Agg Jennie (2012).​ How clean are YOUR hands?

​ Retrieved from,

http://www.dailymail.co.uk/health/article-3269827/How-clean-hands-answer-revealed-un

ique-experiment-shock-change-wash.html

Jennie Agg conducted an experiment to analyze the effects of a poor hand washing protocol

compared to a 30 second rinse with soap. Hands can harbor colonies of bacteria, including,

E.coli, salmonella, the superbug MRSA, as well as flu viruses. She used a special UV

camera to test different protocols, which included the “rinse and shake,” a six second wash

without soap, six seconds with soap, fifteen seconds with soap and thirty seconds with soap.

It was found that after washing for thirty seconds, there was little to no bacteria revealed

by GloGerm while all other routines still saw bacteria.

Attendance Works (2014). ​10 FACTS ABOUT SCHOOL ATTENDANCE​ Retrieved from,

http://www.attendanceworks.org/facts-stats-school-attendance/

“An estimated 5 million to 7.5 million U.S. students miss nearly a month of school each

year.”

Arbogast James, Moore-Schlitz Laura ,Jarvis William R., Harpster-Hagen Amanda, Hughes

Jillian...Parker (2016.) ​ Impact of a Comprehensive Workplace Hand Hygiene Program

on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee

Perceptions and Practices,​ Journal of Occupational & Environmental Medicine: June

2016 - Volume 58 - Issue 6 - p e231–e240 doi: 10.1097/JOM.0000000000000738

Arbogast et. al developed a study to determine the efficiency of a hand hygiene intervention

in reducing health care insurance claims for hygiene preventable infections, absenteeism,

and overall impact on employees. Alcohol-based hand sanitizer was placed in strategic
workplace locations and brief hand hygiene education was given to one group.

Hygiene-preventable health care claims were significantly reduced in the intervention

group by over 20% (P < 0.05). Absenteeism was positively impacted overall for the

intervention group. Employee survey data showed significant improvements in hand

hygiene behavior and perception of company concern for employee well-being.

B4 Brands (2013)​. The Facts About Hand Washing and Hand Hygiene. ​ Retrieved from,

https://www.b4brands.com/blog/facts-hand-washing-hygiene/

“For every 15 seconds spent washing hands, 10 times more bacteria is removed.”

Blevins Melissa (2015). ​How Soap Works. ​Retrieved from,

http://www.todayifoundout.com/index.php/2015/01/plain-old-soap-doesnt-kill-bacteria-

an-really-effective-getting-rid/

This article discusses the effectiveness and importance of soap, as well as how often it

should be used and how to properly use it. When you wash your hands with regular soap

and water, the soap chemically works to break down the oil, while the friction from

rubbing does it mechanically. Thus, the more soap and the longer the hands are rubbed

together, once rinsed away with water, the less oil and microbes left on your hands.

Canadian Centre for Occupational Health and Safety (2017). ​Hand Washing: Reducing the Risk

of Common Infections. ​Retrieved from,

​http://www.ccohs.ca/oshanswers/diseases/washing_hands.html

Informs readers on specific moments after specific situations that you should wash your

hands. When hands are visibly soiled; After using the washroom (includes changing

diapers); After blowing your nose or after sneezing in your hands; Before and after eating,
handling food, drinking or smoking; After touching raw meat, poultry, or fish; After

handling garbage; Visiting or caring for sick people; Handling pets, animals or animal

waste.

The Center for Disease Control (2015). ​Handwashing: A Corporate Activity. ​Retrieved from,

https://www.cdc.gov/healthywater/hygiene/hand/handwashing-corporate.html

Sheds light on the impacts of the use of hand hygiene in the workplace. The impact of on

overall health is explaining how quickly germ can spread and that each individual is a

catalyst for these bacteria. Having a healthier community means healthier employees.

Some financial impacts would be the reduction in employee sick days as well as a reduction

in the spread of disease in the work community.

The Center for Disease Control (2013). ​Hygiene Fast Facts. ​Retrieved from,

https://www.cdc.gov/healthywater/hygiene/fast_facts.html

CDC discussed interesting facts about hygiene (handwashing, face and body hygiene.) “The

use of an alcohol gel hand sanitizer in the classroom provided an overall reduction in

absenteeism due to infection by 19.8% among 16 elementary schools and 6,000 students”

The Center for Disease Control (2016). ​Hand Hygiene in Healthcare Settings. ​Retrieved from,

​https://www.cdc.gov/handhygiene/

Provides information to how effective hand hygiene is in healthcare settings. Cleaning your

hands can prevent the spread of germs, including those that are resistant to antibiotics and

are becoming difficult, if not impossible, to treat. On average, healthcare providers clean
their hands less than half of the times they should. On any given day, about one in 25

hospital patients has at least one healthcare-associated infection.

