School children may be twice as likely to catch H1N1 influenza as adults, as such health policies often stress hand hygiene among school children as one low cost intervention that may prevent influenza from spreading.
A research team led by Wolf-Peter Schmidt at the London School of Hygiene and Tropical Medicine, London, UK used qualitative methods to explore teachers' and students' views on different hand hygiene protocols, as well as interviewing school nurses. Their pilot study in four East London primary schools examined both practical issues and attitudes, and included class exercises in hand washing or lining up to use hand sanitizer.
The researchers found that staff are motivated to contribute to hygiene education over and above what children learn from their parents, provided that expectations are realistic for the school environment. But very frequent and highly monitored hand washing would be hard to keep up over the longer term without the motivation of a major perceived public health threat like the current influenza pandemic. During a busy school day, time was a major factor in deciding what level of hand hygiene could be achieved.
School nurses were more focused on reducing infection, whereas teachers saw hygiene as an important education topic - particularly among the younger age groups. Rinse-free alcohol gel hand sanitizer was the fastest and least messy option. But teachers highlighted to children that this was only for situations where soap and water was in short supply.
"Intensive hand hygiene interventions are feasible and acceptable but only temporarily during a period of a particular health threat like an influenza pandemic and only if rinse-free hand sanitizers are used," according to Schmidt. "In many settings there may be logistical issues in providing all schools with an adequate supply," he added. "Hand hygiene is important in particular for the prevention of gastro-intestinal infections. The effect of hand hygiene on the spread of influenza is less clear, but may be promoted as a precautionary measure, even in the absence of evidence. Our study highlights the practical issues of bringing improved hand hygiene to scale."