Magazine article FDA Consumer

In Day-Care Centers, Cleanliness Is a Must

Magazine article FDA Consumer

In Day-Care Centers, Cleanliness Is a Must

Article excerpt

In Day-Care Centers, Cleanliness Is a Must

Day-care centers have become a way of life in America. More than half of all mothers of children too young to care for themselves hold jobs outside the home. For them--indeed for millions of American families--day-care centers provide a service that is a necessity. If both parents work, a sole parent caring for a child must work, or other family support systems are inadequate, child day care answers a critical need. Unfortunately, though, it often provides something else--a focal point for certain kinds of infectious diseases that can all too easily spread not only to others in the day-care center, but far and wide into the community.

The problem involves illnesses, particularly enteric (small intestine) infections, that usually show themselves as diarrhea and other disturbances in the gastrointestinal tract.

Enteric illnesses are commonly associated with "food poisoning." But in the nation's day-care centers, tainted food is often not the culprit. Rather, the illnesses most often result from fecal contamination because staff and children fail to follow the dictates of ordinary common sense about things like hand washing and cleanliness.

The major contributors to the spread of enteric diseases person-to-person contact, water and food--are interrelated and part of a persistent cycle. Attacking one part of the problem will have little effect. What's needed is a concerted effort directed at all sources of transmission of enteric pathogens.

Studies show that children under 3 who are cared for in day-care centers are more subject to diarrheal attacks that other youngsters. Likewise, day-care center workers and families of these young day-care children seem to suffer more bouts of diarrhea. L.K. Pickering, M.D., a professor of pediatrics at the University of Texas, noted in an editorial in the American Journal of Public Health that diarrhea was 30 percent more common in day-care children than in children cared for at home.

Another study found that day-care children under 3 had diarrhea twice as often as children remaining at home. A study reported in the September 1988 journal Pediatrics found an average of 3.8 diarrhea outbreaks per child per year in day-care centers in Houston, Texas. Similar findings have been reported from cities throughout the United States.

A recent family survey by Pickering and his colleagues showed that the average head of household or spouse lost 13 workdays because of illness in his or her day-care-center child; just under five of those lost days were due to diarrheal disease.

The spread of enteric illnesses to family members is documented in several surveys, one of which found that 10 of 56 family members of ill children were afflicted but only 1 of 45 family members of well children developed the illness. The episodes can be quite severe. One study reported a median duration of 12 days, while another noted that episodes lasted as long as six weeks. Hospitalizations were not all that infrequent.

The cause of these infections is usually some well-known pathogen such as the hepatitis A virus, rotavirus, Giardia, E. coli, Cryptosporidium, Shigella, or Campylobacter.

The human gut, including that of small children, normally contains many of the pathogenic bacteria and viruses that can cause diarrhea, but the body's natural defenses usually keep them well under control. More important, these potentially dangerous organisms don't ordinarily get spread around. But fecal contamination can be a prime source of disease in centers that care for children under 3--those still in diapers and still being toilet trained. Hands, toys, diaper-changing areas, and just about everything else can be contaminated with fecal matter. Children and adults who touch these contaminated objects and then put their fingers to their mouths are prime candidates for disease.

A microbiologist in FDA's Center for Food Safety and Applied Nutrition, writing in the January/February 1989 issue of the Journal of Environmental Health, cautioned that diarrhea may not be the only consequence of fecal contamination in day-care centers. …

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