Child care infection control: the new challenge.

Addressing the new and serious issues raised by this increasingly popular add-on

The days of stay-at-home moms have passed. It frequently takes two incomes to sustain the household budget and provide savings for a child's education. Today, more than 20 million mothers and even more fathers with children between the ages of six and seventeen work outside the home. Add single fathers to the figures and the issues surrounding child care take on paramount proportions. No wonder child care settings are frequently operating at maximum or near capacity.

With the facilities nursing homes have and the proven therapeutic value of children interacting with the geriatric patient, nursing homes are becoming an increasingly common site for child care. Many facilities offer a reduction in child care fees to their employees as an employee benefit, as well as opening up the facility to other members of the general community. This is a very positive trend, but one factor must be kept foremost in mind: The children, the long-term care residents, the staff and the public create new infection control risks that must be addressed by the facility's infection control program.

Table

Organism                       Disease/Symptom

Streptococci                  Causes a sore throat
Influenza                     Pneumonia
Klebsiella                    Causes wound infections
Haemophilus                   Highly contagious pinkeye
Staphylococcus                Boils or pimple
Shigella                      Causes diarrhea
Pseudomonas                   Causes wound infection
Clostridium Difficile         Causes colitis
Bacteroides                   Causes ear infections
E. coli                       Diarrhea or Urinary infections

The infection control issues involved are numerous. Does your facility's child care program have infection control policies, procedures and practices that go beyond handwashing? How does your facility handle plant operations workers in the child care area? How are residents protected from the virulent infectious diseases that children in school populations are known to transmit?

Colds, flu and other diseases often run seasonally through the child care setting, causing parents lost work days as well as family illness that affect both child and parent. Staff shortages can be a significant problem in long-term care facilities. Comprehensive infection control programs can minimize the acquisition and spread of child care infections, improve the quality of your employee's child's life and keep parents (your employee) healthy and working.

The program should be comprehensive and provide for the staff's as well as the children's education on infection control prevention. We all need to be familiar with those organisms that can cause infection in our children. The most common organisms found in child care settings are identified in the Table.

Every child care center should have policies, practices and programs for education, handwashing, immunizations, cleaning of toys, universal precautions, procedures governing plant operation/dietary/other long-term care staff in the child care areas, monitoring of infections by walkthroughs and statistical reporting to reflect the program's effectiveness.

Ask to see your child care center's infection control policies and program. One policy does not constitute a program! If your facility's child care services are subcontracted to an outside child care provider, ask to see their infection control policies and procedures. Just because your facility does not own the child care service does not mean that infection control issues can be ignored.

Hand-to-hand combat" (handwashing) continues to be the best front-line approach to reducing sick days and preventing infection. In a recent Michigan study, children who washed their hands four or more times during the school day had 24% fewer sick days due to colds and 50% fewer days lost because of stomach illness. Handwashing reminder signs are available from CARE-TECH Laboratories at 1-800-325-9681, among other sources.

Handwashing alone, however, is simply not sufficient - creating barriers to transmission is key. During a facility assessment, I remember seeing a plant operation employee who was fixing ceiling pipes outside the two-year-old child care room pick up a crying child to comfort the little one. Though the moment briefly aroused feelings of tenderness in me as I watched this man comfort the child, my thoughts quickly turned to what might be in those pipes overhead, the fact that the man had not washed his hands, and questions as to whether the child's immune system was strong enough to fight off an infection. On the other hand, why was the child so unhappy? Was he ill with an infection? Had he had his hands washed? If not, what organisms were present on his hands, and would the plant operations man go back to working on the pipes (water) and introduce those organisms into the system?

Designing infection control policies should be kept simple and to the point. For example, the design of a policy for plant operations workers in child care areas should focus on boot/shoe covers that place a barrier between the floor where the child plays and where staff/outsiders walk. Protective covering should be considered for extremely soiled clothing. Similar considerations should be given to policies for housekeeping, nursing and dietary staff members who circulate through the child care center.

Infection control programming can take as little as thirty minutes a month from a child care staff member and your facility's infection control professional. Education should involve not only the children, but staff and parents, as well. Infection control policies, assessment and monitoring protocols and educational curricula are available to the long-term care field. Nurses who specialize in infection control can also assist your child care facility in designing an infection control program.

Is your child care facility meeting the infection control issues of the 21st century?

C. Lynn Swisher, RN, MBA, is a consultant with Professional Services Consultants, Inc., Bel Air, MD. For further information, [phone], fax [phone].