Reducing person-to-person transmission requires:

A. Promoting physical distancing

B. Promoting good respiratory hygiene practices

C. Improving hand hygiene behaviours

A. Promoting physical distancing

Source: Tobias Schwarz/AFP via Getty Images

Schools should adhere to national and local guidelines on physical distancing in schools. There are several broad strategies to promote physical distancing, including:

  • Visual cues that support spacing of greater than 1 metre (3 feet) (or distance advised by national government, if different)
  • Reducing density of the buildings and campus
  • Eliminating gatherings
  • Closing or restricting gathering spaces.

For example, where schools are open, the following measures may be considered as part of these strategies to create safer environments:

  • Staggering the beginning and end of the school day so that all pupils do not need to be present at the same time
  • Cancelling assemblies, sports games and other events that create crowded conditions
  • Holding breaks in shifts to avoid overcrowding in corridors and playgrounds
  • Moving lessons outside if feasible, or ventilating rooms as much as possible
  • Demarcating playgrounds into zones to ensure pupils do not mix more than necessary
  • Placing marks on the floor to cue children to stand the correct distance apart while waiting to enter a room, for example painting colourful circles 1 metre apart (or distance advised in national guidelines) in the corridor (see above image for example)
  • Introducing one-way systems for moving through buildings
  • Creating space for children’s desks to be at least one metre apart (or distance advised in national guidelines)
  • Installing desk-top partition/divider screens
  • Reducing pupil-to-teacher ratios by increasing the number of teachers, if possible, to allow for fewer students per classroom (if space is available)
  • Advising against crowding during school pick-up
  • Ensuring only 1 child per seat on school buses and that they are at least 1 metre apart (or distance advised in national guidelines), if possible. This may require increasing the number of school buses per school. Keep windows on the bus open, if possible
  • Creating awareness to ensure the students do not gather and socialise when leaving the school and in their free time

Adhering to physical distancing is just as important for adults working in the school as it is for the students. Teachers should model and teach correct physical distancing behaviours.

B. Promoting good respiratory hygiene practices

Children should be encouraged to cover their mouth and nose with their bent elbow or tissue when coughing or sneezing and to dispose of used tissue immediately. These messages should be incorporated into the curriculum, alongside broader hygiene promotion – refer to the section below entitled ‘Sharing age-appropriate COVID-19 information with children’.

Use of face masks or face coverings in schools should be in line with local and national guidelines. Decision makers can refer to WHO and UNICEF advice when developing national and local policies on the use of face masks/coverings among children in the context of COVID-19. The benefits of mask-wearing among children for COVID-19 control should be weighed against potential harm associated with wearing masks, including feasibility and discomfort, as well as social and communication concerns, and when adapting these policies specifically for schools, the views of teachers and educators on the perception of risks and the time burden required to ensure adherence to COVID-19 policies in schools and classrooms should be considered.

Where masks are advised in schools, sufficient supply of appropriate masks should be ensured for all school children and care should be taken to ensure masks are used safely. For more information on types of masks and how to use them safely see our resource ‘Summary report on masks and COVID-19’. If wearing fabric masks is advised, specific instructions and supplies should be provided for the safe storage, handling and availability of fabric masks. If medical or disposable masks are advised, a system for waste management including disposal of used masks will need to be established to reduce the risk of contaminated masks being disposed of in classrooms and playgrounds.

Note that it is advised that children aged up to five years should not wear face masks. If national or local policies recommend a lower cut off age, appropriate and consistent supervision, including direct line of sight supervision by a competent adult and compliance need to be ensured. It is also important that the age cut-off for wearing a mask is adapted to school settings to avoid stigmatizing and alienating children in mixed-aged groups where individuals may be on opposite sides of a recommended age cut-off. For example, in situations where older children for whom masks are advised are in the same class as younger children who fall below the age cut-off for wearing masks, the older learners might be exempt from wearing masks.

Children with severe cognitive or respiratory impairments who have difficulties tolerating a mask should, under no circumstances, be required to wear a mask. For children of any age with any other developmental disorders, disabilities or other specific health conditions that might interfere with mask wearing, the use of masks should not be mandatory and should be assessed on a case by case basis by the child’s educator and/or medical provider. No child should be denied access to education because of mask wearing or the lack of a mask due to low resources or unavailability.

