title: Is there a relationship between hygiene practices and skin and soft tissue infections in diapered children?
abstract: OBJECTIVE
  The perineal and gluteal regions are the most frequent areas of skin and soft tissue infection (SSTI) in diapered children. No studies have investigated the relationship between perineal and general hygiene practices and SSTIs in this population. This study was conducted to evaluate this relationship.
  
  
  METHODS
  A cross-sectional observational study was conducted in an urban pediatric emergency department. Subjects were recruited into 3 study groups as follows: gluteal/perineal SSTIs (SSTI), diaper dermatitis (DD), or healthy normal skin (NS). Survey responses were analyzed for significance followed by a clinically oriented staged regression to model predictors of SSTI compared with the NS and DD groups.
  
  
  RESULTS
  There were 100 subjects in the SSTI, 206 in the NS, and 151 in the DD groups. Race was the only demographic characteristic that differed between the groups. After adjustment for race, no day care attendance, history of SSTI, household contact with SSTI history, and higher propensity for diaper rash were associated with SSTI compared with NS. Regression results comparing SSTI to DD revealed no day care attendance, history of SSTI, household contact with SSTI history, less sensitive skin, and less diaper cream use to be predictors of SSTI.
  
  
  CONCLUSIONS
  Perineal and general hygiene practices were not significantly different between children with SSTI compared with children with NS or DD. Based on the results of this study, further prospective studies should evaluate diaper hygiene practices that prevent DD and subsequent SSTIs, the preventative role of day care attendance, and effective interventions that minimize the risk of recurrent SSTIs.
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA. ahromi01@exchange.louisville.edu
authors.forename: Annie Heffernan
authors.initials: AH
authors.lastname: Rominger
authors.forename: Charles
authors.initials: C
authors.lastname: Woods
authors.forename: Mary
authors.initials: M
authors.lastname: Fallat
authors.forename: Michelle
authors.initials: M
authors.lastname: Stevenson
mesh_terms: D044383:Black People / Q000706:statistics & numerical data; D002081:Buttocks; D002656:Child Day Care Centers; D003430:Cross-Sectional Studies; D003879:Dermatologic Agents; D003963:Diaper Rash / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D041381:Diapers, Infant / Q000009:adverse effects; D004198:Disease Susceptibility; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D006920:Hygiene; D007223:Infant; D007224:Infant Care / Q000379:methods*; D007231:Infant, Newborn; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D009824:Ointments; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010502:Perineum; D012874:Skin Diseases, Infectious / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
chemical_list: D003879:Dermatologic Agents; D009824:Ointments