“An ounce of prevention is worth a pound of cure.” It’s an old saying but is as relevant now as in the past and has particular importance for today. One of the gold standards in the arsenal of public health is the simple act of hand washing. Twenty seconds of scrubbing under the faucet can save immeasurable time and discomfort by preventing the transmission of some of the most gruesome pathogens. So, when cases of Shigella and other gastrointestinal illnesses began plaguing elementary school children, teachers and staff, the Brevard County Health Department took notice.
Early in March of 2003 the statistics revealed that illnesses were under-reported. Sick children were in school and close contact with other children and staff further exacerbated outbreaks. In the public schools, an outbreak of Shigella took 8-10 weeks to control. Absenteeism of both students and teachers interrupts productivity and learning. Parents depend on a healthy child that stays in school to prevent changes in family priorities and schedules. Increased costs for sitters, lost time at work and medical costs affect families and the community negatively.
Annual outbreaks of gastrointestinal and respiratory illnesses, and the associated absenteeism among students and faculty, had become a common and predictable occurrence within elementary schools. Disruptions to the learning process, as well as, to the delicate balance of schedules between children and their working parents, resulted in a loss of productivity both in and out of the classroom. Prevention was as simple as correct hand washing techniques, but to be truly successful, the educational modality had to be clear, consistent, effective, and easy for schools to implement year-round, or as needed.T
his program targets a very vulnerable segment of our community, our children. When there is no vaccine, there is prevention. Through a short and fun video, school children are frequently reminded that washing their hands will (a) keep them from getting sick, (b) hand washing leaves the germs in the bathroom and on the playground and (c) eating is much safer when hands are clean. The result is children and their teachers begin to pay attention to the cleanliness of their hands and support hand washing efforts in the classroom.
The “Super Hand” Hand Hygiene Program provides a method for the delivery of a sustained prevention message to a targeted audience in a quick and entertaining manner. Using tools common to advertising and marketing, the “Amazing Adventures of Super Hand” videos are versatile 3 to 4-minute programs that and can easily be incorporated into televised morning announcements. Offering a variety of 4 different “adventures” allows the prevention message to be delivered again and again without growing stale. Each video has a different emphasis, addressing hand washing from four different areas but reinforcing the same message: (a) germs are on hands, (b) washing removes the germs effectively and (c) here is how to wash you hands correctly.
Agency Community RolesThe Brevard County Health Department has always taken a proactive role in the health of the community and partnerships have flourished. This has laid the foundation for the “Super Hand” Hand Hygiene Program to be successful and set the stage for collaborations to meet similar challenges in the future.The health department took the lead by bringing together a coalition of community partners to respond to persistent, annual outbreaks of Shigella, and other common childhood illnesses, within Brevard County’s schools.
This coalition included experts from various sections of the health department, including: Epidemiology, School Health, Health Education and Environmental Health, working in collaboration with the Brevard County School District, University of Florida Agricultural Extension Service Outreach Program, and Brevard County Public Safety. Committees were established to address curriculum development, assessment of teaching modalities, implementation strategies, and evaluation methods.
Costs and ExpendituresA committee of representatives from the health department, along with representatives from the University of Florida Agricultural Extension Service, created the videos, posters and brochures. Mass production of the video was an in-kind contribution from the Brevard County Public Safety Office. Families participated by allowing their children to take part in the production of the videos. School health personnel provided orientation to the program and delivered the video, posters, flyers, brochures and instructional guidelines. And lastly, an essential to the reinforcement of this effort, the school district installed hand gel and dispensers in classrooms.
Costs of video production, including personnel, equipment, and materials was shouldered by the health department. Posters, flyers and the pre- and post-tests were a cooperative effort between the Brevard County School District and the Brevard County Health Department. Reproduction of the videos was an in-kind contribution of the training section of Brevard County Public Safety. Hand gel and dispensers were contributed by the school district.
ImplementationThe first step towards implementation was the development of four short educational videos. To address the needs of the targeted audience, it was determined that the video should be “kid-friendly” rather than purely instructional. The use of a super hero “Super Hand” helped to make the video fun to view and easy to understand. Many ideas were offered for the design of “Super Hand”. The super hero was an inverted white glove with eyes, a mouth and red cape. The design of the super hero and the scripts for the “Amazing Adventures of Super Hand” took several sessions and approximately 15 hours. Once the videos were scripted, children were sought. The agency looked to health department staff and their friends to find the perfect group. We used 5 children whose ages were slightly older (4th – 5th grade) than the target audience. The same children appeared in each of the videos. Filming took approximately 20 hours. Schools were used as the back drop for each video. Each video took approximately 4 hours for filming. Editing was completed in approximately 20 hours. Forty DVD copies of the video were provided by the Brevard County Public Safety office. The pre- and post-tests were developed along with the posters and brochures. Posters were developed at age appropriate levels for children and used in the classroom along with a supply of hand gel. Brochures were sent home to the parents.
When all components of the program were produced and packaged, the health department nursing supervisors hand delivered the complete program to guarantee that the project materials would be implemented appropriately and not sit on a shelf.
The Brevard County Health Department has always taken a proactive role in the health of the community and in the process has worked with many agencies, both public and private in various partnerships. This has laid the foundation for the “Super Hand” Hand Hygiene Program to be successful. When outbreaks of Shigella and other gastrointestinal illness interrupted the health and processes of our schools, it was a natural reaction for the health department, the school system and others to meet and develop a plan of action. Shigella was specifically tracked because it is a reportable disease and the data was readily available. Each partner brought resources and talents to the program. Outcomes that truly demonstrate the success of this program are as follows:
Over the last two years, the “Super Hand” Hand Hygiene Project has delivered exceptional results. Shigella outbreaks, once believe to be an annual certainty have stopped. Not a single outbreak of shigellosis or other gastro-intestinal illness has occurred in Brevard elementary schools. When the Super Hand videos are played on a regular basis, children and faculty respond with increased modeling of hand washing technique, awareness and vigilance.
Program implemented in 36 schools and staff successfully oriented to program.
No outbreaks of Shigella or gastrointestinal illness have occurred since implementation throughout the 36 elementary schools representing approximately 20,000 children and over 1500 faculty.
Five cases of Shigella in 2004-2005; 28 cases prior year; five-year average prior to program was 31 per year.
Absenteeism is the lowest rate compared to peer counties.
Steadily declining numbers of school clinic visits for ear/nose/throat and GI ailments among students.
An important part of any project and one that must be considered in planning is how long it will continue, in a word, sustainability. The “Super Hand” Hand Hygiene Program, required significant collaboration and incurred the majority of costs in the initial stages. The commitment to follow through has been faithfully carried out by all participating schools. The health department coordinated the pre- and post-test evaluations. Through the realization of exceptionally positive outcomes, the school district has enthusiastically agreed to continue maintenance of the hand gel dispensers and hand washing facilities. They have also included plans to expand the program, hand gel dispensers, and facilities to all schools.