{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:09:50Z","timestamp":1787242190178,"version":"build-2736575974"},"reference-count":20,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T00:00:00Z","timestamp":1741910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"United States Centers for Disease Control and Prevention through Cooperative Agreement","award":["GH002243"],"award-info":[{"award-number":["GH002243"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>School-aged children are vulnerable to infectious diseases due to their developing immune systems and frequent social interactions. The COVID-19 pandemic underscored the importance of non-pharmaceutical interventions, like hand hygiene (HH). This study evaluated the changes achieved through a school-based intervention to Guatemalan primary school students\u2019 HH knowledge, attitudes, and self-reported practices while collecting teacher feedback to inform future efforts. The intervention included handwashing festivals, environmental nudges, and the regular delivery of soap and alcohol-based hand rub (ABHR). Knowledge, attitudes, and practices (KAP) surveys were conducted pre- and post-intervention with 109 and 144 students, respectively. Six teachers participated in interviews to provide perspectives. Significant improvements were observed in students\u2019 knowledge of HH\u2019s role in preventing disease (pre: 84.4%; post: 96.5; p &lt; 0.01) and recognition of critical moments (pre: 84.4%; post: 92.4%; p &lt; 0.05). Self-reported practices also improved, with more students reporting washing their hands for 20 s or more (pre: 68.8%; post: 79.9%; p &lt; 0.05). Fewer students reported liking ABHR after the intervention (pre: 89%; post: 78.5%; p &lt; 0.05). Teachers reported increased HH practices and provided feedback to enhance interventions. These findings highlight the effectiveness of school-based interventions and emphasize the importance of addressing knowledge gaps and incorporating teacher insights for sustained public health benefits.<\/jats:p>","DOI":"10.3390\/ijerph22030424","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T04:29:18Z","timestamp":1741926558000},"page":"424","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Changes in Hand Hygiene Knowledge, Attitudes, and Practices Among Primary School Students: Insights from a Promotion Program in Guatemala"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5885-1911","authenticated-orcid":false,"given":"Michelle Marie","family":"Pieters","sequence":"first","affiliation":[{"name":"Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3991-7524","authenticated-orcid":false,"given":"Natalie","family":"Fahsen","sequence":"additional","affiliation":[{"name":"Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1517-6995","authenticated-orcid":false,"given":"Christina","family":"Craig","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7091-0160","authenticated-orcid":false,"given":"Kelsey","family":"McDavid","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanako","family":"Ishida","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1128-0656","authenticated-orcid":false,"given":"Christiana","family":"Hug","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4716-4745","authenticated-orcid":false,"given":"Denisse","family":"Vega Ocasio","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"},{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2381-4173","authenticated-orcid":false,"given":"Celia","family":"Cord\u00f3n-Rosales","sequence":"additional","affiliation":[{"name":"Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1000-151X","authenticated-orcid":false,"given":"Matthew J.","family":"Lozier","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1093\/fampra\/cmw002","article-title":"Risk factors for respiratory infections among children attending day care centres","volume":"33","author":"Alexandrino","year":"2016","journal-title":"Fam. 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