***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The objective of this study was to assess the effectiveness of a hygiene program in reducing the incidence of respiratory and diarrheal diseases in toddlers attending day care centers . A r and omized field trial was conducted in 52 day care centers in Quebec , Canada , between September 1 , 1996 and November 30 , 1997 . Absences for any reasons and the daily occurrence of colds and /or diarrhea in toddlers were recorded on calendars by the educators . The number of fecal coliforms on children 's h and s and on educators ' h and s was measured during three unannounced visits . Overall , 1,729 children were followed in 47 day care centers for a total of 153,643 child-days . The incidence rate of diarrhea was considerably reduced by the effect of monitoring ( IRR = 0.73 , 95 % CI = 0.54,0.97 ) , and the intervention reduced the incidence rate of upper respiratory tract infections ( IRR = 0.80 , 95 % CI = 0.68,0.93 ) . Monitoring alone also had an important effect in reducing the level of bacterial contamination on children 's and educators ' h and s. The results indicate that both an intervention program and monitoring alone play a role in reducing infections in children attending day care centers Please cite this paper as : Simmerman et al. ( 2011 ) Findings from a household r and omized controlled trial of h and washing and face masks to reduce influenza transmission in Bangkok , Thail and . Influenza and Other Respiratory Viruses 5(4 ) , 256–267 Background Evidence is needed on the effectiveness of non‐pharmaceutical interventions ( NPIs ) to reduce influenza transmission . Methodology We studied NPIs in households with a febrile , influenza‐positive child . Households were r and omized to control , h and washing ( HW ) , or h and washing plus paper surgical face masks ( HW + FM ) arms . Study nurses conducted home visits within 24 hours of enrollment and on days 3 , 7 , and 21 . Respiratory swabs and serum were collected from all household members and tested for influenza by RT‐PCR or serology . Principal Findings Between April 2008 and August 2009 , 991 ( 16·5 % ) of 5995 pediatric influenza‐like illness patients tested influenza positive . Four hundred and forty‐two index children with 1147 household members were enrolled , and 221 ( 50·0 % ) were aged < 6 years . Three hundred and ninety‐seven ( 89·8 % ) households reported that the index patient slept in the parents ’ bedroom . The secondary attack rate was 21·5 % , and 56/345 ( 16·3 % ; 95 % CI 12·4–20·2 % ) secondary cases were asymptomatic . H and ‐washing subjects reported 4·7 washing episodes/day , compared to 4·9 times/day in the HW + FM arm and 3·9 times/day in controls ( P = 0·001 ) . The odds ratios ( ORs ) for secondary influenza infection were not significantly different in the HW arm ( OR = 1·20 ; 95 % CI 0·76–1·88 ; P‐0.442 ) , or the HW + FM arm ( OR = 1·16 ; 95 % CI .0·74–1·82 ; P = 0.525 ) . Conclusions Influenza transmission was not reduced by interventions to promote h and washing and face mask use . This may be attributable to transmission that occurred before the intervention , poor facemask compliance , little difference in h and ‐washing frequency between study groups , and shared sleeping arrangements . A prospect i ve study design and a careful analysis of sociocultural factors could improve future NPI studies Background : Laboratory-based evidence is lacking regarding the efficacy of nonpharmaceutical interventions ( NPIs ) such as alcohol-based h and sanitizer and respiratory hygiene to reduce the spread of influenza . Methods : The Pittsburgh Influenza Prevention Project was a cluster-r and omized trial conducted in 10 elementary schools in Pittsburgh , PA , during the 2007 to 2008 influenza season . Children in 5 intervention schools received training in h and and respiratory hygiene , and were provided and encouraged to use h and sanitizer regularly .  