The use of masks by children and adolescents in schools should only be considered as one part of a comprehensive strategy to limit the spread of COVID-19.

C. Improving hand hygiene behaviours

There are a range of ways to improve handwashing behaviours. Below we describe how you can create an enabling environment, how to cue handwashing behaviour, how to incorporate hygiene promotion into the curriculum and how to create a schedule for frequent handwashing.

Create an enabling environment: Schools must enable good hygiene practices. To do this, schools should have:

  • Handwashing facilities with both soap and water available at all times (See JMP requirements for basic hand hygiene facilities in school settings).
  • Handwashing facilities that are accessible to all users and that consider different needs based on the student’s age, gender and disability.
  • Water available through on-site taps, boreholes or from a reservoir with containers that are cleaned and filled regularly.
  • An adequate quantity of safe water to allow for personal hygiene practices including handwashing and menstrual hygiene management, as well as for environmental cleaning.

Handwashing stations with soap and water, or alcohol-based handrub dispensers (with between 60%-80% alcohol) should be available:

  • Near every toilet or bathroom to enable handwashing after using the toilet.
  • At the lunchroom entrance to enable handwashing before eating.
  • At school entrances to encourage students to wash hands with soap on arrival at school and upon departure.
  • At the entrance of every classroom (if possible).
  • In dormitories (where applicable).
  • In food preparation areas (where applicable).

Make changes to the environment to cue handwashing: Changes can be made to the physical environment to help remind students and cue handwashing behaviour. These changes can be termed ‘environmental nudges’. This guide from the WASH in Schools Network (WinS) presents a select number of nudge-based interventions. We summarise some of these interventions here:

1. Painting colourful footprints that lead children from the toilet to the handwashing facility and handprints on the facility as a reminder to use it. One study in a school in Bangladesh showed that this nudge increased children's handwashing behaviour by 64%. In a subsequent cluster-randomised controlled trial, this footpath nudge was compared to a high-intensity education-based intervention and was found to be equally effective at the 5- month follow-up.

Source: Dreibelbis et al 2016 (International Journal of Environmental Research and Public Health)

2. Placing an image of eyes above handwashing facilities to give the sense that others are watching and expect to see handwashing. One study in a women’s public restroom found people were 10% more likely to wash hands in the presence of these eyes.

Source: Biran et al 2014. The Lancet, Global health

3. Using soaps with toys embedded inside to draw children’s attention and incentivise them to wash their hands with soap frequently in order to reach the reward. A controlled study in a displacement camp in Iraq found that putting toys in soap made children 4 times more likely to wash their hands with soap in the household.

Source: London School of Hygiene and Tropical Medicine

4. Placing pictures of germs on surfaces that many people touch, such as toilet door handle, to induce a sense of disgust after touching these surfaces and subsequently cue handwashing.

Source: NudgingforKids.com

5. Placing mirrors above handwashing stations to make handwashing more desirable and encourage longer handwashing.

Source: WASHfunders

6. Drawing attention to the soap dispenser or handwashing station with bright colours

Source: DEB Blog: How to teach hand hygiene at school on Global Handwashing Day by Paul Jakeway

Include hygiene promotion as part of the curriculum: Hygiene promotion should be part of the school curriculum. Content should be age-, gender-, ethnicity- and disability-responsive. For more information on how to include hygiene promotion for different age groups (pre school, primary school, and secondary school) refer to the section below entitled ‘Sharing age-appropriate COVID-19 information with children’.

Create a schedule for frequent hand hygiene, especially for young children: Frequent hand hygiene should be established by scheduling times for handwashing sessions supervised by teachers or other school staff. For example, students may be asked to wash their hands hourly.

Want to know more about COVID-19 control strategies for open schools:

Editor Notes:

Written by: Julie Watson

Reviewed by: Kondwani Chidziwisano, Matthew Freeman, Linda Engel, Mohini Venkatesh, WinS Network, Sian White, Robert Dreibelbis

Last updated: 01.09.2020

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