Jan 16, 2013


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.


Target population: Caregivers in child day-care

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.


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

Evaluated population: A total of 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

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).



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

KEYWORDS: Infants, Toddlers, Preschool, Early Childhood Education, Health Conditions/Status, Other Physical Health, Skills Training

Program information last updated on 12/4/07.