title: Prevention of respiratory infections at day care centers: recommendations and systematic review of the evidence.
abstract: Attending a day care center is a risk factor for respiratory infections. The objective of this study is to review which nonspecific prevention measures are recommended for day care centers and the evidence of their usefulness in this setting.
  
  
  
  Recommendations regarding nonspecific prevention at national level were searched using Google and the web sites of the Argentine Society of Pediatrics, the ministries of education and the ministries of health from different countries, both in English and Spanish. Recommendations regarding hand hygiene, clearance of secretions, cleaning the environment and elements, breastfeeding, and exclusion of symptomatic subjects were reviewed. A systematic search of the literature was conducted to find intervention studies at day care centers that evaluated the effectiveness of recommendations, published in Spanish and English. Results and the methodological quality of studies were analyzed.
  
  
  
  Seven guidelines were found. Hand hygiene and environment cleaning were the only recommendations described in all guidelines. The exclusion of symptomatic subjects is mentioned in all, but criteria are heterogeneous. Clearance of nasal secretions and promotion of breastfeeding are outlined only in a few of the guidelines. Eight intervention studies on hand hygiene, cleaning of the environment, and clearance of secretions were found, whose results were heterogeneous and had major methodological limitations.
  
  
  
  A timely and adequate hand hygiene and an appropriate cleaning of the environment have been uniformly recommended by different guidelines as non-specific prevention measures against respiratory infections. The evidence on the usefulness of these measures in this setting is limited.
authors: FUNDASAMIN, Fundación para la Salud Materno Infantil, Buenos Aires, Argentina.
authors: María Elina
authors: ME
authors: Serra
mesh_terms: D002656:Child Day Care Centers; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D017410:Practice Guidelines as Topic; D012141:Respiratory Tract Infections / Q000517:prevention & control*