October 1999
OULU, Finland - Children who attend day care centers have significantly more infections
than those cared for at home. However, it is possible to effectively prevent these infections,
benefiting both families and personnel. A recent study found that such a program is cost-effective
even if a specialist nurse implements the program.
"We conducted a 15-month, randomized, controlled trial involving 20 day care centers from March 1991 to the end of May 1992 to evaluate the efficacy of an infection prevention program. The program was introduced in 10 centers, and 10 other matched centers served as controls," said Matti Uhari, MD, from the department of pediatrics at the University of Oulu here.
The infection prevention program consisted of intensified hand-washing, use of an alcohol-based oily disinfectant, directions on the use of disposable towels, cleaning of the day care centers and regular washing of the toys. If toy washing was not possible, the toys were rotated so they were used only every other day. A healthy adult served food, and tooth brushing was withdrawn. Attention was paid to diaper-changing location and practices. Additionally, day care workers were encouraged to take sick leave at first appearance of symptoms.
The occurrence of infections and absences from day care or work because of infections among the children, their parents and the day care center employees was recorded.
"In eight of the 10 pairs of day care centers, the proportion of days that children were absent because of illness was significantly less at the intervention centers. In the other two pairs of day care centers, compliance was lowest," Uhari said.
Children were divided into two groups: those 3 years of age and younger and those older than 3 years. In both age groups, rhinitis and cough were the most common symptoms of infection.
"The children in the intervention day care centers had significantly fewer days of any of the recorded signs of infection, except diarrhea in the older age group. In most cases, the number of days with symptoms differed considerably, and even the older children benefited from the intervention, although they had less reduction in symptoms," he added.
The number of episodes of any infection among the younger children was 7.8 per person year at risk at the intervention day care centers compared with 8.6 per person year at risk at the control day care centers. The number of episodes in the older children were 4.8 in the intervention centers and 5.2 in the control centers. Episodes were separated by at least three symptom-free days.
Children at the intervention day care centers visited a doctor an average of three times because of illness per person year at risk, compared with 3.8 visits by the children at the control centers, a 21% difference.
The mean number doctor visits due to acute otitis media with effusion was 1.1 among the children at the intervention centers compared with 1.5 at the control centers. Additionally, children at the intervention centers received 24% fewer prescriptions for antimicrobials than children at the control centers.
Parents were absent from work a mean number 3.7 times per person year at risk because of their children's illness at the intervention centers as compared with 4.9 days at the control centers. "The mean number of days when parents were absent from work because of having contracted an infectious disease themselves was the same for the intervention and control centers, 2.4 days per person year at risk, and the mean number of days of sick leave recorded for siblings of the index children was similar in the intervention and control groups," Uhari said.
Among the employees of the day-care centers, the common cold was the most common infectious disease. A significant difference in the number of symptom days was seen between the personnel of the intervention and control centers: 1.4 visits to a physician per person year at risk in the intervention centers compared to two visits at the control centers. "Despite the reduced number of infections, the personnel of the intervention centers had more days of absence because of infections than the personnel of the control centers, 5.3 compared with 4.6 per person year at risk," he explained.
According to the study nurse, the children, in general, complied with all of the instructions and washed their hands diligently, especially on arrival at the center and before eating, even when not reminded to do so. Compliance was calculated as the percentage of the events where instructions were followed. Overall compliance estimates varied from 60% to 90% between the intervention centers.
"This study demonstrates that it is possible by simple hygienic control measures to reduce the number of infections in day care centers, especially among children younger than 3 years of age," he said.
For more information:
- Uhari M, Möttönen M. An open randomized controlled trial of infection prevention in child day-care centers. Pediatr Infect Dis J.1999;18:672-677.
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