Effect of infection control measures on the frequency of diarrheal episodes in child care: A randomized, controlled trial

Background. Diarrheal infections are common in children who attend child ca re, and preventing transmission of disease in this setting depends on actio ns by child care staff. We set out to discover whether transmission of gast rointestinal infections in child care could be reduced by improved infectio n control procedures. Methods. We performed a cluster randomized, controlled trial of an infectio n control intervention conducted in child care centers for 1 city in Austra lia. The intervention was training of child care staff about transmission o f infection and handwashing and focused on both staff and child behavior. I mplementation of the intervention was recorded by an observer. Illness was measured by parent report in telephone interviews every 2 weeks. Results. There were 311 child-years of surveillance for diarrheal episodes. The rate of episodes of diarrhea was 1.9 per child-year in intervention ce nters and 2.7 per child-year in control centers. Multivariable analysis sho wed that diarrheal episodes were significantly reduced in intervention cent er children by 50%. However, the impact of the intervention was confined to children over 24 months of age. For those centers in which children's comp liance with handwashing was high, diarrheal episodes were reduced by 66%. Conclusions. This trial supports education about infection control, for sta ff and children in child care, as a means of reducing transmission of diarr hea. Reduction in episodes of diarrhea in children in child care was limite d to children over 24 months of age.