Abstract
AIM: This review aimed to evaluate the impact of school-based hand hygiene interventions on infectious disease outcomes in school populations. METHODS: A PROSPERO registered review (CRD42024620293) followed by Cochrane methodology MEDLINE, Embase, PubMed and ERIC formed the databases that received the search. The study included English-language research from 2014 to the present that examined school children in educational settings with quantifiable hand hygiene-disease relationships. The screening process and appraisal followed the Critical Appraisal Skills Programme (CASP) checklist. RESULTS: The search produced 4345 records from which 33 studies qualified for inclusion. The interventions included educational programmes and handwashing facilities together with hand sanitiser distribution and Water, Sanitation and Hygiene (WASH) programmes that combined multiple components. Education-only interventions reduced upper respiratory infection-related absences by up to 50%. Soap and water handwashing combined with sanitiser reduced acute gastroenteritis absences by 36%. Integrated WASH programmes lowered diarrhoea and respiratory illness absences. Parental involvement further enhanced effectiveness. CONCLUSIONS: Hand hygiene programmes are most effective when combining education, resources and behaviour change. Their success depends on context, infrastructure and delivery. While reducing disease and absenteeism, challenges like dermatitis and non-compliance remain. Tailored, inclusive approaches and policy-level investment are needed to ensure sustainable, evidence-based impact in schools.