Cluster randomised controlled trial to test the effectiveness of an educational intervention to promote hand washing in reducing absenteeism in primary schools

Lead investigator
Professor Rona Campbell, University of Bristol
  • Good hand hygiene is an important infection control measure as person-to-person contact, including via hands, is a common mode of transmission for gastrointestinal and respiratory infections. Half of all general practitioner consultations, and 12% of all hospitalizations among children aged 0 –14 years are for infections.
  • Improving hand hygiene to lower the transmission of infections could reduce absenteeism of teachers and pupils in schools, and could also potentially prevent secondary infections in the wider community, reduce health service costs and lower the burden on families, some of whom may need to take time off work to care for children.
  • The ‘Hands up for Max!’ campaign was developed by Health Protection Agency (HPA) in collaboration with schools. The resource pack includes: DVD animation teaching correct hand washing technique, lesson plans for KS1 [5-7 yrs] and KS2 [7-11yrs], posters, stickers, homework activities, art competition, a game and fun facts. The resource was developed by the HPA as a low-cost educational intervention that could be readily integrated into existing school curricula.
Aims & objectives
To determine whether the ‘Hands up for Max!’ campaign is effective in reducing absenteeism among pupils and staff in primary schools. To estimate the percentage of absences due to respiratory and gastrointestinal infections. To examine, using a process evaluation, how the 'Hands up for Max!' educational resource was delivered in intervention schools and explore responses to the intervention among pupils and staff.
Study design

Cluster randomised controlled trial. All state primary schools (n = 613) within six local authorities in the South West of England invited to participate in the study. Participating schools (n = 178) randomised to receive the intervention in 2009 (intervention schools) or to receive the resource after all follow-up data were collected in 2011 (control schools).

  • Pupil and staff absence measured using routine absence data for schools available from the Department for Education. Pupil and staff absence due to infectious illness measured using data collected over three months in a sample of participating schools.
  • Detailed process evaluation, involving focus groups with pupils including drawings of hand washing facilities, semi-structured interviews with teachers, direct observation of intervention delivery and hand washing facilities. Four intervention and four control schools were selected for the process evaluation from the 24 schools participating in a sub-study to collect enhanced absenteeism data.
  • Economic evaluation
Further information & publications
Start date
September 2009
End date
December 2012
Trial register number