The majority of interventions (N = 7) were multi-modal, with components similar to healthcare worker hand hygiene programmes, including education, reminders, audit and feedback, and provision of hand hygiene products.
Simple, low-cost interventions to improve hand hygiene could include increased provision of hand towels and running water and improved staff education to challenge their views and perceived barriers to hand hygiene.
Barriers to the provision of hand washing materials still remain.
18 Additionally, provision of hand washing water by the school improved significantly in intervention versus control schools (P < 0.0001).
Kotch 2003 USA assessed the impact of provision of hand washing and diapering equipment on incidence and duration of infectious illness (including diarrhoea) in both children and staff.
Compliance with hand hygiene during routine patient care is measured before and after the intervention, which is a four-day workshop accompanied by provision of hand hygiene products and posters emphasizing the importance of hand hygiene.
However, the United Nations High Commissioner for Refugees (UNHCR) standards for humanitarian emergency assistance recommend the provision of hand washing stations with soap next to communal latrines which addresses hand washing after latrine use.
The subgroups used were: trial setting, provision of hand washing material (soap) as part of intervention, type of promotional activity employed), and quality characteristics (whether outcome assessors were blinded).
We explored and attempted to explain heterogeneity where possible using a pre-defined trial characteristic (provision of hand washing material (soap) as part of intervention, and type of promotional activity employed) and quality characteristics (whether outcome assessors were blind and whether trials had adjusted for clustering).
However, these infections and infection-related deaths are potentially preventable, and there is a clear need for studies in such settings that evaluate low cost preventive interventions such as a hand hygiene campaign associated with provision of improved hand washing facilities or alcohol hand gel.
