Reducing Absenteeism From Gastrointestinal and Respiratory Illness in Elementary School Students: A Randomized, Controlled Trial of an Infection-Control Intervention

CIRI Note: This article shows a good relationship between cleaning high touch surfaces and reduced absenteeism from gastroenterological illness in K-12 students.  Conversely, such cleaning could be expected to have a lesser effect on airborne contaminants, thereby possibly not reducing absenteeism from respiratory illness.

BACKGROUND. Students often miss school because of gastrointestinal and respiratory illnesses. We assessed the effectiveness of a multifactorial intervention, including alcohol-based hand-sanitizer and surface disinfection, in reducing absenteeism caused by gastrointestinal and respiratory illnesses in elementary school students.

METHODS. We performed a school-based cluster-randomized, controlled trial at a single elementary school. Eligible students in third to fifth grade were enrolled. Intervention classrooms received alcohol-based hand sanitizer to use at school and quaternary ammonium wipes to disinfect classroom surfaces daily for 8 weeks; control classrooms followed usual hand-washing and cleaning practices. Parents completed a preintervention demographic survey. Absences were recorded along with the reason for absence. Swabs of environmental surfaces were evaluated by bacterial culture and polymerase chain reaction for norovirus, respiratory syncytial virus, influenza, and parainfluenza 3. The primary outcomes were rates of absenteeism caused by gastrointestinal or respiratory illness. Days absent were modeled as correlated Poisson variables and compared between groups by using generalized estimating equations. Analyses were adjusted for family size, race, health status, and home sanitizer use. We also compared the presence of viruses and the total bacterial colony counts on several classroom surfaces.

RESULTS. A total of 285 students were randomly assigned; baseline demographics were similar in the 2 groups. The adjusted absenteeism rate for gastrointestinal illness was significantly lower in the intervention-group subjects compared with control subjects. The adjusted absenteeism rate for respiratory illness was not significantly different between groups. Norovirus was the only virus detected and was found less frequently on surfaces in intervention classrooms compared with control classrooms (9% vs 29%).


CONCLUSIONS. A multifactorial intervention including hand sanitizer and surface disinfection reduced absenteeism caused by gastrointestinal illness in elementary school students. Norovirus was found less often on classroom surfaces in the intervention group. Schools should consider adopting these practices to reduce days lost to common illnesses.



Thomas J. Sandora, MD, MPH -a,b

Mei-Chiung Shih, PhD – c,d

Donald A. Goldmann, MD – a

a – Division of Infectious Diseases
b – Department of Laboratory Medicine, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts
c – Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
d – Veterans’ Affairs Cooperative Studies Program, Palo Alto, California


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