Children in 5 schools acted as controls . Children with influenza-like illness were tested for influenza A and B by reverse-transcriptase polymerase chain reaction . Results : A total of 3360 children participated in this study . Using reverse-transcriptase polymerase chain reaction , 54 cases of influenza A and 50 cases of influenza B were detected . We found no significant effect of the intervention on the primary study outcome of all laboratory-confirmed influenza cases ( incidence rate ratio [ IRR ] : 0.81 ; 95 % confidence interval [ CI ] : 0.54 , 1.23 ) . However , we did find statistically significant differences in protocol -specified ancillary outcomes . Children in intervention schools had significantly fewer laboratory-confirmed influenza A infections than children in control schools , with an adjusted IRR of 0.48 ( 95 % CI : 0.26 , 0.87 ) . Total absent episodes were also significantly lower among the intervention group than among the control group ; adjusted IRR 0.74 ( 95 % CI : 0.56 , 0.97 ) . Conclusions : NPIs ( respiratory hygiene education and the regular use of h and sanitizer ) did not reduce total laboratory-confirmed influenza . However , the interventions did reduce school total absence episodes by 26 % and laboratory-confirmed influenza A infections by 52 % . Our results suggest that NPIs can be an important adjunct to influenza vaccination programs to reduce the number of influenza A infections among children Transmission of enteric pathogens is facilitated in child day care centers , including family day care homes , by frequent and intimate exposure among susceptible hosts , with diaper changing as the highest-risk procedure for such transmission . The objective of this study was to evaluate the effectiveness of an intervention program in decreasing the incidence of infectious disease symptoms in children attending family day care homes during a 12-month period . Each of 24 family day care homes was r and omly assigned to an intervention or control group . The intervention included four components : ( 1 ) a h and washing educational program and ( 2 ) use of vinyl gloves , ( 3 ) use of disposable diaper changing pads , and ( 4 ) use of an alcohol-based h and rinse by the day care provider .  Symptoms of enteric disease ( diarrhea and vomiting ) were significantly reduced in intervention family day care homes ( p less than or equal to 0.05 ) , whereas respiratory symptoms were not significantly different between intervention and control family day care homes ( p = 0.35 ) . Diarrhea was reported in 1 of every 100 child care days , representing one diarrhea episode per month in a typical family day care home INTRODUCTION The purpose was to determine the effectiveness of an instructional program on h and washing . The hypothesis stated that an instructional program on germs and h and washing in child care could significantly reduce the spread of infectious diseases in the test center . METHOD A longitudinal study was conducted in a field setting with a test group and a control group of 3- to 5-year-old children and their teachers in two similar child care setting s. For 21 weeks illnesses and symptoms of infectious diseases were assessed with a health assessment checklist . The test group received a developmentally appropriate instructional program on germs and h and washing . The teachers in the test group attended workshops on infectious diseases and h and washing . The control group maintained their usual h and washing procedures . RESULT At weeks 1 through 11 benchmark data were collected . At weeks 12 through 21 , peak cold and flu season , the test group had significantly fewer colds than the control group ( chi-squared analysis , 4.338 , 1 df , p < .05 ) ; thus the hypothesis was confirmed . DISCUSSION H and washing has been recognized as one way to manage the spread of infectious diseases in child care centers . H and washing helped to reduce colds at the test center where frequent and proper h and washing practice s were incorporated into the curriculum through an intervention program Background Previous controlled studies on the effect of non-pharmaceutical interventions ( NPI ) - namely the use of facemasks and intensified h and hygiene - in preventing household transmission of influenza have not produced definitive results . We aim ed to investigate efficacy , acceptability , and tolerability of NPI in households with influenza index patients . Methods We conducted a cluster r and omized controlled trial during the p and emic season 2009/10 and the ensuing influenza season 2010/11 . We included households with an influenza positive index case in the absence of further respiratory illness within the preceding 14 days . Study arms were wearing a facemask and practicing intensified h and hygiene ( MH group ) , wearing facemasks only ( M group ) and none of the two ( control group ) . Main outcome measure was laboratory confirmed influenza infection in a household contact . We used daily question naires to examine adherence and tolerability of the interventions . Results We