HYGIENIC INTERVENTION IN CHILD DAY-CARE CENTERS

 

OVERVIEW

 

A hygiene training was developed for caregivers at day-care centers.  In a random assignment study, centers assigned to receive this training were compared with centers assigned to a control group.  Following the training, caregivers at treatment centers significantly improved their handwashing practices.  However, during the eight months after the training, rates of illness at treatment centers were not significantly different than rates of illness at control centers.  That being said, once a number of extraneous variables associated with each illness were controlled for, rates of severe diarrhea at treatment centers were found to be significantly lower than rates at control centers.

 

DESCRIPTION OF PROGRAM

 

Target population: caregivers in child day-care centers

 

The intervention consisted of a three-hour training session on hygiene in day-care centers, with particular emphasis on handwashing and diapering protocol.  Hygiene recommendations included disinfection of toilet and diapering areas; physical separation of diapering areas from food preparation and serving areas; hygienic diaper disposal; daily washing and disinfection of toys, sinks, kitchen floors, and bathroom floors; daily laundering of blankets, sheets, and dress-up clothes; and hygienic preparation, serving, and clean-up of food.  Caregivers were encouraged to always have soap, running water, and paper towels available in their centers.  They were provided with Cal Stat – a waterless, disinfectant scrub – to use only when soap and water were unavailable.

 

Follow-up training was provided at individual day-care sites a week after the initial training and every five weeks thereafter.  Reinforcement training included adaptations, demonstrations, and discussions of hygienic techniques, as well as question-and-answer sessions.

 

EVALUATION(S) OF PROGRAM

Kotch, J.B. et al.  (1994).  Evaluation of an Hygienic Intervention in Child Day-Care Centers.  Pediatrics, 94, 991-994.

 

Evaluated population: 389 children from 24 child day-care centers in Cumberland County, North Carolina constituted the study sample for this intervention.  These children were all under 36 months of age, in day care at least 20 hours per week, and free of chronic illnesses that would predispose them to infections.  Children generally came from families of moderate socioeconomic status.

 

Approach: Centers were matched into pairs and then randomly assigned, within pairs, to either the treatment group or the control group.  Caregivers at centers assigned to the treatment group received the hygienic intervention.  Food handlers at these centers were also provided with a training session.  Regular contact was made with treatment center directors to encourage leadership and support.  Caregivers at control centers did not receive any training until after the study was complete.

 

From October 1988 until May 1999, families involved in the study were contacted biweekly and asked whether their children were experiencing diarrheal and/or respiratory symptoms.  During this time period, researchers also observed center goings on every five weeks, noting the extent to which centers were in compliance with intervention recommendations.

 

Results: Following the intervention, caregivers at treatment centers were significantly more likely to wash their hands after diapering and after coming into contact with children’s mucus, saliva, or vomit.

 

Initial analyses did not reveal any significant differences in rates of illness between treatment and control centers; however, analyses found several differences between the experimental and control populations.  When these variables were controlled, treatment centers were found to have significantly lower rates of severe diarrhea.  The impact was greatest in subgroups comprised of centers that had been in operation for fewer than 6.5 years and centers that cared for younger children (average age below 24 months).

 

SOURCES FOR MORE INFORMATION

 

References:

Kotch, J.B. et al.  (1994).  Evaluation of an Hygienic Intervention in Child Day-Care Centers.  Pediatrics, 94, 991-994.

 

Program categorized in this guide according to the following:

 

Evaluated participant ages: 0-3

Evaluated participant grades: pre-school

Program age ranges in the guide: early childhood

Program components: child care

Measured outcomes: physical health

 

Program information last updated on 12/4/07.

		© Child Trends 2004