Low Handwashing Compliance in Childcare Facilities Leads to More Illnesses

Preschools and their young attendees are notorious as breeding grounds for viral and bacterial illnesses, but now a new study from researchers at the University of Arkansas shows that hand hygiene compliance may be low among caregivers.

In the United States, more than 32 million children are in childcare arrangements while their parents work outside of the home. While almost half of that childcare is provided by a child’s parents or relatives, 25% of that care occurs in organized facilities such as daycare centers, nursery schools, and preschools. Young children in group childcare settings are more prone to illnesses such as colds and infections because their immune systems are still immature, thus making them more susceptible to pathogens. The social environment also leads to more close contact and sharing of toys and drinks, spreading more germs.

Handwashing and maintaining proper hand hygiene regularly are important ways to stop the spread of germs and avoid getting sick, particularly in childcare settings. A recent study on hand hygiene practices by preschool caregivers was recently published in the American Journal of Infection Control, the official journal of the Association for Professionals in Infection Control and Epidemiology. The study authors, a group of University of Arkansas researchers, noted that diarrheal disease caused by rotavirus costs American families an estimated $1 billion each year in medical expenses and lost work for parents staying home with sick children. According to the study, handwashing compliance programs offer a low-cost intervention that can greatly reduce the number of rotavirus cases and other infections among both children and caregivers in group childcare facilities.

In their study, the researchers used surveillance cameras in an early childhood facility caring for infants and children up to 5 years of age to track handwashing compliance by caregivers in 10 classrooms. Each classroom had two cameras monitoring sink areas, with four classrooms having extra sink areas near diaper-changing stations used for infant care. The research team used the visible footage to track handwashing opportunities, collecting a total of 10 hours of video from each of the classrooms on 10 different days over the course of a month. They looked for handwashing compliance based on guidelines from the American Academy of Pediatrics (AAP).

From 25 hours of video footage studied, the team noted a total of 349 handwashing opportunities in the 10 classrooms, or about 14 opportunities per hour. Of those opportunities, they captured 78 handwashing events, showing a handwashing compliance of about 22%. The researchers observed the lowest compliance (7%) among staff taking care of children two to three years of age.

“Handwashing is an important component of reducing illness transmission among children in early childhood centers, especially for the adults in charge of their care,” said lead study author Jennifer Henk, PhD, in a recent press release. “As we seek to improve overall quality in early childhood settings, our study shows the need to adopt creative strategies to increase handwashing compliance and efficacy.”

Interestingly, this early exposure to illness may have its benefits, as a 2010 study showed that while children in group care have higher rates of respiratory tract and ear infections than children cared for at home during the preschool period, the former go on to experience lower rates of infections during their elementary school years.

Appropriate handwashing guidelines should still be followed by all daycare staff and children to avoid the additional spread of disease. (More information on Best Practices for Handwashing is included below.)

Best Practices for Handwashing

The AAP notes that using sterile gloves and hand sanitizers are not as effective in preventing the spread of germs as washing hands under running water. Even with the use of gloves, individuals should still wash their hands; however, if there is no running water, sanitizers or wipes can be used in the interim. The AAP recommends the following best practices for handwashing in childcare settings:

• Caregivers should wash their hands: When arriving for the day or when moving from one group of children to another Before and after eating, preparing, or handling food Before and after feeding an infant or adminstering medicine After touching pets/animals, garbage, or sand in sand boxes After cleaning After changing a diaper or helping a child with toileting After wiping a nose or touching a mouth, sore, or any other bodily fluids When leaving for the day
• Caregivers should help children wash their hands: Before and after they eat After they touch pets/animals After they play in the sand box or a water table After they have had their diaper changed or go to the bathroom After they wipe their nose, or touch their mouths or any bodily fluids

Use liquid soap, disposable towels, and lukewarm water. Lather hands for 10 seconds and rinse hands until they are free of soap and dirt. Washing for a full 10 seconds is the hardest part; sing a song that lasts 10 seconds, or use a timer to make sure this happens. The warm water doesn't necessarily remove more germs, but it helps individuals wash hands longer. Dry hands with a clean, disposable paper towel or single-use cloth towel.

Once hands are clean, individuals should remember not to touch something that is not clean. Throw out diapers, put soiled clothing in bags, and toss the garbage before washing hands. If the water does not shut off automatically, individuals should let it run while drying their hands and then turn the taps off with a towel.