recruited 84 households ( 30 control , 26 M and 28 MH households ) with 82 , 69 and 67 household contacts , respectively . In 2009/10 all 41 index cases had a influenza A ( H1N1 ) pdm09 infection , in 2010/11 24 had an A ( H1N1 ) pdm09 and 20 had a B infection . The total secondary attack rate was 16 % ( 35/218 ) . In intention-to-treat analysis there was no statistically significant effect of the M and MH interventions on secondary infections . When analysing only households where intervention was implemented within 36 h after symptom onset of the index case , secondary infection in the pooled M and MH groups was significantly lower compared to the control group ( adjusted odds ratio 0.16 , 95 % CI , 0.03 - 0.92 ) . In a per- protocol analysis odds ratios were significantly reduced among participants of the M group ( adjusted odds ratio , 0.30 , 95 % CI , 0.10 - 0.94 ) . With the exception of MH index cases in 2010/11 adherence was good for adults and children , contacts and index cases . Conclusions Results suggest that household transmission of influenza can be reduced by the use of NPI , such as facemasks and intensified h and hygiene , when implemented early and used diligently . Concerns about acceptability and tolerability of the interventions should not be a reason against their recommendation .Trial registration The study was registered with Clinical Trials.gov ( Identifier NCT00833885 ) Background The economical impact of absenteeism and reduced productivity due to acute infectious respiratory and gastrointestinal disease is normally not in the focus of surveillance systems and may therefore be underestimated . However , large community studies in Europe and USA have shown that communicable diseases have a great impact on morbidity and lead to millions of lost days at work , school and university each year . H and disinfection is acknowledged as key element for infection control , but its effect in open , work place setting s is unclear . Methods Our study involved a prospect i ve , controlled , intervention-control group design to assess the epidemiological and economical impact of alcohol-based h and disinfectants use at work place . Volunteers in public administrations in the municipality of the city of Greifswald were r and omized in two groups . Participants in the intervention group were provided with alcoholic h and disinfection , the control group was unchanged .  Respiratory and gastrointestinal symptoms and days of work were recorded based on a monthly question naire over one year . On the whole , 1230 person months were evaluated . Results H and disinfection reduced the number of episodes of illness for the majority of the registered symptoms . This effect became statistically significant for common cold ( OR = 0.35 [ 0.17 - 0.71 ] , p = 0.003 ) , fever ( OR = 0.38 [ 0.14 - 0.99 ] , p = 0.035 ) and coughing ( OR = 0.45 [ 0.22 - 0.91 ] , p = 0.02 ) . Participants in the intervention group reported less days ill for most symptoms assessed , e.g. colds ( 2.07 vs. 2.78 % , p = 0.008 ) , fever ( 0.25 vs. 0.31 % , p = 0.037 ) and cough ( 1.85 vs. 2.00 % , p = 0.024 ) . For diarrhoea , the odds ratio for being absent became statistically significant too ( 0.11 ( CI 0.01 - 0.93 ) . Conclusion H and disinfection can easily be introduced and maintained outside clinical setting s as part of the daily h and hygiene . Therefore it appears as an interesting , cost-efficient method within the scope of company health support programmes . Trial registration numberIS RCT N : IS RCT BACKGROUND During the influenza A(H1N1 ) p and emic , antiviral prescribing was limited , vaccines were not available early , and the effectiveness of nonpharmaceutical interventions ( NPIs ) was uncertain . Our study examined whether use of face masks and h and hygiene reduced the incidence of influenza-like illness ( ILI ) . METHODS A r and 
    Output:
    
There was high- quality evidence of a small reduction in respiratory infection in childcare setting s. There was high- quality evidence for a large reduction in respiratory infection with a  h and hygiene intervention  in squatter settlements in a low-income setting .
There was moderate- to high- quality evidence of no effect on secondary transmission of influenza in households that had already experienced an index case .
While h and hygiene interventions have potential to reduce transmission of influenza and acute respiratory tract infections , their effectiveness varies depending on setting , context and compliance