Hospital Infection Prevention-Infection control tips for day-care settings

Policies on immunizations, education, exclusion

Infection control professionals and consultants looking to provide some common-sense advice to day care centers can relay these take-home points from a presentation by Michael Brady, MD, professor of pediatrics and preventive medicine in the College of Medicine at The Ohio State University in Columbus. In answering the rhetorical question, "What can child care centers do to help them reduce infections?," Brady offered several tips, summarized as follows:

Written policies: Have written infection control policies that can be shown to parents and staff. Policies should clarify exclusion of certain ill children and possible cohorting of ill children. They should outline requirements for TB skin testing of staff and all appropriate immunizations. Requirements for childhood immunizations also should be included. They should address class size, staff ratios, and policies for limiting mixing of children from different classes.

Education of staff: Stress hand washing frequently, possibly with waterless soaps if sink access is limited. They should clean contaminated surfaces immediately. Avoid diaper changing and food preparation in the same area. They need to know the infections of concern and their modes of transmission, including periods of communicability and sites of excretion. Survival of the infectious agents in the environment should be discussed, as well as methods of cleaning and disinfection. Staff education must be regularly repeated to reinforce learning and allow for staff turnover.

Education of parents: The child care centers should contact parents and discuss such items as communicable diseases, the exclusion policy at the center, and why it is important that it not be circumvented. Discuss issues relating to proper antibiotic use. "You don't want to have the child-care center pushing the parents to use antibiotics, and you don't want the parents pushing their pediatrician or family practitioner to use antibiotics unless they're appropriate," Brady said.

Exclusion policies: Exclusion has not been shown to be effective for children with upper respiratory infections. However, in dealing with gastroenteritis, it appears that eliminating children who have symptomatic disease can reduce the rate of transmission. In general, kids with colds can stay in day care, and those with diarrhea, particularly diaper-age children, should be considered for exclusion. Readmittance will depend on the infection and duration of symptoms.