A musical mnemonic to recall handwashing technique among young children: A proof-of-concept study

Nisha Thampi; Aparna Darbha; Anna Zumbansen; Gilles Comeau; Anne Tsampalieros; Yves Longtin

doi:10.1016/j.ajic.2026.02.005

A musical mnemonic to recall handwashing technique among young children: A proof-of-concept study

Am J Infect Control. 2026 Feb 16:S0196-6553(26)00087-8. doi: 10.1016/j.ajic.2026.02.005. Online ahead of print.

Authors

Nisha Thampi¹, Aparna Darbha², Anna Zumbansen³, Gilles Comeau³, Anne Tsampalieros⁴, Yves Longtin⁵

Affiliations

¹ CHEO Research Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Pediatrics, CHEO, Ottawa, Ontario, Canada. Electronic address: nthampi@cheo.on.ca.
² CHEO Research Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
³ Music and Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
⁴ CHEO Research Institute, Ottawa, Ontario, Canada.
⁵ Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada.

PMID: 41707914
DOI: 10.1016/j.ajic.2026.02.005

Abstract

Background: A musical mnemonic may help children learn and recall the recommended six-step handwashing technique.

Methods: This proof-of-concept study was conducted in two toddler-aged (1-2 years) and two preschool-aged (3-5 years) classrooms. On Days 1 and 8, students were presented the handwashing technique in prose through demonstration and poster. One toddler and preschool classroom received additional musical mnemonic instruction. Students were observed pre-instruction and Days 1, 2, 8, 9, 22 and 29 for handwashing step completion. The primary outcome was number of steps completed (9-point score); the secondary outcome was handwashing duration.

Results: Over 4 weeks, 378 observations were recorded among 47 students. All groups initially had comparable median [interquartile range] technique scores and durations. Scores significantly increased in classrooms with lyrical compared to prose instruction alone at Day 1 (2.0 [1.0 to 7.0] vs 1.0 [0.3 to 3.5], P=0.046, and Day 29 (2.0 [1.0 to 4.0] vs. 1.0 [0 to 1.0], P = .01). Only lyrical classrooms saw significant improvement in scores from baseline to Day 29 (P = .002). At Day 29, duration was significantly longer in lyrical versus prose classrooms (22s [18 to 32] vs. 5s [3 to 11], P<.001).

Conclusions: A musical mnemonic can improve handwashing quality in preschool classrooms.

Keywords: Hand hygiene; Preschool; Song; Students.