HAND HYGIENE INTERVENTIONS AND FOOD SAFETY PRACTICES IN EDUCATIONAL SETTINGS: A SYSTEMATIC REVIEW
Published:
2026-06-07Downloads
Abstract
Background: Hand hygiene and food safety practices in educational settings remain critical public health concerns, directly impacting student health outcomes and institutional attendance rates. Educational establishments serve as potential transmission sites for respiratory and gastrointestinal infections, making them strategic venues for implementing preventive interventions. Objectives: This systematic review evaluates the effectiveness of hand hygiene and food safety interventions in educational settings on behavioral outcomes and health indicators. Methods: A comprehensive search was conducted across PubMed, Scopus, and Cochrane Library for studies published between 2018 and 2026. Inclusion criteria required interventions targeting hand hygiene or food safety practices in educational settings with quantitative behavioral outcomes. Study quality was assessed using Cochrane Risk of Bias tool version 2 for randomized controlled trials and ROBINS-I for non-randomized studies. Data were synthesized narratively due to heterogeneity in intervention designs and outcome measures. Results: Six studies met inclusion criteria, with sample sizes ranging from 61 to 717 participants across Malaysia, Kenya, Ghana, Saudi Arabia, and Turkey. Among food handlers, handwashing compliance improved from 9.09% to 22.27% (p<0.01), overall food safety compliance increased from 74% to 84% (p<0.001), and contamination prevention scores rose from 62.37 to 90.58 (p<0.001). Among schoolchildren, handwashing after toilet use increased from 0% to 88% (d=2.6, p=0.005), with sustained improvements at follow-up assessments. Conclusion: Educational interventions effectively improve hand hygiene and food safety behaviors in educational settings, particularly when combining theoretical frameworks, demonstrations, and interactive learning components to achieve sustained behavior change.
Keywords:
behavior change educational intervention food safety hand hygiene school healthReferences
1. Willmott M, Nicholson A, Busse H, MacArthur GJ, Brookes S, Campbell R. Effectiveness of hand hygiene interventions in reducing illness absence among children in educational settings: a systematic review and meta-analysis. Arch Dis Child. 2016;101(1):42-50. DOI:10.1136/archdischild-2015-308875
2. Azor-Martinez E, Cobos-Carrascosa E, Seijas-Vazquez ML, Fernandez-Canamas MD, Perez-Moreno J, Hidalgo-Vicario MI, et al. Hand hygiene program decreases school absenteeism due to upper respiratory infections. J Sch Health. 2016;86(12):873-881. DOI:10.1111/josh.12454
3. Mbakaya BC, Lee PH, Lee RL. Hand hygiene intervention strategies to reduce diarrhoea and respiratory infections among schoolchildren in developing countries: a systematic review. Int J Environ Res Public Health. 2017;14(4):371. DOI:10.3390/ijerph14040371
4. McMichael C. Water, sanitation and hygiene (WASH) in schools in low-income countries: a review of evidence of impact. Int J Environ Res Public Health. 2019;16(3):359. DOI:10.3390/ijerph16030359
5. Uyanık G, Dağhan Ş. The effect of the theory of planned behavior based hand hygiene intervention program on the health outcomes and school absenteeism of the primary school students: Quasi-experimental study. J Infect Dev Ctries. 2025;19(5):626-636. DOI:10.3855/jidc.18507
6. Fung F, Wang HS, Menon S. Food safety in the 21st century. Biomed J. 2018;41(2):88-95. DOI:10.1016/j.bj.2018.03.003
7. Appiah-Brempong E, Newton S, Harris MJ, Gulis G. Effect of a theory-based hand hygiene educational intervention for enhancing behavioural outcomes in Ghanaian schools: a cluster-randomised controlled trial. Int J Public Health. 2020;65(1):99-109. DOI:10.1007/s00038-019-01310-4
8. Jeong SY, Kim OS. Influencing factors on hand hygiene behavior of nursing students based on theory of planned behavior: A descriptive survey study. Nurse Educ Today. 2016;36:159-164. DOI:10.1016/j.nedt.2015.09.014
9. Younie S, Mitchell C, Bisson MJ, Crosby S, Kukona A, Laird K. Improving young children's handwashing behaviour and understanding of germs: The impact of A Germ's Journey educational resources in schools and public spaces. PLoS One. 2020;15(11):e0242134. DOI:10.1371/journal.pone.0242134
