Wash Your Hands! Cover Your Mouth!

Influenza cases of one strain dropped following hygiene instruction in elementary schools

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Want a cheap and easy way to reduce the likelihood that you or your children might catch - or pass on - at least one strain of the flu? Cover your mouth and use hand sanitizer.

A recent clinical trial actually has shown that teaching school children to follow good hygiene procedures, including covering their coughs and using hand sanitizer regularly, reduced the overall amount of sick days among the kids and the number of cases of one strain of the flu.

"Cover your mouth when you cough and wash your hands."

Samuel Stebbins, MD, the Director of the Center for Public Health Preparedness and an epidemiology professor at the University of Pittsburgh, led a study to find out how much teaching simple hygiene to children might decrease their illnesses during flu season.

During the 2007 to 2008 flu season, 3360 children in 10 elementary schools in Pittsburgh participated in the trial. Children in five of the schools served as the control group and received no special information.

Children in the other five of the schools, however, were trained in "hand and respiratory hygiene." They were given hand sanitizer regularly and were encouraged to use it.

Before the instruction was provided, the researchers recorded that the hygiene practices of the children across all 10 schools was approximately similar.

During the course of the study, the children used hand sanitizer on average about 2.4 times per day in the schools that had focused on its use. Teacher surveys indicated that children did change their behavior to be more hygienic following on the instruction they received.

The instruction primarily included signs that reminded students to "WHACK the Flu," where each letter stood for a different word:

  • Wash or sanitize your hands often
  • Home is where you stay when you are sick
  • Avoid touching your eyes, nose and mouth
  • Cover your coughs and sneezes
  • Keep your distance from sick people.

During the season, any children with flu-like symptoms was tested for the two main types of influenza: influenza A and influenza B. A total of 54 influenza A and 50 influenza B cases occurred among the 10 schools.

The researchers did not find an overall difference in the total number of cases across the schools taught hygiene skills compared to the control schools.

But they did find a difference in the number of cases of one strain of flu that struck the kids. Children in the hygiene-lesson schools had about half as many cases of influenza A and had about 26 percent fewer school absences.

The researchers only calculated the percentage of absences for all the absences that they were able to gather information on regarding the reason for the absence. This became a limitation for the study since reasons were only available for about 34 percent of the absences.

The researchers concluded that even though the overall number of cases of flu was not significantly affected by the hygiene program, there was enough of an impact in absenteeism that the teaching of good coughing and hand-cleaning hygiene is worth it.

"Our results suggest that [non-drug instructions] can be an important adjunct to influenza vaccination programs to reduce the number of influenza A infections among children," the researchers wrote.

The study appeared in November in the Pediatric Infectious Disease Journal. The research was funded by grants from the National Institutes of Health and the Centers for Disease Control and Prevention. The authors did not have any relevant conflicts of interest with the study.

Reviewed by: 
Review Date: 
April 25, 2012
Last Updated:
October 8, 2012