Injuries to Preschool Children and Infection Control Practices in Childcare Programs
Waibel, Ruth, Misra, Ranjita, Journal of School Health
Injuries represent the leading cause of death for children aged 0 to 12 years, and thus pose a national health problem. (1,2) Furthermore, injuries that involve bleeding or secretion of bodily fluids may pose a risk of infection. (3) The Consumer Product Safety Commission reported more than 800,000 injuries to children in 2000. Many occurred in childcare programs (CCP). (4) With 20.5% of American children younger than age six receiving part-time to full-time childcare, more research should focus on injuries and control of infections from exposure to blood or bodily fluids in the CCP. Hence, this study examined rate of injuries in childcare centers and infection control practices used by childcare staff associated with blood or bodily fluids.
Rates of injury in CCPs vary in relation to location, type of childcare, definition of injury, and data sources. Annual injury rates range from 0.7 to 5.1 injuries per child. (5) Rates of injury also vary by age of child, time of day, and season of the year, with the highest rates occurring in summer and spring months, and at the peak times of 11 am and 4 pm. The most frequent site of injury is the playground. (6-8) In general, toddlers (12 to 36 months of age) and males face a higher risk of severe injuries than older children and females in CCP. (10-12)
Toddlers face the highest risk for injuries from bites or falls, (12) with 50% of injuries resulting in infection. (13) Bleeding injuries and biting episodes provide potential routes of transmission for blood borne pathogens (microorganism or infectious agent that is present in the blood) in CCP, and a concern for parents. (3) Common blood borne pathogens include Hepatitis C, Hepatitis B, and human immunodeficiency virus (HIV). (14) Infection control practices exist as part of standard precautions that childcare staff apply to blood, all bodily fluids, secretions, non-intact skin, and exposed mucous membranes. (14)
Child-to-child or child-to-adult caregiver transmission of blood borne pathogens can occur in CCP, though rarely. (15) Actual rates of transmission depend on a combination of conditions: 1) presence of one or more infected child in the CCP, and 2) biting or bleeding events that could transmit a blood borne pathogen. Though few seroprevalence studies examined incidence rates of blood borne infectious diseases among children in CCP, asymptomatically infected children are present in childcare environments. (16)
Childcare personnel face a challenging task: to provide a safe environment, prevent injury, and comply with regulations. State and federal regulations mandate amount of space, staff-child ratios, and reportable diseases, but do not deal effectively with the problem of disease transmission or injury prevention. (17) Considerable variation exists among programs, and current infectious disease and injury control policies and practices in facilities often fall short of American Public Health Association and American Academy of Pediatrics guidelines. (18)
Prevention intervention requires that CCP staff intercede quickly when aggressive behavior seems imminent. (19) Staff member qualifications include a training program developed and presented by the state department of human services, the state board of education, (20) or a qualified resource. Appropriate techniques, provided by qualified staff, include cleaning a scratch or bleeding site, preventive practices for minor infections, and monitoring behavior to reduce or proactively defend against aggressive behavior. These first aid and preventive actions reduce the rate of post injury infections, and limit transmission of more serious infections such as HIV or Hepatitis B. Because child care workers respond to and provide reports of injury, they must understand risks and infections associated with intentional (biting behavior) and unintentional injuries.
Human bites can cause serious infection. …