in contrast to what we have found with influenza) (Ferguson et al., 2020). Given that children are largely unaffected by coronavirus, and appear have a minimal effect in spreading it through school attendance, government advice has been that schools stay open. Given this advice, schools are now having to implement huge amounts of social distancing measures, as well as rigorous sanitation standards- including frequent use of hand washing and sanitisers.

Reference List

  1. Borch, L., Thorsteinsson, K., Warner, T. C., Mikkelsen, C. S., Bjerring, P., Lundbye-Christensen, S., Arvesen, K., & Hagstroem, S. (2020). COVID-19 reopening causes high risk of irritant contact dermatitis in children. Danish Medical Journal, 67(9), [A05200357]. Borch, L., Thorsteinsson, K., Warner et al
  2. Wong, G., Li, A., Ng, P. and Fok, T., 2003. Severe acute respiratory syndrome in children. Pediatric Pulmonology, 36(4), pp.261-266.
  3. Kam KQ, Yung CF, Cui L, et al. . A well infant with coronavirus disease 2019 (COVID-19) with high viral load [manuscript published online ahead of print 28 February 2020]. Clin Infect Dis 2020. doi:10.1093/cid/ciaa201
  4. Fox,  JP Hall,  CE Cooney,  MK Foy  HM Influenza virus infections in Seattle families, 1975-1979: study design, methods, and the occurrence of infections by time and age.  Am J Epidemiol. 1982;116212- 227
  5. Neuzil KM, Hohlbein C, Zhu Y (2002) Illness among schoolchildren during influenza season: effect on school absenteeism, parental absenteeism from work, and secondary illness in families. Arch Pediatr Adolesc Med 156: 986–991.
  6. Nandrup-Bus I (2009) Mandatory handwashing in elementary schools reduces absenteeism due to infectious illness among pupils: a pilot intervention study. Am J Infect Control 37: 820–826.
  7. Stebbins S, Cummings DA, Stark JH, Vukotich C, Mitruka K, et al. (2011) Reduction in the incidence of influenza a but not influenza b associated with use of hand sanitizer and cough hygiene in schools: a randomized controlled trial. Pediatr Infect Dis J 30: 921–926
  8. Manning S, Barry T, Wilson N, Baker MG. Update: Follow-up study showing post-pandemic decline in hand sanitiser use, New Zealand, December 2009 . Euro Surveill. 2010;15(3):pii=19466. Available online: Manning S, Barry T, Wilson N, Baker MG
  9. White CG, Shinder FS, Shinder AL, Dyer DL (2001) Reduction of illness absenteeism in elementary schools using an alcohol-free instant hand sanitizer. J Sch Nurs 17: 258–265.

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