Investing in hygiene for life

Bringing small children together in a crowded space is a recipe for spreading infections. Some infections are inevitable, but many studies show that better hygiene standards in preschools and schools have a significant impact on illness-related absence. Marianne Bengtsson, a hygiene nurse at a local disease control agency in western Sweden, has worked for over ten years with disease control in preschools, and has witnessed first-hand how hygiene can affect education quality.

One notable environment is preschools. Children in preschools are more often ill than children that are cared for at home, which among other things leads to unnecessary use of antibiotics. Since 2006, Marianne Bengtsson has worked as a hygiene nurse assisting preschools in western Sweden. Her work was initiated as a project by the local disease control department as a way to prevent infections, reduce the usage of antibiotics, and battle antimicrobial resistance.

− They received a lot of calls from the preschools regarding infections. The staff working in preschools have not received any education in hygiene and health, and there are very limited resources available for them to gain the necessary knowledge. That’s why we have introduced specific hygiene nurses that can support the preschools.

Today, the project has been turned into a permanent branch of the local disease control department and expanded into several municipalities in the region. Among other things, the hygiene nurses educate the preschool teachers, inspect the hygiene facilities and routines, monitor the infection rates and develop education material and methods for teaching the children.

A key part of their work is monitoring the absence rate in the preschools. Statistics show significant differences between municipalities, districts, and even departments within the same preschool.

Mother with two kids in the bathroom (photo)

− There are preschools that have absence rates of about 20%, where the average child has missed school every fifth day, while in other schools they have only missed every tenth day. Children who attend schools with a higher absenteeism among students and teachers, miss out on a lot of opportunities to learn. Preschool lays the foundation for future education, and these children simply do not get the same chance, says Marianne Bengtsson.

Preschools that have gone through this program and learned how to achieve better hand hygiene have shown improved absence rates between 7-13%. In a region with a population of 1.7 million, the program produced yearly savings of USD 5.5 million, 10,000 fewer doctor visits and 3,000 fewer prescriptions for antibiotics.5

Even though there are clear benefits in improving school attendance, few preschools and schools keep track of their statistics.

In a region with a population of 1.7 million, the program produced

USD 5.5 million
yearly savings,

fewer doctor visits and

fewer prescriptions for antibiotics.

− The responsible authority, in this case the municipalities, should monitor the absence rates in their preschools and schools. This is not only a tool for working with hand hygiene, by better statistics you can identify other problems as well. In our project we have found cases of mold and dampness by looking at the absence rates.

Apart from closer monitoring, Marianne Bengtsson also wishes for clearer rules in hygiene facilities in preschools and schools.

− Today there are recommendations, but they are not enforced. We visit a lot of preschools, even newly built ones, where the layout makes it difficult to achieve good hand hygiene.

Success factors for implementing good hand hygiene in preschools:

  • Basins, soap, and paper towels that are easily accessible for both children and teachers.
  • A hygiene sponsor among the teachers who can adapt routines to the specific school’s situation.
  • Educated teachers that understand why hand hygiene is important and have enough time to make sure all children wash their hands according to the routines.
  • Parents and other adults around the children that lead by example.
  • Playful ways, such as songs, rhymes, and games, to establish hand hygiene routines.

5 Västra Götalandsregionen, HYFS Final report 2006-2012, 2014.