Published online July 2, 2007
PEDIATRICS Vol. 120 No. 1 July 2007, pp. e29-e36 (doi:10.1542/peds.2005-0760)
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ARTICLE

Hand-Washing and Diapering Equipment Reduces Disease Among Children in Out-of-Home Child Care Centers

Jonathan B. Kotch, MD, MPHa, Patricia Isbell, PhD, MPHa, David J. Weber, MD, MPHb,c, Viet Nguyen, MD, MPHa, Eric Savage, MAd, Elizabeth Gunn, BSd, Martie Skinner, PhDd, Stephen Fowlkes, MAa, Jasveer Virk, MPHa and Jonnell Allen, MPHa

Departments of a Maternal and Child Health
b Epidemiology, School of Public Health
c Departments of Medicine and Pediatrics, School of Medicine
d Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, North Carolina

OBJECTIVE. The objective of this study was to determine whether the installation of equipment for diaper-changing, hand-washing, and food preparation that is specifically designed to reduce the transmission of infectious agents would result in a decrease in the rate of diarrheal illness among children and their teachers in child care centers.

METHODS. Twenty-three pairs of child care centers were matched on size and star-rated license level. One member of each pair was randomly assigned to an intervention group and the other to a control group. Intervention centers received new diaper-changing, hand-washing, and food-preparation equipment, and both intervention and control centers received hygiene and sanitation training with reinforcement and follow-up as needed. Families with children in participating classrooms were called biweekly to ascertain the frequency and severity of any diarrheal illness episodes. Staff attendance was monitored, and staff hygiene and sanitation behaviors were observed and recorded monthly.

RESULTS. Although hygiene and sanitation behaviors improved in both intervention and control centers, there was a significant difference favoring the intervention centers with respect to frequency of diarrheal illness (0.90 vs 1.58 illnesses per 100 child-days in control centers) and proportion of days ill as a result of diarrhea (4.0% vs 5.0% in control centers) among the children. Staff in those same classrooms were reported to have a significantly lower proportion of days absent as a result of any illness (0.77% in treatment centers versus 1.73% in control centers).

CONCLUSION. Diapering, hand-washing, and food-preparation equipment that is specifically designed to reduce the spread of infectious agents significantly reduced diarrheal illness among the children and absence as a result of illness among staff in out-of-home child care centers.

Key Words: child care centers • diarrhea prevention and control • hand-washing • hygiene

Abbreviations: UNC-CH—University of North Carolina at Chapel Hill • CCHC—child care health consultant • df—degrees of freedom

Accepted Jan 25, 2007.


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