Child Care Center Hand Hygiene Programs' Cost-Effectiveness in Preventing Respiratory Infections Azor-Martinez, Ernestina García Mochón, Leticia López Lacort, Mónica Marie Strizzi, Jenna Muñoz Vico, Francisco Javier Jiménez-Lorente, Carmen Pilar Fernández-Campos, María Amparo Bueno Rebollo, Cristina del Castillo-Aguas, Guadalupe Balaguer-Martinez, Josep Vicent Gimenez-Sanchez, Francisco Child care Infectious Diseases Medical education Background: We previously demonstrated that a hand hygiene program, including hand sanitizer and educational measures, for day care center (DCC) staff, children, and parents was more effective than a soap-and-water program, with initial observation, in preventing respiratory infections (RIs) in children attending DCCs. We analyzed the cost-effectiveness of these programs in preventing RIs. Methods: A cluster, randomized, controlled and open study of 911 children aged 0 to 3 years, attending 24 DCCs in Almeria. Two intervention groups of DCC-families performed educational measures and hand hygiene, one with soap-and-water (SWG) and another with hand sanitizer (HSG). The control group (CG) followed usual hand-washing procedures. RI episodes, including symptoms, treatments, medical contacts, complementary analyses, and DCC absenteeism days, were reported by parents. A Bayesian cost-effectiveness model was developed. Results: There were 5201 RI episodes registered. The adjusted mean societal costs of RIs per child per study period were CG: €522.25 (95% confidence interval [CI]: 437.10 to 622.46); HSG: €374.53 (95% CI: 314.90 to 443.07); SWG: €494.51 (95% CI: 419.21 to 585.27). The indirect costs constituted between 35.7% to 43.6% of the total costs. Children belonging to the HSG had an average of 1.39 fewer RI episodes than the CG and 0.93 less than the SWG. It represents a saving of societal cost mean per child per study period of €147.72 and €119.15, respectively. The HSG intervention was dominant versus SWG and CG. Conclusions: Hand hygiene programs that include hand sanitizer and educational measures for DCC staff, children, and parents are more effective and cost less than a program with soap and water and initial observation in children attending DCCs. 2026-02-26T11:07:30Z 2026-02-26T11:07:30Z 2021-12 journal article Published version: Azor-Martinez E, Garcia-Mochon L, Lopez-Lacort M, Strizzi JM, Muñoz-Vico FJ, Jimenez-Lorente CP, Fernandez-Campos MA, Bueno-Rebollo C, Del Castillo-Aguas G, Balaguer-Martinez JV, Gimenez-Sanchez F. (2021). Child Care Center Hand Hygiene Programs' Cost-Effectiveness in Preventing Respiratory Infections. Pediatrics; vol. 148 (6): e2021052496. doi: 10.1542/peds.2021-052496 1098-4275 0031-4005 https://hdl.handle.net/10481/111581 10.1542/peds.2021-052496 eng open access AAP Publications