The Center for Disease Control (2012). ​Information for Schools & Childcare Providers

Retrieved from,

https://www.cdc.gov/flu/school/index.htm

Discusses how educators can help promote health and wellbeing in the classroom.

Encourage students to stay home when they are sick and to cover their nose and mouth

with a tissue when they cough or sneeze. Also, encourage proper handwashing and help

avoid students from touching their eyes, nose and mouth. Most importantly, use hand

sanitizer and disinfect contaminated surfaces regularly.

The Center for Disease Control (2016). ​Show Me the Science - When & How to Use Hand

Sanitizer. ​Retrieved from,

​https://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html

Informs the readers when and how to use hand sanitizer, as well as giving them a why.

They also mention that hand sanitizer does not eliminate all germs and should not be used

over the normal soap and water.

The Center for Disease Control (2015). ​“Show Me the Science- Why Wash Your Hands?”

Retrieved from, ​https://www.cdc.gov/handwashing/why-handwashing.html

Keeping hands clean is one of the most important steps we can take to avoid getting sick

and spreading germs to others. Many diseases and conditions are spread by not washing

hands with soap and clean, running water. This article explains how germs spread and how
they can be killed, as well as some statistics on cases where people did not wash their hands

as often as they should of.

Dierssen-Sotos Trinidad, Brugos-Llamazares Verónica, Robles-García Mónica,

Rebollo-Rodrigo Henar, Fariñas-Álvarez Concepción, Antolín-Juarez Francisco

Manuel...Lopez (2010). ​Evaluating the impact of a hand hygiene campaign on improving

adherence.​ Health Psychology

http://doi.org.ezproxy.lib.uconn.edu/10.1016/j.ajic.2009.08.014

Compliance with hand hygiene (HH) was monitored by direct observation in 3 hospitals

before and after implementation of an HH informational campaign, separately analyzing

the effect of a training program. The final results showed training plus an informational

campaign doubled the probability of HH, whereas the informational campaign without

training decreased adherence, acting as a deleterious factor in HH adherence.

Dizikes Peter (2014).​ In the cloud: How coughs and sneezes float farther than you think.

Retrieved from,

http://news.mit.edu/2014/coughs-and-sneezes-float-farther-you-think

Peter Dizikes reveals just how far bacteria from a sneeze can travel. The study found that

the smaller the droplets that emerge in a cough or sneeze may travel five to 200 times

further than they would if those droplets simply moved as groups of unconnected particles

— which happens when one sneeze in their elbow or tissue.

Food and Drug Administration (2015). ​Employee Health and Hand Hygiene. ​Retrieved from,

​https://www.fda.gov/Food/GuidanceRegulation/

The FDA registered handbook that discusses how to prevent foodborne illnesses in people

who handle food. The Big 5 foodborne pathogens include noroviruses, ​Salmonella, E. coli,

Shigella​ and Hepatitis A virus. To reduce the presence of these bacterias, wash your hands

and workplace before and after working with food.

Global Handwashing Program (2017). ​ Why Handwashing? ​Retrieved from,

http://globalhandwashing.org/about-handwashing/why-handwashing/economic-impact/

Discusses the cost effective impacts proper hand hygiene has on public health.

Grenard, S (2014). ​Hand-Transmitted Infection. ​Retrieved from,

​http://www.anapsid.org/handwash1.html

Steve Grenard discusses how hand transmission is a critical factor in the spread of

bacteria, pathogens and viruses. Each year over 80 million estimated cases of food

poisoning occur in the United States alone. The US spends $7.6 billion annually on health

care and lost productivity resulting from foodborne illness. What's worse is that foodborne

illness kills as many as 10,000 people each year. In health care, a New England Journal of

Medicine (July 9, 1992) study reported that health care workers (in hospitals, long-term
health care facilities, nursing homes, clinics, and doctor's offices) fail to meet established

procedural handwashing requirements over 60% of the time.

Guinan Maryellen, Mcguckin Mary Ann, Yousef Ali (2002). ​The effect of a comprehensive

handwashing program on absenteeism in elementary schools.​ American Journal of

Infection Control. DOI: 10.1067/mic.2002.120366

Researchers looked further into the effects of interventions and hand sanitizer on

elementary schools in Pennsylvania. There was lower absenteeism in 23 of the 27 months

the test groups(P < .001) compared with the control groups. The test group had 50.6%

fewer episodes of absenteeism than the control group (277 vs 140 episodes).

