Gastroenteritis, or infectious diarrhea, is a common illness that affects children worldwide. Commonly caused by a group of viruses and bacterial pathogens, the disease can either be acute or chronic and has emerged as a vital childhood infection. Indeed, statistics reveal that as many as 200 million cases are recorded in children under five and that the illness has an estimated mortality of 50,000 children yearly, especially in developing countries. Simple handwashing with soap has been considered an essential preventive strategy. Hence, for school going children in developing countries, does the use of hand wash compared to no hand wash reduce the chances of developing gastroenteritis over a one year period?
Hand Hygiene and Healthcare Workers
Hand hygiene interventions can only be successful in schools for controlling diarrheal illnesses if they are practiced and endorsed by healthcare workers. Engdaw, Gebrehiwot and Andualem (2019) carried out research to access hygiene compliance and associated factors among primary healthcare providers using an institutional-based cross-sectional study. Using self-administered questionnaires and observational checklists, the authors found out that only 14.19% of the participants practiced good hand hygiene. Compliance was associated with the availability of soap, training, and knowledge about proper hand hygiene. Engdaw et al. (2019) concluded that hand hygiene practice among healthcare providers was poor and cited this to be an essential factor that derailed control of diarrheal illnesses among school children due to lack of appropriate interventions for handwashing programs.
In yet another study to explore factors of hand hygiene practice among nurses, Hammerschmidt and Manser (2019) conducted a survey of 165 nurses and 27 nursing managers in Germany. The research results indicated that many nurses knew effective hand hygiene procedures, although compliance with standards only depended on role modelling. The authors also realized that even though nurses acted as role models and had the potential to influence hand hygiene programs, most of them did not appreciate this task adequately.
Handwashing Promotions in Schools
In research conducted by Ejemot-Nwadiaro, Ehiri, Arikpo, Meremikwu and Critchley, handwashing promotion was viewed as an essential strategy for reducing diarrheal illnesses for children in the low and middle-income countries. The authors aimed at assessing the effects of these promotions using data from various databases involving randomized controlled trials and cluster randomized control trials. Using articles from child daycare centers and schools, Ejemot-Nwadiaro et al. (2015) found out that handwashing promotions among communities prevented more than one-quarter of the diarrheal illnesses with a rate ration of 0.72 and a 95% confidence interval of 0.62-0.83. Furthermore, the authors realized that in a trial conducted within a hospital setup with high-risk populations, handwashing promotion significantly reduced episodes of diarrhea. However, the research failed to identify appropriate ways to maintain handwashing for longer durations.
In another research conducted to identify hand hygiene interventions for reducing diarrhea and respiratory infections Mbakaya, Lee and Lee identified appropriate handwashing as imperative to controlling infections among school children. Mbakaya et al. (2017) used data from school children aged 6-12 years within the developing countries to identify whether appropriate handwashing techniques were imperative for reducing the illnesses. The authors used randomized and cluster control trials and realized that hand hygiene was an essential factor for lowering diarrheal diseases among this targeted population by as much as 40%. Mbakaya et al. (2017) also identified the role of school health workers in categorizing and prioritizing multi0-level handwashing interventions as key in continuing the practice. Furthermore, it emerged that appropriate techniques were crucial for reducing not only morbidity and mortality but also costs of treatment of diarrheal illness as well as school absenteeism rates.
Conclusion
Health promotion remains an important aspect of nursing. Hand washing as a program is critical to providing a primary intervention strategy for controlling diarrheal illnesses among children who are frequently burdened by pathogens. The PICOT question acts as a guideline for helping nurses realize their role as models for developing and maintaining programs in schools, nursing homes and children centers. Such a strategy helps improve hygiene and prevent the surging morbidity and mortality rates that are also directly linked to increases in school absenteeism rates.