INFECTIONS
December 8, 2016

Childcare's Dirty Secret

There's too little handwashing going on at many daycare sites, and kids pay the price.

Washing your hands is probably the single best way to avoid picking up — and transmitting — a wide variety of illnesses. Yet many of us, including doctors and other health care workers, don't always wash our hands as often as we should.

This includes child care workers. Yes, a study using surveillance cameras found workers at one early child care center in Arkansas washing their hands less than one-quarter of the time that they were supposed to.

Children who spend time in an early child care center are two to three times more likely to acquire infections than children cared for at home.

Children under five years old don't have fully developed immune systems, making them more susceptible to communicable diseases — getting sick. The Centers for Disease Control and Prevention (CDC) estimates that proper handwashing could prevent about 30% of diarrhea-related sicknesses and about 20% of respiratory infections in children.

Guidelines established by the American Academy of Pediatrics call for daycare workers to wash their hands after entering the classroom, contact with bodily fluids, taking out the garbage, handling a cell phone, touching sand and cleaning. They also call for handwashing before and after diapering, eating, and food and drink preparation/handling.

Two cameras were placed in each of 10 classrooms in the center. Workers knew about the cameras but did not know what their purpose was. Ten hours of video footage were shot in each classroom, and two and a half hours of footage from each classroom was evaluated.

The researchers found 349 total situations where the guidelines called for handwashing. Of these, people — workers, paraprofessional aides, and parents — washed their hands only 78 times, making the compliance rate a troubling 22%.

The individual rates of compliance were 30% for caregivers, 11% for aides and only 4% for parents.

Aghast parents should realize that the study authors think current handwashing guidelines may be partly to blame because they're too restrictive. If workers fully complied with them, they'd need to wash their hands 14 times an hour and spend 12 minutes each hour doing so. Expecting this may be unrealistic.

Child care workers sometimes struggle with multiple demands for their attention, with crying infants and handwashing regulations both insisting on being first.

If workers fully complied with current handwashing guidelines, they'd need to wash their hands 14 times an hour and spend 12 minutes each hour doing so.

Arkansas law does not permit substitution of hand sanitizers for handwashing. The study authors suggest that guidelines might be followed better if they were tweaked, perhaps allowing use of sanitizers after some less risky events.

Still, it's likely that workers and aides (and parents) can do better than they did in this study. Other studies have shown that children who spend time in an early child care center are two to three times more likely to acquire infections than children cared for at home. More handwashing would likely help lower this.

The study appears in the American Journal of Infection Control and is freely available.

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