Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2013 Jun 3:13:259.
doi: 10.1186/1471-2334-13-259.

A hand hygiene intervention to decrease infections among children attending day care centers: design of a cluster randomized controlled trial

Tizza P Zomer  1 , Vicki Erasmus, Nico Vlaar, Ed F van Beeck, Aimée Tjon-A-Tsien, Jan Hendrik Richardus, Hélène A C M Voeten
Affiliations
Randomized Controlled Trial

A hand hygiene intervention to decrease infections among children attending day care centers: design of a cluster randomized controlled trial

Tizza P Zomer et al. BMC Infect Dis. .

Abstract

Background: Day care center attendance has been recognized as a risk factor for acquiring gastrointestinal and respiratory infections, which can be prevented with adequate hand hygiene (HH). Based on previous studies on environmental and sociocognitive determinants of caregivers' compliance with HH guidelines in day care centers (DCCs), an intervention has been developed aiming to improve caregivers' and children's HH compliance and decrease infections among children attending DCCs. The aim of this paper is to describe the design of a cluster randomized controlled trial to evaluate the effectiveness of this intervention.

Methods/design: The intervention will be evaluated in a two-arm cluster randomized controlled trial among 71 DCCs in the Netherlands. In total, 36 DCCs will receive the intervention consisting of four components: 1) HH products (dispensers and refills for paper towels, soap, alcohol-based hand sanitizer, and hand cream); 2) training to educate about the Dutch national HH guidelines; 3) two team training sessions aimed at goal setting and formulating specific HH improvement activities; and 4) reminders and cues to action (posters/stickers). Intervention DCCs will be compared to 35 control DCCs continuing usual practice. The primary outcome measure will be observed HH compliance of caregivers and children, measured at baseline and one, three, and six months after start of the intervention. The secondary outcome measure will be the incidence of gastrointestinal and respiratory infections in 600 children attending DCCs, monitored over six months by parents using a calendar to mark the days their child has diarrhea and/or a cold. Multilevel logistic regression will be performed to assess the effect of the intervention on HH compliance. Multilevel poisson regression will be performed to assess the incidence of gastrointestinal and respiratory infections in children attending DCCs.

Discussion: This is one of the first DCC intervention studies to assess HH compliance of both caregivers and children, as well as the incidence of gastrointestinal and respiratory infections in children, as outcome measures. When an effect of the intervention on improving HH compliance and/or reducing incidence of infections is shown, (inter)national dissemination of the intervention in other DCCs may be considered.

Trial registration: Netherlands trial registry: NTR3000.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Timeline of data collection and phased implementation of a hand hygiene intervention at child day care centers (DCCs).
See this image and copyright information in PMC

References

    1. Louhiala PJ, Jaakkola N, Ruotsalainen R, Jaakkola JJ. Day-care centers and diarrhea: a public health perspective. J Pediatr. 1997;131(3):476–479. doi: 10.1016/S0022-3476(97)80083-2. - DOI - PubMed
    1. Louhiala PJ, Jaakkola N, Ruotsalainen R, Jaakkola JJ. Form of day care and respiratory infections among Finnish children. Am J Public Health. 1995;85(8 Pt 1):1109–1112. - PMC - PubMed
    1. Zutavern A, Rzehak P, Brockow I, Schaaf B, Bollrath C, von Berg A, Link E, Kraemer U, Borte M, Herbarth O. Day care in relation to respiratory-tract and gastrointestinal infections in a German birth cohort study. Acta Paediatr. 2007;96(10):1494–1499. doi: 10.1111/j.1651-2227.2007.00412.x. - DOI - PubMed
    1. Silverstein M, Sales AE, Koepsell TD. Health care utilization and expenditures associated with child care attendance: a nationally representative sample. Pediatrics. 2003;111(4 Pt 1):e371–375. - PubMed
    1. Carabin H, Gyorkos TW, Soto JC, Penrod J, Joseph L, Collet JP. Estimation of direct and indirect costs because of common infections in toddlers attending day care centers. Pediatrics. 1999;103(3):556–564. doi: 10.1542/peds.103.3.556. - DOI - PubMed

Publication types