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Study reveals low handwashing rates in child care
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Researchers observed low rates of handwashing compliance among personnel at a child care facility in Northwest Arkansas.
“Handwashing is an important component of reducing illness transmission among children in early childhood centers, especially for the adults in charge of their care,” Jennifer K. Henk, PhD, assistant professor of human environmental sciences at the University of Arkansas, said in a press release.
Surveillance cameras were used to determine the number of handwashing opportunities and to assess the number and quality of handwashing occurrences in each of the 10 classrooms in the facility, which provided care for children ranging in age from younger than 1 year to 5 years. Personnel were aware of the cameras, but not aware of the study’s purpose. For each classroom, footage was recorded for 10 hours on 10 separate days over the course of a month. The researchers then selected a random 2.5-hour period from the footage in each classroom for coding and analysis.
To determine the events that constituted a handwashing opportunity, Henk and colleagues used the AAP’s “Caring for Our Children” guidelines, which state that handwashing should occur at the following times:
- after entering the classroom;
- after handling a cell phone;
- after contact with bodily fluids;
- after taking out or touching garbage;
- after cleaning;
- after touching sand;
- before and after food and drink preparation and handling;
- before and after eating; and
- before and after diapering.
Results of their analysis were published in the American Journal of Infection Control.
The researchers identified a total of 349 handwashing opportunities in the 25 hours of footage that they analyzed. Overall, 78 handwashing events took place, which corresponded to an overall compliance rate of 22%.
Source: APIC
Compliance was highest among caregivers (30%), with lower rates for paraprofessional aides (11%) and parents in the classroom (4%). Researchers found no significant differences in compliance based on the room or the ages of the children being cared for. Furthermore, after comparing compliance rates of teachers and paraprofessional aides, no significant difference was found between the two groups of personnel. For all personnel between the 10 rooms, median compliance was 20.2% (95% CI, 8-35). Only 7% of personnel taking care of children aged 2 to 3 years washed their hands — the lowest rate by age group.
Each handwashing event was divided into several observable steps, such as using soap, lathering with soap outside of running water, using a paper towel and turning off the faucet with a paper towel. Among these steps, drying hands with a paper towel had the highest rate of compliance (97%) and turning the faucet off with a paper towel had the lowest (17%). Additionally, only 6% of handwashing occurrences lasted for the 20-second duration recommended in the “Caring for Our Children” guidelines.
Researchers noted that their footage also provided evidence of potential sources for cross-contamination, such as pens being used immediately after diaper changes but before handwashing. This, they wrote, suggests the need to review cleaning and sanitizing policies.
“Our study shows the need to adopt creative strategies to increase compliance and efficacy, to mitigate the potential for cross-contamination via fomites, and to consider usage of current technology in assessing behaviors,” the researchers concluded. – by Sarah Kennedy
For more information:
American Academy of Pediatrics. Caring for Our Children. National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, Third Edition. http://cfoc.nrckids.org/webfiles/CFOC3_updated_final.pdf.
Disclosure: The researchers report no relevant financial disclosures.
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