Hand Hygiene in Childcare Centers: Nothing to Sneeze at!
LewisFirst, MD, MS, Editor in Chief, Pediatrics
With winter coming and children spending more and more time indoors playing together,
spread of viral infections is certain to occur. Perhaps nowhere are the risks greater
for such spread than in childcare centers where young children are in close contact
with each other for most of the day. Given the many developmental benefits of a good
childcare program, the risk of infection should not be a deterrent, especially if
staff and in turn children are well trained in proper hand hygiene to lower the risk
of infection. But can one actually reduce the rate of infections in childcare centers
with hand hygiene, and if so what type of hand hygiene (alcohol-based hand sanitizer
versus soap and water) works best? Azor-Martinez et al. (10.1542/peds.2018-1245) opted to answer this question by performing a randomized cluster trial involving
more than 900 children ages 0-3 years in 24 daycare centers in Spain. The authors
randomized the centers into three groups after childcare providers and parents in
all centers in this study got an educational talk on hand hygiene. One group was
then taught by protocol handwashing using an alcohol-based hand sanitizer with the
dispensers also sent home to be used under parental supervision. A second group got
a regular soap dispenser and a protocol on soap and water handwashing to be done at
the center and at home, and the third group was told to do routine hand washing. During
an eight-month follow-up period, the investigators gathered data on the incidence
of respiratory infections and numbers of days missed attending the childcare center.
So what happened?
During the follow-up period, statistically fewer respiratory infections, days missed,
and fewer antibiotic prescriptions were noted in the centers that used the hand-sanitizer
protocol compared to the control group. It is interesting to note that the centers
that used the routine soap and water protocol had a higher risk of respiratory infections
compared to the control group. Why is this? The authors offer an explanation in
their discussion of their findings that is well worth your linking to this study,
given that there is much more to this study than briefly described in this blog. We
have to lend a hand, a clean hand, to the investigators for designing an alcohol-based
hand sanitizer program that is quite generalizable to other centers and worth sharing
with the centers in your community. If you want to see fewer acute visits for viral
infections this winter, come clean and read this study to learn more.