Health Systems and Policy Research

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The Development of Age-Appropriate Creative Activities for Teaching Hand Hygiene for Kindergarten Children

Janet Pui Lee Cheung

Proper hand hygiene (HH) practice can effectively reduce the transmission of many infectious conditions among children in childcare settings. However, poor HH compliance is evident in young children, Therefore a 4-week educational programme  that consider the cognitive developmental stage of children on increasing their knowledge and promoting hand hygiene practices was developed. Creative activities were planned for the illustration of hand hygiene concepts in terms of “right moments”, “right steps”, and “right duration”. These activities include, but not limited to, the use of an animated video illustrating the relationship between germs and diseases; a wooden hand model painted with seven rainbow colors corresponding to different hand regions; fluorescent gel to simulate “germs” which can be easily spread by person-to-person contacts; and the use of agar plate experiment to explain the germ concept. The intervention group (n = 33) received the hand hygiene program, whereas another group served as the waitlist control (n = 20). Hand sanitizer coverage was evaluated using a hand scanner. After the intervention, the experimental group had higher knowledge level toward hand hygiene than the control group (p < 0.001). Significant improvements in hand hygiene performance at the left palm and dorsum (p < 0.05), right palm (p < 0.05), and overall hand coverage (p < 0.05) were observed in the experimental group. The study demonstrated that the knowledge and proper hand hygiene (HH) practice of children can be positively influenced by the use of an age-appropriate education program. The results of this study have implications for school health educators and parents for promoting HH practices among children at home and at the school level.


Janet Pui Lee Cheung has completed her bachelor degree in nursing in 2014 from the University of Hong Kong and master degree in infection control in 2020 from the Hong Kong Polytechnic University. She is a registered nurse who worked as a school nurse in an international kindergarten and currently working in the palliative unit in a public hospital.