Cluster randomised controlled trial to test the effectiveness of an educational intervention to promote hand washing in reducing absenteeism in primary schools
1. Is the Hands up for Max! educational hand washing intervention effective in reducing absenteeism, through reducing the spread of infectious illness, in primary school pupils and staff?
2. What percentage pupil and staff absence is due to infectious illness?
3. Is there a difference in hand washing behaviour, knowledge and attitudes between pupils and staff in the intervention and control arms of the trial?
4. Is the Hands for Max! resource cost effective?
5. What can a detailed process evaluation tell us about intervention delivery, hand washing facilities in schools, and pupil and staff hand washing behaviour, knowledge, and attitudes?
University of Bristol, Faculty of Medicine and Dentistry Committee for Ethics approved in January 2009 (ref: 080908)
Pragmatic cluster randomised controlled single centre trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Intervention arm: Hands up for Max! hand washing intervention delivered in primary schools during autumn term 2009 in addition to usual hygiene education.
Control arm: Usual hygiene education continued during autumn term 2009. Hands up for Max! resource offered to schools in autumn term 2010 after all follow-up data for trial completed.
Absence data collected for intervention and control schools for school year 2008/2009 as baseline measure (pre intervention), and absence data for school year 2009/2010 as follow-up data (post intervention).
Primary outcome measure
Pupil and staff absence measured using routine absence data for schools available from the Department for Education. Pupil and staff absence due to infectious illness measured using data collected over 3 months (Jan - April 2010) in a sample of participating schools (sub-study schools, n = 24).
Secondary outcome measures
1. Pupil and staff hand washing behaviour, knowledge, and attitudes measured using self-report questionnaires completed in sub-study schools (n = 24) during March - May 2010
2. Economic evaluation completed using data collected on NHS and wider workforce costs as a result of absence due to illness in sub-study schools (n = 24), collected over 3 months (Jan - April 2010)
3. Process evaluation including:
3.1. Observations of hand washing facilities
3.2. Observation of intervention delivery
3.3. Exploration of hand washing behaviour
3.4. Knowledge and attitudes through interviews with teachers and focus groups with pupils
The process evaluation was completed over 3 months: November 2009 - January 2010.
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Maintained primary schools (including infant and junior schools) and special schools in the South West of England
2. Pupils aged 5 - 11 years, either sex
Target number of participants
176 primary schools (178 recruited)
Participant exclusion criteria
Independent primary schools and pupil referral units in the South West of England.
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
School of Social and Community Medicine
University of Bristol (UK)
Research and Enterprise Development (RED) Office
National Institute for Health Research (NIHR) (UK) - Research for Patient Benefit (RfPB) Programme (ref: PB-PG-1207-15212)
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
2013 results in: http://www.ncbi.nlm.nih.gov/pubmed/23947388
Chittleborough CR, Nicholson AL, Young E, Bell S, Campbell R, Implementation of an educational intervention to improve hand washing in primary schools: process evaluation within a randomised controlled trial., BMC Public Health, 2013, 13, 757, doi: 10.1186/1471-2458-13-757.