10. Crosby S, Laird K, Younie S. Interactive health-hygiene education for early years: the creation and evaluation of learning resources to improve understanding of handwashing practice. Int J Early Years Educ. 2019;27(4):374-390. DOI:10.1080/09669760.2019.1628010
11. McNicholl J, Younie S, Crosby S, Laird K. A clinical trial evaluation of handwashing products and educational resources to improve hand hygiene in paediatric patients and school children. Front Public Health. 2024;12:1427749. DOI:10.3389/fpubh.2024.1427749
12. Limon MR, Vallente JPC. Document analysis of foodborne diseases and intervention strategies in Philippine basic education for the last 17 years. Food Control. 2022;142:109216. DOI:10.1016/j.foodcont.2022.109216
13. Hussain NRN, Mokhtar WMW, Jaafar NI, Hassan NN, Rahman AR. The effect of food safety education on handwashing practices in school canteens' food handlers. Sains Malays. 2018;47(9):2119-2128. DOI:10.17576/jsm-2018-4709-21
14. Rossi MDSC, Stedefeldt E, Cunha DT, Rosso VV. Food safety knowledge, optimistic bias and risk perception among food handlers in institutional food services. Food Control. 2017;73:681-688. DOI:10.1016/j.foodcont.2016.09.035
15. Mouajou V, Adams K, DeLisle G, Quach C. Hand hygiene compliance in the prevention of hospital-acquired infections: a systematic review. J Hosp Infect. 2022;119:33-48. DOI:10.1016/j.jhin.2021.09.016
16. Nik Rosmawati NH, Wan Manan WM, Noor Izani NJ, Nurul Huda N, Amin Ruhaya AR. The effect of Food Safety Education on handwashing practices in school canteens' food handlers. Sains Malays. 2018;47(9):2119-2128. DOI:10.17576/jsm-2018-4709-21
17. Kaugi RW, Sang AK, Mwangi M. Knowledge, attitudes and practices on food safety among food handlers in selected hospitals, Nairobi County, Kenya. J Food Saf. 2024;44(2):e13094. DOI:10.1111/jfs.13094
18. Wong SYW, Nahar N, Islam MS, Lee TY. Exploring food safety knowledge, attitude and practices among food handlers in Malaysian hospitals. Food Control. 2022;138:109015. DOI:10.1016/j.foodcont.2022.109015
19. Appiah-Brempong E, Harris M, Newton S, Gulis G. Examining school-based hygiene facilities: A mixed-methods assessment in the Brong Ahafo region of Ghana. BMC Public Health. 2019;19:581. DOI:10.1186/s12889-019-6902-2
20. Al Nadwi HH, Al-Busaidi NA, Al-Alimi ARA. Food safety knowledge, practice and attitudes of food handlers in institutional food services in Muscat, Oman. Int J Food Saf Nutr Public Health. 2022;12(2):135-145. DOI:10.1504/IJFSNPH.2022.10046893
21. Öncu E, Aksu H, Gaytancıoğlu D. Evaluation of food safety knowledge and practices of food handlers working in university canteens. Prog Nutr. 2018;20(3):334-343. DOI:10.23751/pn.v20i3.6498
22. Alzaher AA, Almudarra SS, Mustafa MH, Gosadi IM. The importance of hand hygiene education on primary schoolgirls' absence due to upper respiratory infections in Saudi Arabia: a cluster randomized controlled trial. Saudi Med J. 2018;39(10):1044-1049. DOI:10.15537/smj.2018.10.23344
23. Biswas D, Bhushan S, Kurian SA, Syed NI, Kumari R, Ravikeerthi P, et al. Investigation of hand hygiene practices and infection reduction among school children in Delhi. J Prev Med Hyg. 2019;60(3):E212-E218. DOI:10.15167/2421-4248/jpmh2019.60.3.1149
24. Denbæk AM, Andersen A, Bast LS, Bundgaard H, Fomsgaard A, Gram L, et al. Importance of implementation level when evaluating the effect of the Hi Five Intervention on infectious illness and illness-related absenteeism. Am J Infect Control. 2018;46(5):512-519. DOI:10.1016/j.ajic.2017.10.021
25. Veys K, Dockx K, Van Remoortel H, Avonts D, Vandenberg O, Beutels P, et al. The effect of hand hygiene promotion programs during epidemics and pandemics of respiratory droplet-transmissible infections on health outcomes: a rapid systematic review. BMC Public Health. 2021;21(1):4. DOI:10.1186/s12889-021-11815-4
26. Berhanu A, Mengistu DA, Temesgen LM, Tsadik AG, Mengistie B, Worku A. Hand washing practice among public primary school children and associated factors in Harar town, eastern Ethiopia: an institution-based cross-sectional study. PLoS One. 2022;17(7):e0270200. DOI:10.1371/journal.pone.0270200
27. Talaat M, Afifi S, Dueger E, El-Ashry N, Marfin A, Kandeel A, et al. Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt. Emerg Infect Dis. 2011;17(4):619-625. DOI:10.3201/eid1704.101353
28. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179-211. DOI:10.1016/0749-5978(91)90020-T
