School Hygiene Practices and Challenges, a Comparative Review of India and the United States

School hygiene is a critical component of child health, safety, and educational development, as schools provide an important setting for promoting healthy behaviors and preventing communicable diseases. Adequate Water, Sanitation and Hygiene (WASH) facilities, hygiene education, and effective school health policies contribute to improved health outcomes, reduced illness-related absenteeism, and enhanced learning environments. This comparative literature review examined school hygiene policies, practices, infrastructure, implementation strategies, monitoring, challenges, and health-related outcomes in India and the United States. Literature was identified through searches of academic databases, including Google Scholar, PubMed/MEDLINE, and ERIC, and through authoritative governmental and international sources. Peer-reviewed studies, systematic/scoping reviews, and relevant policy and programme documents published between 2010 and 2026 were included and synthesized comparatively across common thematic domains. India primarily focuses on expanding sanitation infrastructure, supply of drinking water, school nutrition, and adolescent health, through national hygiene initiatives targeting several school health and wellness programmes. In contrast, the United States emphasizes integrated school health frameworks, drinking-water quality, and institutional accountability through coordinated public health policies and school-based interventions. Despite these efforts, both countries continue to face persistent challenges related to equitable WASH access, infrastructure maintenance, behavioral compliance, and effective implementation of school hygiene policies. Differences in policy structures and socioeconomic contexts further influence the implementation and monitoring of school hygiene measures. Overall, the reviewed evidence demonstrates that sustainable improvements in school hygiene require coordinated, multisectoral approaches that integrate functional infrastructure, continuous hygiene education, behavioral reinforcement, routine monitoring, and institutional commitment. Strengthening these interconnected components is essential for creating safe, healthy, and inclusive learning environments that support children's long-term health, well-being, and educational outcomes.