Hygienic conditions in child-care facilities in North Carolina and South Carolina: an integrated microbial and observational study.
BACKGROUND
In the United States almost one-quarter (23%) of children younger than age 5 years participate in some form of out-of-home child care; these children are 2.3-3.5 times more likely to contract acute gastrointestinal illness.


METHODS
Observational investigations were done to understand the hygienic conditions and practices of 40 child-care facilities in North Carolina and South Carolina. These data were compared with microbiological indicator data (aerobic plate counts and coliform counts) collected from selected surfaces in each facility. Results from the two data sets were analyzed using nonparametric statistical methods to reveal potential risk factors for enteric disease transmission.


RESULTS
Statistically significant differences (P ≤ .05) in surface microbial counts were observed when comparing family child-care homes versus centers and between facilities participating in the Child and Adult Care Food Program and those that do not participate. Facilities without written surface cleaning or food preparation policies had statistically significantly higher microbial counts on surfaces.


CONCLUSIONS
Our unique study, which combined observational and microbiological data, provided revealing information about the relationship between hygiene indicators and sanitary practices in child-care facilities in the southeastern United States.
Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC.
You
Y
Li
Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC.
Lee-Ann
LA
Jaykus
Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC.
Sheryl
S
Cates
Division of Public Health and Policy Research, RTI International, Research Triangle Park, NC.
Kelly
K
Wohlgenant
Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC.
Xi
X
Chen
Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC. Electronic address: afraser@clemson.edu.
Angela M
AM
Fraser
D001420:Bacteria, Aerobic / Q000302:isolation & purification*; D058491:Bacterial Load; D002656:Child Day Care Centers; D002675:Child, Preschool; D004755:Enterobacteriaceae / Q000302:isolation & purification*; D004783:Environmental Microbiology; D005260:Female; D006801:Humans; D007223:Infant; D017053:Infection Control / Q000379:methods*; D008297:Male; D009657:North Carolina; D012499:Sanitation / Q000379:methods*; D013022:South Carolina
Child care centers; Family daycare home; Microbial indicators; Sanitation