title: Hand hygiene compliance and environmental determinants in child day care centers: an observational study.
abstract: BACKGROUND
  Children attending day care centers (DCCs) are at high risk for contracting infections, for which hand hygiene (HH) is an effective prevention measure. The study objectives were to assess caregivers' compliance to HH guidelines in DCCs and to identify environmental determinants of HH behavior.
  
  
  METHODS
  We observed caregivers' compliance to HH guidelines and collected data on environmental determinants (ie, number of sinks, number and type of towel and soap facilities, availability of alcohol-based hand sanitizers). Using multilevel logistic regression analyses, odds ratios (OR) with 95% confidence intervals (CI) were obtained for environmental determinants of HH behavior.
  
  
  RESULTS
  In 122 participating DCCs, 350 caregivers and 2,003 HH opportunities were observed. The overall compliance was 42% (95% CI: 40%-44%). Compliance for different activities for which HH was indicated ranged from 20% to 79%. In the multivariable model, the number of towel facilities per caregiver (OR, 2.33; 95% CI: 1.40-3.88) and type of towel facilities were significantly associated with HH. Hands were most frequently washed when only paper towels were available compared to only fabric towels (OR, 1.47; 95% CI: 1.00-2.16) or a combination of both paper and fabric towels (OR, 2.13; 95% CI: 1.32-3.44).
  
  
  CONCLUSIONS
  HH compliance of caregivers in Dutch child DCCs can be improved. Interventions for this should take into account environmental determinants such as the number and type of towel facilities.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. T.Zomer@rotterdam.nl
authors.forename: Tizza P
authors.initials: TP
authors.lastname: Zomer
authors.forename: Vicki
authors.initials: V
authors.lastname: Erasmus
authors.forename: Ed F
authors.initials: EF
authors.lastname: van Beeck
authors.forename: Aimée
authors.initials: A
authors.lastname: Tjon-A-Tsien
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Richardus
authors.forename: Hélène A C M
authors.initials: HA
authors.lastname: Voeten
mesh_terms: D000328:Adult; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D003428:Cross Infection / Q000517:prevention & control*; D004784:Environmental Monitoring / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D063373:Hand Hygiene; D006801:Humans; D007223:Infant; D007374:Interior Design and Furnishings; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D055815:Young Adult