Infection control in day care centers crucial to reducing burden of infection

Issue: January 2016

NEW YORK — Infections among children initiated in day care settings can affect the health of parents and staff, requiring greater compliance with infection control procedures within day care centers, according to a presentation at the 2015 Infectious Diseases in Children Symposium.

Day care centers put a huge portion of children at risk because their large size, extended hours, new staff and large population of toddlers makes them an optimal setting for harboring infectious pathogens, according to Susan E. Coffin, MD, MPH, clinical director of the division of infectious diseases at The Children's Hospital of Philadelphia.

Susan E. Coffin

“Infection control sounds like the deed that just cannot be done,” Coffin said. “The risk of child care-associated infections may be as high as 18 times higher than that experienced by children who are in a home setting.”

According to Coffin, the likelihood of infection increases in the winter months when viruses spread more easily.

“Child care-associated illnesses are by and large a seasonal event,” she said. “And just what causes these child care-associated illnesses? Viruses, viruses, viruses!”

Rotavirus is the most common pathogen among children in day care, with norovirus as a close second, according to research cited by Coffin. She also stated that rhinovirus is the most common respiratory pathogen found in children who attend day care.

Coffin also noted that children in day care are likely to contract at least one child care-associated illness per year, and that a significant amount of children attending day care carry more than one pathogen.

“The interesting thing about this data is that a fair amount of children carry two or more pathogens,” she said. “It is likely that a good number of these children had back-to-back infections — in which, the residual genetic material from infection number one was still hanging around when they got infected with infection number two.”

According to Coffin, children infected at a day care center often pose a broader risk to the health of family members and the community. When children return home after becoming infected at school, they bring the pathogens with them and usually spread it throughout their household.

“One thing that gets lost in the conversation about child care illnesses, is that the children themselves aren’t the only ones who suffer,” she said. “A huge amount of in-home transmission is related as a secondary event to in day care transmissions. It gets passed around in day care, makes its way out into the community, and then is further populated.”

According to Coffin, the burden of day care-related infections on parents is not only associated with their health, but also affects them financially.

“The economic burden of this group of illnesses is enormous,” she said. “It has been estimated that in the U.S. alone each year, day care-associated illness may account for up to $1.8 billion, and that is largely associated with the loss of parental work time, which for some parents can range up to 4 weeks per year.”

According to Coffin, the solutions to this problem require more than just rigorous hand hygiene. Rather, they include vaccination adherence, letter policies for returning to school, rational exclusion policies and consultations based on each child’s individual risk factors.

Another key component to child care infection control cited by Coffin, was the need for better education of staff members on the modes of infection transmission.

“You need to teach staff about contact transmissions, through hands and fomites,” she said. “You also need to teach them about respiratory transmission, and the importance of covering your cough and being mindful about the risk of respiratory droplets.”

Coffin also emphasized the importance and effectiveness of cleaning within day care centers.

“In a study, both total illnesses and missed days at school were significantly reduced after rigorous training in environmental cleaning, which included cleaning of all hard toys, every day,” she said. “This may be an important factor as you talk with any child care settings or parents, which may make a difference.”

According to Coffin, pediatricians often get caught in the crosshairs between child care centers and parents, regarding exclusion policies. However, she said this could provide an opportunity to make a difference in the way staff and parents think about infection control.

“This really pushes us to think more about what the burden is and what we, as child care activists, can do,” Coffin said. – by David Costill

Reference:
Coffin SE. “Infection control” (an oxymoron?) in day care center and school settings. Presented at: IDC NY; Nov. 21-22, 2015; New York.

Disclosure: Coffin reports no relevant financial disclosures.