Good hand hygiene may reduce
the spread of infections in families with children
who are in out-of-home child care. Alcohol-based hand
sanitizers rapidly kill viruses that are commonly associated
with respiratory and gastrointestinal (GI) infections.
The objective of this study was to determine whether a
multifactorial campaign centered on increasing alcoholbased
hand sanitizer use and hand-hygiene education
reduces illness transmission in the home.
Methods. A cluster randomized, controlled trial was
conducted of homes of 292 families with children who
were enrolled in out-of-home child care in 26 child care
centers. Eligible families had >1 child who was 6 months
to 5 years of age and in child care for >10 hours/week.
Intervention families received a supply of hand sanitizer
and biweekly hand-hygiene educational materials for 5
months; control families received only materials promoting
good nutrition. Primary caregivers were phoned biweekly
and reported respiratory and GI illnesses in family
members. Respiratory and GI-illness–transmission
rates (measured as secondary illnesses per susceptible
person-month) were compared between groups, adjusting
for demographic variables, hand-hygiene practices,
and previous experience using hand sanitizers.
Results. Baseline demographics were similar in the 2
groups. A total of 1802 respiratory illnesses occurred
during the study; 443 (25%) were secondary illnesses. A
total of 252 GI illnesses occurred during the study; 28
(11%) were secondary illnesses. The secondary GI-illness
rate was significantly lower in intervention families compared
with control families (incidence rate ratio [IRR]:
0.41; 95% confidence interval [CI]: 0.19–0.90). The overall
rate of secondary respiratory illness was not significantly
different between groups (IRR: 0.97; 95% CI: 0.72-1.30).
However, families with higher sanitizer usage had a marginally
lower secondary respiratory illness rate than
those with less usage