29. Janz NK, Becker MH. The Health Belief Model: A decade later. Health Educ Behav. 1984;11(1):1-47. DOI:10.1177/109019818401100101
30. Wang M, Huang L, Pan C, Bai L. Adopt proper food-handling intention: An application of the health belief model. Food Control. 2021;127:108169. DOI:10.1016/j.foodcont.2021.108169
31. Mullan BA, Wong CL. Hygienic food handling behaviours. An application of the Theory of Planned Behaviour. Appetite. 2009;52(3):757-761. DOI:10.1016/j.appet.2009.01.007
32. Bülbül Maraş G, Kocaçal E. Exploring determinants of hand hygiene among nursing students: A theory of planned behavior approach. BMC Nurs. 2024;23:406. DOI:10.1186/s12912-024-02062-0
33. McLaughlin AC, Walsh EG, Walmsley CG. Self-reported reasons for hand hygiene in 3 groups of health care workers. Am J Infect Control. 2012;40(7):653-658. DOI:10.1016/j.ajic.2011.08.011
34. Apisarnthanarak A, Eiamsitrakoon T, Mundy LM. Hand hygiene behavior: translating behavioral research into infection control practice. Infect Control Hosp Epidemiol. 2013;34(11):1137-1145. DOI:10.1086/673445
35. Baghaei R, Sharifian E, Kamran A. Can theoretical intervention improve hand hygiene behaviour among nurses? Psychol Res Behav Manag. 2016;9:133-138. DOI:10.2147/PRBM.S104993
36. Contzen N, Meili IH, Mosler HJ. Changing handwashing behaviour in southern Ethiopia: a longitudinal study on infrastructural and commitment interventions. Soc Sci Med. 2015;124:103-114. DOI:10.1016/j.socscimed.2014.11.025
37. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81-95. DOI:10.1007/s12160-013-9486-6
38. Nicholson PJ, Mayho G, Sharp C. Effectiveness of behaviour change techniques used in hand hygiene interventions targeting older children: A systematic review. Soc Sci Med. 2021;280:114026. DOI:10.1016/j.socscimed.2021.114026
39. Huis A, van Achterberg T, de Bruin M, Grol R, Schoonhoven L, Hulscher M. A systematic review of hand hygiene improvement strategies: a behavioural approach. Implement Sci. 2012;7:92. DOI:10.1186/1748-5908-7-92
40. Aiello AE, Coulborn RM, Perez V, Larson EL. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health. 2008;98(8):1372-1381. DOI:10.2105/AJPH.2007.124610
41. Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis. 2003;3(5):275-281. DOI:10.1016/S1473-3099(03)00606-6
42. Jackson C, Vynnycky E, Mangtani P. The relationship between school holidays and transmission of influenza in England and Wales. Am J Epidemiol. 2016;184(9):644-651. DOI:10.1093/aje/kww083
43. Freeman MC, Clasen T, Brooker SJ, Akoko DO, Rheingans R. The impact of a school-based hygiene, water quality and sanitation intervention on soil-transmitted helminth reinfection: a cluster-randomized trial. Am J Trop Med Hyg. 2013;89(5):875-883. DOI:10.4269/ajtmh.13-0237
44. Lee HK, Abdul Halim H, Thong KL. Assessment of food safety knowledge, attitude, self-reported practices, and microbiological hand hygiene of food handlers. Int J Environ Res Public Health. 2017;14(1):55. DOI:10.3390/ijerph14010055
45. Stratev D, Odeyemi OA, Pavlov A, Kyuchukova R, Fatehi F, Bamidele FA. Food safety knowledge and hygiene practices among veterinary medicine students at Trakia University, Bulgaria. J Infect Public Health. 2017;10(6):778-782. DOI:10.1016/j.jiph.2016.12.001
46. Egan MB, Raats MM, Grubb SM, Eves A, Lumbers ML, Dean MS, et al. A review of food safety and food hygiene training studies in the commercial sector. Food Control. 2007;18(10):1180-1190. DOI:10.1016/j.foodcont.2006.08.001
47. Bloomfield SF, Aiello AE, Cookson B, O'Boyle C, Larson EL. The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers. Am J Infect Control. 2007;35(10 Suppl 1):S27-S64. DOI:10.1016/j.ajic.2007.07.001
48. Suen LKP, So ZYY, Yeung SKW, Lo KYK, Lam SC. Epidemiological investigation on hand hygiene knowledge and behaviour: a cross-sectional study on gender disparity. BMC Public Health. 2019;19:401. DOI:10.1186/s12889-019-6705-5
49. Raosoft MS, Rahman N, Islam S, Tanjia N, Mitra AK, Hossain A, et al. Inadequate food safety knowledge and hygiene practices among street food vendors in Dhaka, Bangladesh. Sci Rep. 2024;14(1):17349. DOI:10.1038/s41598-024-68099-y
50. Lotfinejad N, Peters A, Tartari E, Fankhauser-Rodriguez C, Pires D, Pittet D. Hand hygiene in health care: 20 years of ongoing advances and perspectives. Lancet Infect Dis. 2021;21(8):e209-e221. DOI:10.1016/S1473-3099(21)00191-7
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