Hammond B, Ali Y, Fendler E, Dolan M, Donovan S (2000). ​Effects of hand sanitizer use on

elementary school absenteeism. ​Infection Control.

Hammond B et. al indicated a connection between handwashing and illness-related

absenteeism in school settings. This study involved 5 individual school districts, 16

individual schools, and more than 6000 students in Delaware, Ohio, Tennessee, and

California. Individual schools in each district were paired into product and control groups.

In the product group schools, an alcohol gel hand sanitizer was used by the students and

staff when entering and leaving the classroom. Absenteeism due to infection was recorded,

and the data were statistically analyzed. Results showed an overall reduction in

absenteeism compared to the controlled groups.

King D, Ivo V, Ruth T, Maureen F, Ara D, Birnbach D (2016). ​‘Priming' Hand Hygiene

Compliance in Clinical Environments. ​ Health Psychology 35.1 (2016): 96-101.

This study used two different approaches in improving hand hygiene compliance (HHC),

Olfactory priming and Visual priming, to test the effectiveness of these subtle reminders,

clean scents and female/male eyes, in the surroundings of a hospital. The patients, workers,

and visitor were all observed for the experiment, however, they had no knowledge of this in

order to get the most candid results possible. Results showed that olfactory priming was

best at persuading people to wash their hands.

Lau C, Springston E, Sohn M, Mason I, Gadola E, Damitz M...Gupta. (2012). ​Hand hygiene

instruction decreases illness-related absenteeism in elementary schools: a prospective

cohort study.” B​MC Pediatrics. doi: 10.1186/1471-2431-12-52

This study collected and analyzed absences of 773 students attending two public

elementary schools in Chicago. Classes were systematically assigned to an intervention or

control group. Out of 773 students, 1.886 absences were reported during October to May.

Total absent days and percent illness related days were significantly lower in the

intervention group (which received a short instruction during flu season every 2 months).

Adding hand hygiene instruction to existing hand hygiene practices improved attendance.

Mayo Clinic (2016). ​Hand-washing: Do's and don'ts. ​Retrieved from,

​http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/hand-

​washing/art-20046253

Mayo Clinic Staff reports the handwashing do’s and don’ts. Wash your hands before and

after preparing food, treating wounds, coughing or whenever they look dirty. Wash your

hands by first wetting your hands with running water, then apply soap and rub vigorously
for at least 20 seconds. Rinse well and dry completely. Hand sanitizer can be substituted

and is suggested for children and adolescents.

Minnesota Department of Health (2006). ​Handwashing Gets Results​, Retrieved from,

http://www.health.state.mn.us/handhygiene/schools/results.html

Minnesota Department of Health handwashing poster that describes the results of proper

hygiene. Study of 305 Detroit students who washed four times a day found 24% fewer colds

and 51% less stomach upset. Minnesota daycare-teachers helped the kids wash their hands

every morning when they arrived and the staff disinfected all area parents may have

touched and results showed 50% fewer illnesses at daycare.

Minnesota Department of Health (2013). ​Hands and Bacteria Poster ​Retrieved from,

http://www.health.state.mn.us/handhygiene/why/handsbacteria.html

Minnesota Departrment of Health handwashing poster that intrigues the viewer by

discussing how much bacteria is on one’s hands. On each square centimeter of skin, there

are about 1,500 bacteria.

Montana Government (2016). ​Communicable Diseases in Schools ​Retrieved from,

​http://dphhs.mt.gov/schoolhealth/communicabledisease

The Montana State Government Communicable Disease Epidemiology Program discusses what all

school districts within the state should do in terms of hand hygiene. Districts should: maintain their

vigilance for increasing absenteeism due to respiratory, gastrointestinal or other communicable

illnesses, report any increases in absenteeism rates and collaborate with local health departments

for outbreak investigation. Also, communicable diseases can be prevented through handwashing,

staying home when ill, education, disinfectants, vaccinations and health care facilities.
Pellegrino R, Crandall P, Seo H. (2016). ​Using Olfaction and Unpleasant Reminders to Reduce

the Intention-behavior Gap in Hand Washing.​ Scientific Reports, 6,18890.

http://doi.org/10.1038/srep188

This study used prospective memory (PM) scenarios to measure the effectiveness of a

control and sensory reminders of disgust to influence handwashing behavior and

performance. Participants were given cues of disgust which were smell (rotten fish) visual

(dirty toilet) auditory (belch) and control (poster) which influenced participants into

remembering to wash their hands when shown a group of vegetables vs. cotton, metal etc.

