Table 1 Characteristics of studies included in the systematic review, demographics and descriptive statistics

Cluster Randomized Controlled Trials (RCTs)

White ⁴¹ 2001 United States

1 private and 2 public elementary schools grades K-6; 72 initial classes (n = 1626 students) *

Target group:

• 16 classes, n = 388 students

Control group:

• 16 classes, n = 381 students

• GI or respiratory-related

• Parents reported events

• Education: presentation and video describing germs and proper handwashing techniques (1 hr session)

• Large involvement of both parents and school staff

• Each child received 1-oz bottle of SAB (CleanHands^®) (alcohol-free) instant hand sanitizer

• Instructed to use spray under teacher supervision to supplement handwashing

• Education: presentation and video describing germs and proper handwashing techniques (1 hr session)

• Large involvement of both parents and school staff

• Each child received 1-oz bottle of placebo formulation

• Instructed to use spray under teacher supervision to supplement handwashing

Crossover

Dyer ²⁷ 2000 United States

Private elementary school (K-6); 2 classrooms per grade level, n = 30 students per classroom

Target group:

• Children grades K-6

• 1 classroom per grade level

• n = 210 students

Control group:

• Children grades K-6

• 1 classroom per grade level

• n = 210 students

• GI (symptoms including vomiting, abdominal pain, and diarrhea)

• Respiratory-related (symptoms included cough, sneezing, sinus trouble, bronchitis, fever alone, pink eye, headache, mononucleosis, and acute exacerbation of asthma)

• Parents reported events

• Education: presentation and video describing germs and proper handwashing techniques (1 hr session)

• Each child received 1-oz bottle of SAB (CleanHands^®) (alcohol-free) instant hand sanitizer

• Instructed to use spray under teacher supervision to supplement handwashing

• Education: presentation and video describing germs and proper handwashing techniques (1 hr session)

• Instructed to wash hands as usual

Morton ¹⁶ 2004 United States

1 elementary school in northern New England, grades K-3; 17 classrooms and n = 285 students eligible

PHASE 1:

Target group:

• 9 classrooms

Control group:

• 8 classrooms

• PHASE 2:

• reversed

• GI (symptoms including influenza, diarrhea, nausea, or vomiting (with or without fever))

• Respiratory-related (symptoms included nasal congestion, cough, or sore throat (with or without fever))

• Parents reported events

• Education: guardians provided with study information and a contact number for the school nurse; additionally, monthly updates were provided

• Education: students received a carefully planned education program; 45 minute "Germ Unit", Glo Germ™ presentation

• Reinforcement: 1^st week: daily reminders given to students, after 1^st week reinforcement given weekly and after holidays; each classroom visited twice by school nurse during two arms

• AlcoSCRUB^® dispensers were furnished in each classroom, located near the classroom entrance at a height that was accessible to all students

• Gel use was monitored, and reinforcement was given to classes with low use

• Education: information was presented by school nurse about proper handwashing

• Instructed to wash hands as usual

Cluster Non-randomized Controlled Trials (NRCTs)

Hammond ³¹ 2000 United States

18 public elementary schools grades K-6 in 6 school districts *

Target group:

• 5 school districts: District 1 (Ohio; K-5; n = 1440 students), District 2 (Ohio; 2,3; n = 266 students), District 3 (Delaware; 3,4; n = 110 students), District 4 (Tennessee; K-6; n = 680 students), District 5 (California; K-5; n = 579 students)

Control group:

• 5 school districts: District 1 (K-5; n = 1136 students), District 2 (2,3; n = 552 students), District 3 (3,4; n = 113 students), District 4 (K-6; n = 592 students), District 5 (K-5; n = 612 students)

• Infectious process such as cold, flu, and gastroenteritis (common infectious illnesses such as pink eye, abscesses, and skin infections were not included)

• No information regarding reporting of events

• Each test classroom was equipped with a dispenser of PURELL instant alcohol-based hand sanitizer; also placed in other locations around the school

• Reinforcement by study co-ordinators every 3 months

• No intervention

Guinan ¹⁰ 2002 United States

5 elementary schools; 4 schools had 4 classrooms, 1 school had 2 classrooms (coed and single sex schools)

Target group:

• Children grades K-3

• 4 schools with 2 classrooms, 1 school with 1 classroom

• n = 145 students

Control group:

• Children grades K-3

• 4 schools with 2 classrooms, 1 school with 1 classroom

• n = 145 students

• Infectious process such as cold, flu, and gastroenteritis

• Children and parents reported events

• Had to be 5 days between episodes to count

• Education: presentation and video describing germs and proper handwashing techniques (1 hr session)

• Each test classroom was equipped with a dispenser of an alcohol-based hand sanitizer

• No intervention

Cluster Controlled Trials-randomization unclear

Thompson ¹⁵ 2004 United States (abstract only)

5 grade two classrooms, and 1 one/two combination classroom, n = 138 children

Target group:

• 3 classrooms

Control group:

• 3 classrooms

• Illness = cold, flu, conjunctivitis, and gastrointestinal symptoms

• Teachers recorded absences

• Age appropriate interactive learning session

• Alcohol-based hand sanitizer installed in intervention classrooms

n/a