Results of an Observational Study of Childcare Centers in North and South Carolina to Determine Risk Factors for the Spread of Enteric Pathogens

Introduction: In the U.S., 61% of children spend time in childcare. Close-personal contact and suboptimal hygiene of children and workers provide opportunities for the spread of enteric pathogens. The purpose of this study was to determine risk factors for the spread of enteric pathogens in the childcare environment.

Methods: Site visits were conducted in 51 infant and/or toddler classrooms at 37 childcare facilities in North and South Carolina. For 45 minutes, data collectors observed one childcare provider and recorded types of surfaces touched and handwashing and diaper-changing procedures. A classroom audit, including a sketch of the classroom floor plan, was prepared on-site.

Results: 142 handwashing events were observed; 63% were non-compliant with CDC handwashing guidelines and 58% were non-compliant with North and South Carolina childcare regulations. Cross-contamination occurred after 63% of 90 non-compliant handwashing events. Of 34 diaper-changing events observed, 97% were non-compliant with CDC recommendations, including the provider not properly washing hands following diaper-changing. Also, 23 required handwashing events that did not occur. Sixty-one percent (61%) of classrooms with a diaper-changing area had trashcans easily accessible from the diaper-changing area, so providers did not have to touch a surface before disposing of dirty diapers. Handwashing sinks were adjacent to the diaper-changing area in 55% of classrooms.

Conclusion: Handwashing compliance rates were low even though handsinks were accessible. Specified dirty-diaper trashcans were also accessible to prevent contaminating other surfaces. Following proper handwashing and diaper-changing practices can reduce the spread of enteric pathogens in childcare facilities.