title: An observational study of frequency of provider hand contacts in child care facilities in North Carolina and South Carolina.
abstract: BACKGROUND
  Children enrolled in child care are 2.3-3.5 times more likely to experience acute gastrointestinal illness than children cared for in their own homes. The purpose of this study was to determine the frequency surfaces were touched by child care providers to identify surfaces that should be cleaned and sanitized.
  
  
  METHODS
  Observation data from a convenience sample of 37 child care facilities in North Carolina and South Carolina were analyzed. Trained data collectors used iPods (Apple, Cupertino, CA) to record hand touch events of 1 child care provider for 45 minutes in up to 2 classrooms in each facility.
  
  
  RESULTS
  Across the 37 facilities, 10,134 hand contacts were observed in 51 classrooms. Most (4,536) were contacts with porous surfaces, with an average of 88.9 events per classroom observation. The most frequently touched porous surface was children's clothing. The most frequently touched nonporous surface was food contact surfaces (18.6 contacts/observation). Surfaces commonly identified as high-touch surfaces (ie, light switches, handrails, doorknobs) were touched the least.
  
  
  CONCLUSIONS
  General cleaning and sanitizing guidelines should include detailed procedures for cleaning and sanitizing high-touch surfaces (ie, clothes, furniture, soft toys). Guidelines are available for nonporous surfaces but not for porous surfaces (eg, clothing, carpeting). Additional research is needed to inform the development of evidence-based practices to effectively treat porous surfaces.
authors: Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC. Electronic address: afraser@clemson.edu.
authors: Angela
authors: A
authors: Fraser
authors: Food and Nutrition Policy Research, RTI International, RTP, NC.
authors: Kelly
authors: K
authors: Wohlgenant
authors: Food and Nutrition Policy Research, RTI International, RTP, NC.
authors: Sheryl
authors: S
authors: Cates
authors: Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC.
authors: Xi
authors: X
authors: Chen
authors: Department of Food, Nutrition, and Bioprocessing, North Carolina State University, Raleigh, NC.
authors: Lee-Ann
authors: LA
authors: Jaykus
authors: Department of Food, Nutrition, and Bioprocessing, North Carolina State University, Raleigh, NC.
authors: You
authors: Y
authors: Li
authors: Department of 4-H Youth Development and Family & Consumer Sciences, North Carolina State University, Raleigh, NC.
authors: Benjamin
authors: B
authors: Chapman
mesh_terms: D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D004781:Environmental Exposure; D050456:Fomites; D006235:Hand Disinfection; D006801:Humans; D007223:Infant; D017053:Infection Control / Q000379:methods*; D009657:North Carolina; D010988:Play and Playthings; D012499:Sanitation / Q000379:methods*; D013022:South Carolina
keywords: Child care providers; Hand contact; Nonporous surfaces; Observational study; Porous surfaces