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CDC and Partners Work to Advance Hand Hygiene Practices in Primary Schools in Central America

October 9, 2023

By: Brittany M. Robinson and Victoria Trinies, Centers for Disease Control and Prevention

Learning about and practicing hand hygiene in primary education settings is critical to preventing the spread of infectious diseases among school-aged children and staff. Hand hygiene behavior, particularly handwashing with soap, is especially important at moments like after using the toilet and before eating. However, teachers don’t always have the tools they need to teach their students about hand hygiene and schools in low-resource settings often lack hygiene materials. This can make it difficult for educators to implement handwashing lessons and for students to regularly practice handwashing.

CDC Partners Mobilize to Improve Hand Hygiene in Schools

As part of efforts to reduce the spread of COVID-19 in Central America, CDC’s Waterborne Disease Prevention Branch provided technical assistance and collaborated with implementing partners from research institutions, CDC country offices, and ministries of health and education to support water, sanitation, and hygiene (WASH) activities in Belize, El Salvador, and Guatemala.

Starting in 2022, field staff conducted baseline assessments to understand the hand hygiene needs in each of the twelve project schools. These assessments found that there were gaps in students’ hand hygiene knowledge and practice, inconsistent hand hygiene lessons in school curriculums, and shortages of supplies for hand hygiene practice.

To overcome these challenges, CDC and partners developed a series of hand hygiene promotion programs based on the needs of each setting. Activities included providing schools with guidance for organizing hygiene festivals, creating ideas for lesson plans, setting up behavioral nudges like handwashing signs and painted footsteps leading to sinks for handwashing, and donating hand hygiene supplies.

Staff-Led Handwashing Festivals and Health Fairs

In Guatemala and El Salvador, partners worked with teachers and administrators from participating schools to develop materials for hand hygiene festivals and health fairs. The materials were designed to allow teachers and students to channel their creativity into creating games, songs, and parades to share hygiene messages within their schools and communities. An administrator in El Salvador commented that the fair in their school was “…educational, because the children learned the process of washing their hands and, most importantly, they continued practicing it. It was a very important fair, because it has shown the students and the entire educational community the steps to protect themselves against bacteria and viruses.”


Invitations schools created to invite community members to their hand hygiene fairs

A Gentle Nudge to Wash Hands

In Belize, behavioral “nudges” were placed near handwashing stations to encourage students to practice handwashing at key times. These visual cues included footsteps leading students to handwashing stations, colorful handwashing messages above sinks, arrows pointing to soap dispensers, and handwashing reminders inside stalls and above urinals. Soap was provided to participating schools during the intervention period to supplement existing supplies. One school administrator commented on the benefit of the visual cues: “The students, they’re not used to practice handwashing regularly, you know? So now that these stickers are there, ‘Okay, as I go into the bathroom, before I walk out, I need to wash my hands.’ So, it helps them a lot with the reminder, seeing it there.”

Nudges installed at a school sink, including a footpath, handwashing message, and arrow pointing to soap

Photo Credit: Anh Ngoc Ly, Baylor College of Medicine

Project Outcomes

These projects are now ending and final data on the impact of the interventions are being collected. However, partners have already observed improvements in students’ hand hygiene knowledge. These projects reinforce that consistent provision of hand hygiene supplies and localized approaches can improve health in areas with limited access to hand hygiene resources.

CDC continues to collaborate with domestic and global partners to improve access to water, sanitation, and hygiene (WASH) services and infrastructure around the world. For more information on CDC’s efforts to improve access to WASH and other global WASH information, visit CDC’s Global Water, Sanitation, and Hygiene site.

Category: Community Forum

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