The results proved that olfactory senses were most effective at making participants to

remember to wash their hands.

Piedmont Healthcare (n.d) ​Too much hand washing can make you sick. ​Retrieved from,

http://www.piedmont.org/living-better/too-much-hand-washing-can-make-you-sick

Piedmont Healthcare analyzes the repercussions of excessive handwashing. Over-washing

can cause hands to dry out, crack and bleed, which allows germs to enter the body. Some

researchers believe hand sanitizer overuse may be causing children to lose the ability to

build up resistance to bacteria. Samer Blackmon, M.D., an internal medicine specialist at

Piedmont, supports this theory.“By constantly using hand sanitizer, you eliminate the

bacteria that helps build up your immune system, allowing antibiotic-resistant bugs to

enter your system and make you very sick.”

Rees Susan, Houlihan Beth, Safdar Nasia , Sanford-Ring Sue, Shore Teri, Schmitz Michelle

(2013). ​Success of a Multimodal Program to Improve Hand Hygiene Compliance. ​Hand

Hygiene adherence.

Researches Rees S. et al. describe successful implementation of a quality improvement

initiative focusing on a hand hygiene program that used the multimodal interventions of

tailored education, monthly feedback, and reminders. Compliance rates improved from

July 2011 to December 2012 by 57.4%. Efforts are continuing to ensure program

sustainability.

Robert Wood Johnson Foundation (2016). ​The Relationship Between School Attendance and

Health. ​Retrieved from,

http://www.rwjf.org/en/library/research/2016/09/the-relationship-between-school-attenda

nce-and-health.html

The Robert Wood Johnson Foundation discusses how health interferes with school

attendance. The effects of chronic absenteeism can last a lifetime and negatively impact

education, health, financial stability and employment. And chronic absenteeism affects

graduation rates. Student who are“chronically absent for any year between eighth and

twelfth grade are over seven times more likely to drop out.”

Scrub Club (n.d) ​Teacher’s Guide,​ Retrieved from,

http://www.scrubclub.org/assets/pdf/teachers_guide.pdf

A teacher's guide explaing how to instill proper hand washing protocol in students. Each

year, more than 164 million school days are lost due to illness, which could be greatly
reduced with proper hand washing. By directly teaching students on how to properly wash

hands, the presence of illnesses and absences in a given classroom can be reduced.

Stone Patricia, Hasan Sumya, Quiro Daves, Larson Elaine (2007). ​Effect of Guideline

Implementation on Costs of Hand Hygiene. ​Nursing Economic$, 25(5), 279–284.

​Infections can be extremely costly to individuals and healthcare facilities. To

prevent this loss in money, people can become more aware of the bacteria being spread
throughout their surroundings and frequently washing their hands. The hands of
healthcare personnel serve as vectors for the transmission of organisms between patients,
hand hygiene is one effective strategy to reduce HAIs. Suggestions on how to improve four
critical components of a multidimensional hand hygiene program are discussed: (a) clinical
staff, including new hire and trainees, understand key elements of hand hygiene practice
(demonstrate knowledge); (b) clinical staff, including new hire and trainees, use
appropriate technique when cleansing their hands (demonstrate competence); (c) alcohol
based hand rub and gloves are available at the point of care (enable staff); and (d) hand
hygiene is performed at the right time and in the right ways (verify competency, monitor
compliance, and provide feedback).
Unicef (n.d) ​Fast Facts and Figures About Handwashing, ​Retrieved from,

http://unicef.in/Story/129/Fast-Facts-And-Figures-About-Handwashing

Unicef gives detailed figures on how hand hygiene can reduce childhood deaths caused by

diarrhoea and pneumonia.

World Health Organization (2016). ​Five moments for hand hygiene. ​Retrieved from,

​http://www.who.int/gpsc/tools/Five_moments/en/

WHO Guidelines declare the five most important moments for hand washing for people in
the medical field or anyone exposed to bacteria. They instruct anyone to clean their
hands before touching a patient (handshaking, clinical examination etc.), before any
aseptic task (oral care, medications etc.), after exposure to bodily fluids (blood, urine
etc.), after touching a patient and her/his immediate surroundings and after touching
object in the patient's immediate surroundings (bed linen, furniture etc.)