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Shaughnessy, R., Hernandez, M. & Haverinen-Shaughnessy, U. Effects of classroom cleaning on student health: a longitudinal study. J Expo Sci Environ Epidemiol 32, 767–773 (2022).

Effects of classroom cleaning on student health : a longitudinal study

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Author: Shaughnessy, Richard1; Hernandez, Mark2; Haverinen-Shaughnessy, Ulla1,3
Organizations: 1University of Tulsa, Tulsa, OK, USA
2University of Colorado, Boulder, CO, USA
3University of Oulu, Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: Springer Nature, 2022
Publish Date: 2023-02-03


Background: School districts across the world have been grappling with how to keep their schools open, students healthy, and prevent the spread of viruses in their communities.

Objectives: The aims of this study included assessing both (1) the effectiveness of enhanced classroom cleaning and disinfecting protocol on surface biocontamination and (2) the associations between surface biocontamination and student absence due to illnesses.

Methods: Cleaning effectiveness was assessed using quantitative adenosine triphosphate (ATP) measurements during a 10-week study period in a sample of 34 public schools (15,814 students), of a district located in the Western US. The schools were randomly assigned to 17 intervention schools implementing enhanced cleaning and disinfecting protocol and 17 control schools cleaning as usual. General estimating equations (GEEs) were used for modeling associations between ATP levels and weekly aggregates of student absences due to respiratory and gastrointestinal illnesses, which were recorded by the schools according to district wide protocol.

Results: The weekly average ATP levels on logarithmic scale were 5.02 (SD 0.53) and 5.26 (SD 0.48) in the intervention and control schools, respectively, where the difference is statistically significant (p < 0.001). The probability of weekly absence due to gastrointestinal illness was significantly associated with ATP levels (parameter estimate 1.16, 95% CI 1.01–1.34, per unit (log) increase of weekly average ATP), where the model accounts for student level, gender, ethnic group, and socioeconomic status as well as for school level attendance, total absence ratio, and ventilation adequacy in classrooms. Associations were not found between ATP levels and weekly probability of any absence, or absence due to respiratory illness.

Significance: Enhanced cleaning resulted in a significantly lower level of biocontamination on desktops in the intervention group. In addition, a statistically significant association was established between ATP levels on classroom desks and probability of absence due to gastrointestinal illness.

Impact: We found that enhanced cleaning protocol, including bi-weekly cleaning of classroom desks, as well as training of custodians and teachers, monitoring of effectiveness, and feedback, yielded a moderate but statistically significantly lower level of biocontamination on desktops, indicated by quantitative ATP monitoring. Within the range of weekly average desktop ATP levels observed, the probability of reported absence due to gastrointestinal illness is estimated to increase from 0.021 to 0.026. Based on the results, enhanced surface cleaning and monitoring its effectiveness is a possible district, state, or even national level policy to support healthy school environments.

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Series: Journal of exposure science & environmental epidemiology
ISSN: 1559-0631
ISSN-E: 1559-064X
ISSN-L: 1559-0631
Volume: 32
Issue: 5
Pages: 767 - 773
DOI: 10.1038/s41370-022-00427-8
Type of Publication: A1 Journal article – refereed
Field of Science: 212 Civil and construction engineering
Funding: The collection of ATP data and data analyses were funded by Reckitt Benckiser, who also supported the district by providing cleaning products for the intervention schools.
Copyright information: © The Author(s), under exclusive licence to Springer Nature America, Inc. 2022. This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: