The Effect of a School Based Hand Sanitizer Program on Asthma

描述(由申请人提供)：在美国，儿童哮喘是一个有充分记录的公共卫生问题。儿童哮喘的影响可以通过医疗保健费用和发病率来衡量。哮喘发病率是季节性的，秋季发病最多，仲夏最少。与年龄有关的季节性变化很强，小学生最容易受到季节性变化的影响。此外，儿童哮喘发病率的年度高峰已被证明与学年开始有关。最近的研究表明，儿童的这种季节性主要与病毒呼吸道感染有关。人们普遍认为，经常洗手是防止包括病毒在内的传染病传播的最有效手段。然而，学龄儿童的有效洗手充其量也是不一致的。学校的环境为有效洗手提供了多重障碍，例如时间限制，以及经常缺乏肥皂、毛巾和位置合理的洗手池。用来防止过度用水的弹簧式水龙头无意中对彻底洗手造成了额外的障碍。在这样的环境中，可以通过抗菌免洗洗手液有效地完成手消毒。因此，我们建议与单个学区合作，以实现以下具体目标：1.开发一种简单的基于学校的干预措施，使用洗手液来减少哮喘儿童的哮喘恶化。2.在活动组和安慰剂组中实施以学校为基础的互联网监测系统，以记录哮喘症状、峰值流量计读数、缺课情况和在学校使用抢救药物。3.随机选择26所学校使用活性洗手液或安慰剂洗手液。4.使用交叉设计，比较活动组和安慰剂组的哮喘儿童每月至少恶化一次的时间平均比例。改善学校环境中的手部卫生可能是降低哮喘恶化风险的相对简单但有效的方法。通过实现这些具体目标，这项研究将为学校环境中使用洗手液的有效性提供有价值的信息。

DESCRIPTION (provided by applicant): Pediatric asthma is a well documented public health issue in the United States. The impact of pediatric asthma can be measured by both health care costs and morbidity. Asthma morbidity is seasonal with the greatest number of exacerbations occurring in autumn and the fewest in mid-summer. There is a strong age-related seasonal variability with grade school children being the most vulnerable to seasonal changes. Furthermore, the annual peak asthma morbidity for children has been shown to be associated with the start of the school year. Recent research suggests that this seasonality in children is primarily related to viral respiratory tract infections. Regular handwashing has been widely recognized as the most effective means to combat the spread of infectious illness, including viruses. However, effective handwashing among school-age children is inconsistent at best. The school setting provides multiple barriers to effective handwashing such as time constraints, and frequent lack of soap, towels, and strategically located sinks. Spring loaded faucets which serve to prevent overuse of water inadvertently pose an additional barrier to thorough hand cleansing. Hand sanitization in such settings may be effectively accomplished by antimicrobial rinse-free hand sanitizers. Therefore, we propose to collaborate with a single school district to achieve the following specific aims: 1. Develop a simple school based intervention using hand sanitizers to decrease asthma exacerbations in children with asthma. 2. Implement a school based internet monitoring system within both the active and placebo groups to record asthma symptoms, peak flow meter readings, school absences, and use of rescue medications at school. 3. Randomize 26 schools to either active or placebo hand sanitizer. 4. Use a cross-over design to compare the active and placebo groups with regard to time-averaged proportion of children with asthma who have at least one exacerbation per month. Improving hand hygiene in the school environment may be a relatively simple, yet effective way to reduce the risk of asthma exacerbations. By achieving these specific aims, this study will provide valuable information on the effectiveness of hand sanitizers in the school setting.