Feasibility of elementary school children's use of hand gel and facemasks during influenza season

Background: The feasibility of non-pharmacologic interventions to prevent influenza's spread in schools is not well known. Objectives: To determine the acceptability of, adherence with, and barriers to the use of hand gel and facemasks in elementary schools. Patients and Methods: Intervention: We provided hand gel and facemasks to 20 teachers and their students over 4 weeks. Gel use was promoted for the first 2 weeks; mask use was promoted for the second 2 weeks. Outcomes: Acceptability, adherence, and barriers were measured by teachers' responses on weekly surveys. Mask use was also measured by observation. Results: The weekly survey response rate ranged from 70% to 100%. Averaged over 2 weeks, 89% of teachers thought gel use was not disruptive (week 1 - 17/20, week 2 - 16/17), 95% would use gel next winter (week 1 - 19/20, week 2 - 16/17), and 97% would use gel in a pandemic (week 1 - 20/20, week 2 - 16/17). Averaged over 2 weeks, 39% thought mask use was not disruptive (week 1 - 6/17, week 2 - 6/14), 35% would use masks next winter (week 1 - 5/17, week 2 - 6/14), and 97% would use masks in a pandemic (week 1 - 16/17, week 2 - 14/14). About 70% estimated that their students used hand gel ≥4×/day for both weeks (week 1 - 14/20, week 2 - 13/17). Students' mask use declined over time with 59% of teachers (10/17) estimating regular mask use during week 1 and 29% (4/14) during week 2. By observation, 30% of students wore masks in week 1, while 15% wore masks in week 2. Few barriers to gel use were identified; barriers to mask use were difficulty reading facial expressions and physical discomfort. Conclusions: Hand gel use is a feasible strategy in elementary schools. Acceptability and adherence with facemasks was low, but some students and teachers did use facemasks for 2 weeks, and most teachers would use masks in their classroom in a pandemic.