Can a handwashing intervention make a difference? Results from a randomized controlled trial in Jerusalem preschools
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Updated: Aug 14, 2026
A Method to Test the Efficacy of Handwashing for the Removal of Emerging Infectious Pathogens
Published on: June 7, 2017
Laura Rosen1, Orly Manor, Dan Engelhard
1Hebrew University School of Public Health, P.O.B. 12272, Jerusalem 91120, Israel. Lrosen@vms.huji.ac.il
Insights
A preschool hygiene program significantly increased children's handwashing with soap. However, the intervention did not reduce illness absenteeism, highlighting the need for improved strategies to combat childhood illness in early education settings.
Area of Science:
- Pediatric Health
- Public Health Interventions
- Infectious Disease Prevention
Background:
- Preschools are key environments for childhood illness transmission.
- Understanding effective interventions to reduce illness in young children is crucial.
Purpose of the Study:
- To evaluate a preschool hygiene program's impact on handwashing and illness absenteeism.
- To determine if a hygiene intervention can reduce school absences due to sickness.
Main Methods:
- Cluster randomized trial involving 40 preschools and 1029 children.
- Intervention included educational components and environmental changes over 66 study days.
- Measured handwashing rates and illness absenteeism as primary outcomes.
Main Results:
- A threefold increase in handwashing with soap was observed.
- Sustained behavioral and environmental changes occurred over six months.
- Neither preschool nor home intervention reduced illness or overall absenteeism.
Conclusions:
- Preschools are effective venues for promoting sustained behavioral changes in hygiene.
- Current hygiene interventions may not be sufficient to reduce illness absenteeism.
- Further research is needed to develop enhanced approaches for reducing illness in preschool settings.
Background:
Preschools are often focal points for the spread of illness among young children. The objective of this preschool intervention trial was to determine whether a hygiene program can promote handwashing and thereby reduce illness absenteeism.
Methods:
This cluster randomized trial included 40 Jerusalem preschools with 1029 children for 6 baseline days and 66 study days, yielding 73,779 child days. The main outcomes were rates of handwashing and illness absenteeism. The intervention included an educational program and environmental changes. A simultaneous subtrial was run to test a home component.
Results:
This multi-site intervention program produced sustained behavioral and environmental changes over a 6-month period. An approximately threefold increase in handwashing with soap was observed among preschool children exposed to the intervention. Neither the preschool nor the home intervention program reduced illness absenteeism or overall absenteeism.
Conclusions:
This trial illuminates the potential of the preschool as a promising venue for health promotion activities leading to sustained behavioral change, yet suggests the need for enhanced approaches for reducing illness absenteeism.
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