Kent State University / Price Chopper Employee Wellness Study

The annual costs of seasonal influenza in the United States have been estimated at $87.1
billion (1), while costs from the common cold have been estimated at $40 billion (2). Office
employees are at increased risk for contracting communicable disease at work, since they
spend nearly half of their waking hours in this setting, work in close proximity with each
other, and share equipment. Furthermore, employers in the U.S. have a compelling interest to
reduce the spread of infectious disease, because they pay for the direct and indirect costs
of absenteeism in employee wages, replacement of staff, reduced quality of services, rising
health care premiums, and if self-insured, direct health care expenditures (3).

Hand hygiene is the single most important action to reduce the transmission of pathogens that
result in healthcare acquired infections (4). Moreover, hand hygiene and respiratory
etiquette have been recommended as primary non-pharmaceutical strategies in the early stages
of an epidemic before a suitable vaccine is available (5). While influenza vaccine uptake is
the most important recommendation to prevent influenza, the vaccine only protects against 3
or 4 of the most prevalent circulating strains in a given flu season (6) and does not provide
protection against non-influenza viral and bacterial pathogens. Meta-analysis has shown that
numerous community intervention studies in schools, daycare, and private homes have reduced
illness from infectious disease by 21-31% (7).

Despite the enormous burdens from communicable disease and the importance of the workplace as
a setting for the potential spread of infections, to date, only four randomized control
trials have been performed world-wide among office-based employees to assess the efficacy of
hand hygiene interventions to reduce the spread of communicable disease, including acute
respiratory infections (ARI), influenza-like illness (ILI) and gastrointestinal infections.
Collectively, these interventions have shown promising results. Hubner and colleagues (2010)
found a 65% reduction in the odds of contracting the common cold among workers with improved
hand hygiene in a public administrative setting in Germany (8), while Savolainen-Kopra and
colleagues (2012) found a reduction in infectious illness among office employees in Finland
who participated in a study arm that utilized soap and water and educational training (9). In
the U.S., Stedman-Smith and colleagues (2015) found a 31% significant reduction in
self-reported ARI / ILI and gastrointestinal illness combined in a multi-modal hand hygiene
pilot randomized cluster trial among office employees at a Midwestern government center (10).
While, Arbogast and colleagues (2016) found a significant reduction in health care claims for
communicable infections spread by hand-to-mouth modes of transmissions over a 13-month,
multi-component hand hygiene trial which utilized education, hand sanitizer and disinfectant
wipes (11).

This is a comprehensive non-pharmaceutical randomized cluster hygiene improvement
intervention to reduce self-reported acute respiratory tract infections (ARIs) /
influenza-like-illness (ILI) and gastrointestinal (GI) illness, absenteeism, and presenteeism
over a 90-day trial. The Intervention group will receive hygiene supplies (hand sanitizer,
surface disinfectant wipes, tissues) and educational materials in varied mediums, including
brief educational videos, and motivational posters hung in common work areas, in addition to
hand sanitizer, along with hand sanitizer and surface disinfectant wipes installed in shared
work areas. The control group will perform their usual hygiene activities and will not
receive an intervention. Predominate pathways for the spread of ARI/ILI and non-foodborne GI
infections include: (1) droplets that land on the nose, mouth, or are inhaled from infected
persons' who cough, sneeze or talk; or (2) pathogens on hands contaminated from fomites or
from touching infected persons, which come in contact with portals of entry including the
mouth and nose.(12). This multi-modal intervention is developed to promote improvements in
the performance of protective behaviors that will reduce the spread of pathogens for ARI/ILI
and GI infections by minimizing exposure from these two common pathways.

Identical weekly surveys will be administered to the intervention and control groups to
measure self-reported illness, absenteeism and presenteeism; related behavior and attitudinal
beliefs will be included in the surveys at specified longer intervals during the study. A
sub-analysis will be performed to determine if those at high-risk for complications resulting
in severe morbidity and mortality from infections show a reduction in self-reported
infections, absenteeism and presenteeism. The intervention and control groups were randomized
by work floors before the onset of the enrollment period.

It is hypothesized that employees in the intervention group will experience reduced
self-reported illness, absenteeism and presenteeism along with improved protective hygiene
behaviors, and attitudinal beliefs relative to those in the control group over the 90-day
trial. Statistical analysis will be performed to determine if a relative reduction in
self-reported communicable infections, absenteeism, and presenteeism, along with the
improvement of related behaviors and attitudinal beliefs occurred among members in the
intervention group relative to the control group over the 90-day trial. Statistical analysis
will include the use of multiple imputation to impute missing variables, and the calculation
of incidence rate ratios with 95% confidence intervals. Incident rate ratios will be
calculated using generalized linear mixed models with a Poisson distribution and a log link
function that will be adjusted for potential confounders and intercluster correlation.

Inclusion Criteria:

- At least 18 years or older

- No known allergies to alcohol or surface disinfecting wipes;

- Works at least 30% of office hours at the study host site;

- Consent to receiving emails from Kent State University.

Exclusion Criteria:

- Under 18 years of age;

- Known allergies to alcohol or surface disinfecting wipes;

- Works less than 30% of office hours at the study host site;

- Does not consent to receiving emails from Kent State University.