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Does hygiene intervention at day care centres reduce infectious illnesses in children? An intervention cohort study
Thorolfur Gudnason1, Birgir Hrafnkelsson, Brynja Laxdal
1Chief Epidemiologist's Office, Directorate of Health, Reykjavík, Iceland. thorolfur@landlaeknir.is
Insights
A hygiene intervention in preschool day care centers did not significantly reduce illness rates. High baseline hygiene standards may have limited the intervention's effectiveness, suggesting other risk factors need investigation.
Area of Science:
- Pediatric Health
- Infectious Disease Epidemiology
- Public Health Interventions
Background:
- Day care attendance is a significant risk factor for illness transmission among preschool children.
- Respiratory and gastrointestinal illnesses are common in this age group.
- Understanding effective interventions in day care settings is crucial for child health.
Purpose of the Study:
- To evaluate the effectiveness of a hygiene intervention on reducing illness rates in preschool children attending day care centers.
- To assess the impact of the intervention on febrile, respiratory, and gastrointestinal illnesses.
- To analyze intervention effects based on child age and duration.
Main Methods:
- A cohort trial involving 30 day care centers (DCCs) across two communities.
- Intervention applied to half of the DCCs, with illness episodes and risk factors monitored over 2.5 years.
- Statistical analysis using a multivariate mixed effects hierarchical Poisson regression model.
Main Results:
- No significant difference in illness rates (febrile, respiratory, gastrointestinal) between intervention and non-intervention DCCs.
- The hygiene intervention showed no differential effectiveness based on children's age (<3 years vs. older) or over time.
- High compliance with the hygiene protocol was observed among staff and through product usage.
Conclusions:
- The lack of significant impact may be attributed to a high baseline hygiene standard at the participating day care centers.
- Recall bias cannot be entirely ruled out as a contributing factor to the observed results.
- Further research should explore other risk factors beyond hygiene for illness transmission in day care settings.
Background:
Day care attendance is a major risk factor for respiratory and gastrointestinal illnesses in preschool children. In this study, we describe the results of a hygiene intervention cohort trial at day care centres (DCCs) on the rates of febrile, respiratory, and gastrointestinal illnesses in preschool children.
Methods:
Thirty DCCs in 2 communities were included. The number of illness episodes was registered for each child every 6 months, as well as potential risk factors. The hygiene intervention was introduced in half of the DCCs and the results analysed using a multivariate mixed effects hierarchical Poisson regression model.
Results:
The study lasted 2.5 y, of which the hygiene intervention lasted 1.5 y. Two thousand three hundred and forty-nine children participated, delivering 2832 person-y. Adjusted incidence rate ratios of the illnesses at the intervention and non-intervention DCCs were not significantly different for any of the illnesses. The intervention was not more effective in children less than 3 y of age than in older children and no significant effects were seen with time. Compliance with the hygiene protocol was good as measured by the use of hygiene products and by a survey among the staff at the DCCs.
Conclusions:
The most likely explanation for the lack of effects of the intervention is that the baseline standard of hygiene at the DCCs was probably too high for the intervention to demonstrate significant results, but recall bias cannot be excluded. Even though hygiene is important for minimizing the spread of microbes at DCCs, other risk factors need to be studied.
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