Scientific and Technical Achievements

The Introduction of Hand Hygiene Promotion Project in Kindergartens of Shenzhen City

Hand, foot and mouth disease (HFMD) is a common infectious disease in the children at 0~6. In recent years the incidence of HFMD keeps on increasing in Shenzhen city. Children in kindergartens are the high risk group for HFMD, clustering HFMD cases always occur in kindergartens. In 2015 Shenzhen Center for Disease Control and Prevention (Shenzhen CDC) cooperated with Erasmus Medical Center (EMC) to conduct hand hygiene intervention in kindergartens, to improve the hand hygiene compliance of children and teachers to prevent HFMD. The aim of this paper is to describe the design of a cluster randomized controlled trial to evaluate the effectiveness of this intervention. We hope to develop a simple and easy measurement to decease the HFMD incidence in kindergarten children, it also can be apply to children at 0~3 scattered in communities. The study results can provide reference for HFMD prevention all over China.

Stratified cluster random sampling technique is performed in this study. 18 kindergartens were selected from Nanshan and Baoan district in Shenzhen city, totally 220 classes, 648 teachers and 8275 children have participated in this intervention study. 18 selected kindergartens are allocated randomly into 3 groups: 6 in kindergarten intervention group, 6 in kindergarten and family intervention group, and 6 in control group. These kindergartens are stratified by sponsor and district. 18 kindergartens are assigned to either intervention or control group by means of computer generation. The intervention consisting of four components: 1. Hand hygiene products: 2 soap dispensers and 2 paper towel dispensers are installed in each classroom, and provide refill for 6 months. 2. Kick off activity: Practicing hand washing technique, reading story and playing electronic game about hand hygiene with children. 3. Health education materials: including posters, stickers, booklets, story books and paper games, etc. 4. Health Education Session: 1 hour hand hygiene training for teachers and parents. The primary outcome measure will be observed HH compliance of teacher and children, measured at baseline and one, three, and six months after start of the intervention. The secondary outcome measure will be the HFMD incidence of chidlren, monitored over six months by school doctors and teachers using a absence report card to collect absence reason. Multilevel logistic regression will be performed to assess the effect of the intervention on HH compliance. Multilevel Poisson regression will be performed to assess the HFMD incidence in children attending kindergartens.

This study is the first randomized controlled trial for HFMD, the comprehensive intervention which merged health education, social cognitive, and behavior psychology and health environmental determinants together is different from traditional health education. The strength of this study is the randomized controlled trial design with a large sample size of over 8000 children, and a long-term hand hygiene for half a year, and uses HH compliance and children FMD incidence as outcome measures.

深圳市幼儿园手部卫生促进项目简介

　　手足口病是0~6岁儿童的常见传染病，近年来深圳市手足口发病率逐年增高。幼儿园儿童是手足口病的高危群体，易出现聚集性发病。手部卫生对手足口病的发生有显著影响。2015年深圳市疾病预防控制中心与荷兰Erasmus大学合作在幼儿园中开展手部卫生干预，改善儿童及教师的手部卫生依从性，以预防手足口病。项目旨在发展一种简便易行的干预措施以有效降低幼儿园儿童手足口病发病率，同时也能用于社区中的0~3岁散居儿童。研究成果预期可在在深圳市所有幼儿园中推广，也可为全国手足口病防制工作提供借鉴和参考。

　　项目采用分层整群随机抽样技术，在深圳市南山区和宝安区抽取18家幼儿园，合计220个班级， 648名教师和8275名儿童参与了干预项目。分为3组：幼儿园干预组（6家），幼儿园及家庭干预组（6家）和空白对照组（6家）。按照举办主体和所在地区进行分层，然后将各层内的幼儿园随机分配到干预组和对照组中。干预措施包括四项核心策略：1. 发放洗手用品：每个教室安装2个洗手液分配器，2个擦手纸分配器，并提供半年用量补充；2. 启动活动：演示洗手的正确步骤，与儿童一起讲故事玩游戏； 3. 发放健康教育材料，包括各类海报、贴纸、画册、知识手册等； 4. 健康教育课程：给老师及家长提供1小时培训课程。评价干预效果的首要指标是儿童及教师的手部卫生依从性，通过在干预开始前、干预开始后的第一、二个月和干预结束后进行四轮观察获得；另一个指标是幼儿园儿童手足口病发病率，通过由校医及教师对干预期间所有缺勤儿童均填写一份缺勤调查表获得。