A Quasi-Experimental Pre-Post Assessment of Hand Hygiene Practices and Hand Dirtiness Following a School-Based Educational Campaign

Michelle M. Pieters (), Natalie Fahsen, Christiana Hug, Kanako Ishida, Celia Cordon-Rosales and Matthew J. Lozier
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Michelle M. Pieters: Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
Natalie Fahsen: Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
Christiana Hug: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
Kanako Ishida: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
Celia Cordon-Rosales: Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
Matthew J. Lozier: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA

IJERPH, 2025, vol. 22, issue 8, 1-12

Abstract: Hand hygiene (HH) is essential for preventing disease transmission, particularly in schools where children are in close contact with other children. This study evaluated a school-based intervention on observed HH practices and hand cleanliness in six primary schools in Guatemala. Hand cleanliness was measured using the Quantitative Personal Hygiene Assessment Tool. The intervention included (1) HH behavior change promotion through Handwashing Festivals, and (2) increased access to HH materials at HH stations. Handwashing Festivals were day-long events featuring creative student presentations on HH topics. Schools were provided with soap and alcohol-based hand rub throughout the project to support HH practices. Appropriate HH practices declined from 51.2% pre-intervention to 33.1% post-intervention, despite an improvement in median Quantitative Personal Hygiene Assessment Tool scores from 6 to 8, indicating cleaner hands. Logistic regression showed higher odds of proper HH when an assistant was present. The decline in HH adherence was likely influenced by fewer assistants and changes in COVID-19 policies, while improvements in hand cleanliness may reflect observational bias. These findings emphasize the importance of sustained behavior change strategies, reliable HH material access, and targeted interventions to address gaps in HH practices, guiding school health policy and resource allocation.

Keywords: hand hygiene; COVID-19; education campaign; behavior change; hand dirtiness (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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