Paul Forsyth, Susan Young, Kirsty Hughes, Ruby James, Cheryl Oxley, Ruth Kelly, Rebecca Jones, Sarah Briggs, Lynn Mackay-Thomas, Yvonne Millerick, Maggie Simpson, Clare J Taylor, Simon Beggs, Susan Piper, Simon Duckett
Multiprofessional heart failure self-development framework
Open heart
illnessrelated absenteeism important problem among preschool school children low middle high income countries appropriate hand hygiene one commonly investigated implemented strategy reduce spread illness subsequently number days spent absent hand hygiene strategies involve washing hands soap water however associated number factors act barrier use requiring running water need dry hands cleaning alternative method involves washing hands using rinsefree hand wash technique number benefits traditional hand hygiene strategies may prove beneficial reducing illnessrelated absenteeism preschool school children 1 assess effectiveness rinsefree hand washing reducing absenteeism due illness preschool school children compared hand washing conventional hand washing soap water hand hygiene strategies 2 determine rinsefree hand washing products effective headtohead comparisons exist effect additional strategies combination rinsefree hand washing outcomes interest february 2020 searched central medline embase cinahl 12 databases three clinical trial registries also reviewed reference lists included studies made direct contact lead authors studies collect additional information required date language restrictions applied randomized controlled trials rcts irrespective publication status comparing rinsefree hand wash form hand rub hand sanitizer gel foam etc conventional hand washing using soap water hand hygiene programs education alone intervention population interest children aged two 18 years attending preschool childcare day care kindergarten etc school primary secondary elementary etc primary outcomes included child student absenteeism reason absenteeism due illness adverse skin reactions following standard cochrane methods two review authors zm ct cl cs tb independently selected studies inclusion assessed risk bias extracted relevant data absences extracted number student days absent total days sometimes reported raw numbers times incidence rate ratio irr also extracted adverse event data calculated effect sizes risk ratios rrs present 95 confidence intervals cis used standard methodological procedures expected cochrane data analysis followed grade approach establish certainty findings review includes 19 studies 30747 participants studies conducted usa eight studies two conducted spain one china colombia finland france kenya bangladesh new zealand sweden thailand six studies conducted preschools daycare centres children aged birth five years remaining 13 conducted elementary primary schools children aged five 14 years included studies judged high risk bias several domains mostnotably across domains performance detection bias due difficulty blind delivering intervention assessing outcome additionally every outcome interest graded low low certainty evidence primarily due high risk bias well imprecision effect estimates inconsistency pooled data outcome absenteeism reason pooled estimate rinsefree hand washing irr 091 95 ci 082 101 2 studies lowcertainty evidence indicates may little difference groups absenteeism illness pooled irr 082 95 ci 069 097 6 studies lowcertainty evidence indicates rinsefree hand washing may reduce absenteeism 13 days absent per 1000 compared rinsefree group 16 days absent per 1000 outcome absenteeism acute respiratory illness pooled irr 079 95 ci 068 092 6 studies lowcertainty evidence indicates rinsefree hand washing may reduce absenteeism 33 days absent per 1000 compared rinsefree group 42 days absent per 1000 evaluating absenteeism acute gastrointestinal illness pooled estimate found irr 079 95 ci 073 085 4 studies lowcertainty evidence indicates rinsefree hand washing may reduce absenteeism six days absent per 1000 compared rinsefree group eight days absent per 1000 may little difference rinsefree hand washing rinsefree group regarding adverse skin reactions rr 103 95 ci 08 132 3 studies 4365 participants lowcertainty evidence broadly compliance intervention appeared range moderate high compliance 9 studies 10749 participants verylow certainty evidence narrativley authors reported substantial issues compliance overall studies included data perception reported teachers students perceived rinsefree hand wash positively willing continue use 3 studies 1229 participants verylow certainty evidence findings review may identified small yet potentially beneficial effect rinsefree hand washing regimes illnessrelated absenteeism however certainty evidence contributed conclusion low low according grade approach therefore uncertain research required levels schooling evaluate rinsefree hand washing regimens order provide conclusive highercertainty evidence regarding impact considering use rinsefree hand washing program local setting needs consideration current rates illnessrelated absenteeism whether small beneficial effects seen translate meaningful reduction across settings