Effectiveness of a School-Based Hand Sanitizer Program on Reducing Asthma Exacerbations

In the United States, almost 9 million children have been diagnosed with asthma. It is a
leading cause of hospitalizations and school absenteeism among children. Asthma symptoms are
often seasonal, with the greatest number of exacerbations occurring in autumn and the fewest
in mid-summer. Elementary school children are the most vulnerable to these seasonal changes,
and many children experience an increase in exacerbations at the beginning of the school
year. Recent research suggests that this seasonal peak in exacerbations is primarily caused
by viral respiratory tract infections that are spread among children in school. Regular
handwashing has been widely recognized as the most effective way to stop the spread of
viruses and infectious illnesses. However, effective handwashing methods among school-age
children can be inconsistent. Time constraints, a frequent lack of soap and towels,
inconveniently located sinks, and water-saving faucets are all barriers to thorough
handwashing. Improving hand hygiene through the use of antimicrobial rinse-free hand
sanitizers in school classrooms may be a simple and effective way to reduce the risk of
transmitting viruses that can cause asthma exacerbations. The purpose of this study is to
evaluate the effectiveness of a school-based hand sanitizer program at decreasing
exacerbations in children with asthma.

This study will enroll children with asthma who are attending one of the 32 participating
schools. Each school will be randomly assigned to either use their usual hand hygiene
practices in Year 1, followed by a two-step hand hygiene program including hand washing plus
hand sanitizer in Year 2, or vice versa. Each participant will log in to an Internet-based
data collection system on a daily basis to document their asthma symptoms and peak flow meter
readings. Teachers will also log in daily to verify participants' data and to document
participants' absences and the reason for the absence. Quick relief medication use will be
recorded and measured through the use of a Doser device on participants' inhalers.

Inclusion Criteria:

- Diagnosed with asthma

- Enrolled in a participating elementary school