By Vishwadha Chander

(Reuters Health) – Singing the steps of good handwashing technique to the tune of a popular nursery rhyme may help young children learn the process and fend off common infections picked up in school, a small Canadian study suggests.

Dr. Nisha Thampi and colleagues adapted the tune of the song Brother John, also known as Frere Jacques, replacing its lyrics with a six-step handwash practice prescribed by World Health Organization.

“As a mother of two school-going children, I think a lot about germs at work and home,” said Thampi, medical director of the Infection Prevention and Control Program at Children’s Hospital of Eastern Ontario, in Ottawa.

“People may be surprised there’s an issue with how we wash our hands,” Thampi said in an email. “While there have been public health campaigns about when to wash our hands, that is, the right moments, there has been relatively little focus on how to wash our hands, the right technique, particularly among children.”

Because there didn’t seem to be an existing musical video targeted at children showing the six-step technique using the recommended handwash duration of 20 to 30 seconds, Thampi and colleagues decided to develop their own musical mnemonic. They wrote the lyrics with the help of schoolchildren.

“To get my own children to wash their hands with the proper technique, I played with each step until it fell into a song pattern that flowed nicely to the tune of Brother John,” Thampi said.

The Brother John lyrics:

“Are you sleeping, are you sleeping,

Brother John, Brother John,

Morning bells are ringing, morning bells are ringing,

Ding, ding, dong; ding, ding, dong”

. . . were replaced with:

“Scrub your palms, between the fingers

Wash the back (one hand), wash the back (other hand)

Twirl the tips (one hand) around (other hand)

Scrub them upside down

Thumb attack (one thumb)! Thumb attack (other thumb)!”

Thampi then used her 8-year-old daughter as a test case.

“She heard the first version of the song and helped revise it to have better flow. She demonstrated it to her friends and classmates,” Thampi said.

To test whether the routine would be effective in removing germs, the researchers applied fluorescent markings on the hands of the children, who were between 6 and 9 years old, before they washed with soap and water while singing the song. After the routine, there was a significant reduction in the markings, according to a report in The BMJ.

“This song is a fun way to teach children how to wash their hands and has the potential to decrease the burden of germs on hands, a very common way of catching an infection,” Thampi told Reuters Health.

She said her daughter also taught the song and technique to Thampi’s 4-year-old son.

To be effective, the technique should ideally be implemented early in life, used regularly and embedded into the national curriculum in schools, said Nicky Milner, director of medical education at the School of Medicine, Anglia Ruskin University, in Chelmsford, UK.

Involving schoolchildren in the design of actions and choice of song was also key to the technique’s effectiveness, she added.

“We know children enjoy learning through the use of songs that are easily remembered and accompanied by simple actions,” Milner said in an email.

There is potential for the technique to be used internationally, if the song choice reflects local songs in different countries, she noted.

“This approach may help reduce the global burden of infections that are spread by poor hand hygiene,” she said.

Thampi’s team hopes to validate their findings in larger school settings and demonstrate that the song is effective in reducing respiratory and gastrointestinal illnesses, and school absenteeism.

“We are also in the process of translating the mnemonic into other languages so the song and video can be easily adopted across the globe,” she said.

SOURCE: The BMJ, online December 16, 2019.