Duration or technique to improve the effectiveness of children' hand hygiene: A randomized controlled trial

•The handwashing practice is crucial for preventing the infection diseases.•There isn't basic hand washing procedure developed specifically for children.•The duration-based procedure has limited effect for hand hygenia efficiency.•Multi-stage hand hygiene training can prevent the omitted areas of the hands.•Multi-stage handwashing technique should be included in training program for children. How to wash hands is as important as when and how often to wash hands for acquiring proper hand hygiene habits. The study aimed to compare the effect of education based on technique or duration for developing children's handwashing skills. The double-blind randomized controlled study was conducted in a primary school between the 10th and 28th of December, 2018 with 155 children who were divided into Group-I, Group-II, and Control groups. One group was taught by a multi-stage technique, the other was by duration-based teaching, and the control group was provided with usual training. Handwashing efficacy was assessed by variance analysis on fluorescent residue after using glo-germ. The students' mean age was 9.74 ± 0.69 years, 53.6% of them were girls. Effective handwashing was highest in the Group-I. There was a difference between Group-I and Group-II, and Group-I and Control group in terms of hand cleanness. The frequently missed areas when cleaning hands were palmar surface, dorsal metacarpal area, and fingertips. Teaching hand hygiene to children by multi-step technique may increase the handwashing effectiveness. Conducting comparative studies with new techniques including fewer stages is recommended.