Effectiveness of hand-hygiene interventions in reducing illness-related absence in educational settings in high income countries: systematic review and behavioural analysis

Aim Control of infection is important to prevent school absence. We aimed to review hand-hygiene interventions in high income countries aiming to reduce gastrointestinal and upper-respiratory tract infection-related absence in educational settings, and identify which intervention components are effective. Subject and methods A systematic review and meta-analysis. Interventions were coded according to Behaviour Change Techniques Taxonomy. We searched MEDLINE, Embase, CINAHL, Cochrane Library, Education Resource Information Centre, Science and Social Sciences Citation Index and the British Education Index from 1 September 2014 to 25 May 2022, papers included in a 2014 review by Willmott et al., and hand-searching reference lists of included studies. We also searched for, and coded, relevant international guidelines on hand-hygiene. Results We screened 1653 papers, including 11 papers from 9 studies. Meta-analysis showed that school-based interventions significantly reduced respiratory tract and gastrointestinal infection-related absence (relative rate ratio 0.754; 95% confidence interval 0.602 to 0.944). Evidence from subgroup analysis supports the use of more than seven behaviour change techniques, targeting both adults and children, and providing information on the risks of inadequate hand-hygiene as well as instruction. The effectiveness of individual behaviour change techniques could not be determined. We found no evidence to support the interventions currently recommended in a range of international guidelines. Conclusion School-based hand-hygiene interventions are effective in reducing infection-related absence. There is some evidence that the number and type of behaviour change techniques used in interventions is important in increasing intervention success.