A review of enteric outbreaks in child care centers: effective infection control recommendations

Child care environments facilitate the spread of enteric infections because of diapering, confined spaces, and children's unhygienic habits. This study reviews documented outbreaks of enteric illness in daycare centers (DCCs) to identify infectious agents, modes of transmission, morbidity/mortality, ages, secondary cases, and practices found effective by investigators. A systematic review of the literature, including peer-reviewed journals and public health records, identified reports of DCC enteric outbreaks published in English occurring between January 1996 and November 2006. In the 75 studies reviewed, 1,806 children were reported ill and 104 were reported hospitalized (mainly associated with Escherichia coli O157:H7). For bacterial outbreaks, the modes of transmission were person-to-person (43%), food (29%), and animal contact (11%). The mode of transmission was largely unknown (51%) for viral outbreaks. One hundred twenty-six staff cases and at least 212 additional ill household contacts were identified. The most frequently identified effective management practices included management of symptomatic cases, enhanced hand hygiene, safe food handling practices, and improved environmental cleaning. Although most children recover quite uneventfully from enteric illness, some can be seriously affected, especially by E. coli O157:H7. Staff, family members, and the community may become ill from secondary spread; therefore, it is important for DCCs to have effective infection control procedures in place to prevent and control outbreaks.