title: Effect of infection control measures on the frequency of diarrheal episodes in child care: a randomized, controlled trial.
abstract: BACKGROUND
  Diarrheal infections are common in children who attend child care, and preventing transmission of disease in this setting depends on actions by child care staff. We set out to discover whether transmission of gastrointestinal infections in child care could be reduced by improved infection control procedures.
  
  
  METHODS
  We performed a cluster randomized, controlled trial of an infection control intervention conducted in child care centers for 1 city in Australia. The intervention was training of child care staff about transmission of infection and handwashing and focused on both staff and child behavior. Implementation of the intervention was recorded by an observer. Illness was measured by parent report in telephone interviews every 2 weeks.
  
  
  RESULTS
  There were 311 child-years of surveillance for diarrheal episodes. The rate of episodes of diarrhea was 1.9 per child-year in intervention centers and 2.7 per child-year in control centers. Multivariable analysis showed that diarrheal episodes were significantly reduced in intervention center children by 50%. However, the impact of the intervention was confined to children over 24 months of age. For those centers in which children's compliance with handwashing was high, diarrheal episodes were reduced by 66%.
  
  
  CONCLUSIONS
  This trial supports education about infection control, for staff and children in child care, as a means of reducing transmission of diarrhea. Reduction in episodes of diarrhea in children in child care was limited to children over 24 months of age.
authors.affiliation: National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia. leslee.roberts@anu.edu.au
authors.forename: L
authors.initials: L
authors.lastname: Roberts
authors.forename: L
authors.initials: L
authors.lastname: Jorm
authors.forename: M
authors.initials: M
authors.lastname: Patel
authors.forename: W
authors.initials: W
authors.lastname: Smith
authors.forename: R M
authors.initials: RM
authors.lastname: Douglas
authors.forename: C
authors.initials: C
authors.lastname: McGilchrist
mesh_terms: D020958:Australian Capital Territory / Q000453:epidemiology; D002656:Child Day Care Centers; D002675:Child, Preschool; D016000:Cluster Analysis; D003968:Diarrhea, Infantile / Q000453:epidemiology / Q000517:prevention & control*; D006235:Hand Disinfection; D006801:Humans; D007223:Infant; D015999:Multivariate Analysis; D011446:Prospective Studies