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Sneezing and Germs
"Respiratory viruses cause sneezing and coughing...Nasal secretions [from sneezing] can travel at a velocity of over 20 meters per second and a distance greater than three meters (about 10 feet) to contaminate surrounding fomites [or surfaces]."
- "Significance of Fomites in the Spread of Respiratory and Enteric Viral Disease"
by Stephanie A. Boone and Charles P. Gerba, Department of Soil, Water and Environmental Science, University of Arizona, Tucson, Arizona 85721
By Thomas J. Sandora, MD, MPH, Mei-Chiung Shih, PhD, and Donald A. Goldmann, MD
ABSTRACT
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.
PEDIATRICS Vol. 121 No. 6 June 2008, pp. e1555-e1562 (doi:10.1542/peds.2007-2597)
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