Health Education (germs) - Primary Years


Chittleborough CR, Nicholson AL, Basker E, Bell S, Campbell R. (2012). Factors influencing hand washing behaviour in primary schools: process evaluation within a randomized controlled trial. Health Education Resources. 27(6):1055-68

Hugonnet, S. & Pitte (2000). Hand hygiene revisited: Lessons from the past and present. Current Infectious Disease Reports. 2: 484.

Judah, G, Aunger, R., Schmidt, W.P Michie, S. Granger, S. & Curtis V. (2009). Experimental pretesting of hand-washing interventions in a natural setting. American Journal of Public Health, 99:S405–S411

Randle, J. Metcalfe, J., Webb, H., Luckett, J.C.A., Nerlich, B. Vaughhan, N., Segal, J.L. & Hardie, K.R. (2013). Impact of an educational intervention upon the hand hygiene compliance of children. Journal of Hospital Infection. 85(3): 220-225

Skinner, B. F. (1953) The Possibility Of A Science Of Human Behaviour. NY: The Free House.

Turner, R.B. (2005). New considerations in the treatment and prevention of rhinovirus infections. Pediatric Annals. 34(1):53-7

What are microorganisms?

Microorganisms are microscopic organisms that can take the form of a bacteria, virus or fungi, they are found everywhere and can be useful in cheese, bread, insulin and vaccine production. However, it is the pathogenic bacteria (faecal coliforms such as Escherichia coli) that cause stomach aches, and viruses (Rhinoviruses and Influenza) that cause coughs and colds, that should be the focus of early years children's learning. Hence, children need to be taught preventative measures, such as hand washing and covering their mouths and noses when they cough and sneeze, as well as understanding the relationship between microorganisms and disease.

How are microorganisms transmitted?

Pre-school children need to understand where germs come from and how they can be passed on to other children and friends/relatives and cause illness to them.

Faecal – oral route: this is the when faeces particles containing bacteria such as E. coli are introduced to the mouth, this is common in early years children due to inadequate toilet training, difficulties cleaning themselves, coupled with lack of hand washing and then putting their hands into their mouths or biting nails.

Airborne transmission: Viruses such as Rhinovirus (common cold) are transmitted via respiratory droplets produced when people cough or sneeze, they can move large distances in the air due to air currents, these particles are then breathed in by other individuals and the virus has then been transmitted between people. The “catch it, bin it, kill it” campaign by the UK government was a successful intervention on understanding the consequences of poor hygiene practices, however, hand washing is still deemed the best method for the prevention of Rhinovirus and respiratory infections (Turner 2005).

Prevention of disease?

Hand washing has been shown to be the most effective measure in infection control to prevent cross contamination of disease in a number of research studies (Hugonnet & Pitte, 2000). With a 3rd of infections being preventable with good hand hygiene (Judah et al. 2009), however, young children often do not have the appropriate etiquette and knowledge in order to readily implement hand washing routines, therefore educational resources and interventions are often required in order for them to do so (Randle et al. 2013)

It has been shown that children learning why and how to wash their hands is perceived as important by teachers and knowledge about the spread of germs was important to pupils when implementing hygiene practices in a randomised controlled study in primary schools on factors influencing hand washing (Chittleborough et al. 2012).

Early Years

Due to germs (bacteria, viruses and fungi) being invisible to the naked eye, it is hard for primary age children to build links between microorganisms, poor hygiene practices and disease. Establishing the fundamental learning principles of behaviourism whereby children learn the sequence of ABC – antecedents, behaviour and consequences (Skinner 1953), the outlined knowledge can be instilled in children’s daily hygiene practices and understanding of disease.


A set of interactive resources called ‘A Germ’s Journey’ has been developed between a microbiologist and educationalist to teach about germs and the consequences of hand washing, i.e. good health or bad health. These have been developed to engage children in a number of different activities to embed their learning about health and hygiene; a book, a website with games, downloadable colouring sheets and an optional hand washing activity appropriate for ages 3-7 years.

Through engaging with A Germ’s Journey book and website (, and using the behaviourism principles ABC, children learn that the antecedents are germs in the environment, behaviour is washing hands, and the consequence is keeping well, or not washing hands and getting unwell. Resources include posters and even a song!


Germs Journey News Desk Event | 27th May 2021

Innovations for Global Challenges | Webinar Series | Department for International Trade


National Handwashing Day - 15/10/2020 | De Montfort University Doctoral College Lecture Series | Hands, Soap and the Control of Infectious Disease


Universal Children’s Day - 20/11/2020 | De Montfort University Doctoral College Lecture Series | Research and the Covid-19 Crisis


Strength of evidence

Strength of evidence 5*

The forthcoming paper outlines the background to the guide and to its testing in schools. 

Crosby, S., Laird K. & Younie S. (forthcoming, 2018) Interactive Health-Hygiene Education for Early Years: A Germ’s Journey, International Journal of Early Years Education.


Transferability (across contexts) 5*

The Germ's Journey education resources can be used in any early years setting globally if there is a wifi connection there. The interactive resources have been specially designed so they are accessible for all and free at the point of access (, they have been illustrated so they are culturally relevant around the world and translated into a number of languages. Hard copies of the book are only available for purchase however, the online game of "A Germ's Journey" gives the concept of the book electronically on the website.  The resources can also be used in any crisis or emergency setting.

Editor's Comments

"Basic knowledge about how to limit the spread of viruses and bacteria is fundamental to healthy living and the knowledge in this guide will be new to some community members in both developed and developing nations." Sarah Younie.