title: Children's hand hygiene behaviour and available facilities: an observational study in Dutch day care centres.
abstract: BACKGROUND
  Children attending day care centres are at increased risk of infectious diseases, in particular gastrointestinal and respiratory infections. Hand hygiene of both caregivers and children is an effective prevention measure. This study examined hand hygiene behaviour of children attending day care centres, and describes hygiene facilities at day care centres.
  
  
  METHODS
  Data were collected at 115 Dutch day care centres, among 2318 children cared for by 231 caregivers (August to October 2010). Children's hand hygiene behaviour was observed and data on hand hygiene facilities of the day care centres collected by direct unobtrusive observation. National guidelines indicate hand hygiene is required before eating, after toilet use and after playing outside.
  
  
  RESULTS
  Among 1930 observed hand hygiene opportunities for children, overall adherence to hand hygiene guidelines was 31% (95% CI: 29-33%). Adherence after both toilet use and playing outside was 48%. Hands were less frequently washed before eating, where guideline adherence was 15%. In 38% of the playrooms there was no soap within reach of children and 17% had no towel facilities. In over 40% of the playrooms, appropriate hand hygiene facilities for children were lacking.
  
  
  CONCLUSIONS
  Adequate hand washing facilities were available for children in only half of the participating day care centres in our study and children washed their hands in only 15-48% of the occasions defined by official guidelines. More attention is needed to hand hygiene of children attending day care centres in the prevention of infectious diseases.
authors.affiliation: 1 Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands a.vanbeeck@erasmusmc.nl.
authors.forename: A H Elise
authors.initials: AH
authors.lastname: van Beeck
authors.affiliation: 2 Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
authors.forename: Tizza P
authors.initials: TP
authors.lastname: Zomer
authors.affiliation: 1 Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Eduard F
authors.initials: EF
authors.lastname: van Beeck
authors.affiliation: 1 Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Richardus
authors.affiliation: 2 Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
authors.forename: Helene A C M
authors.initials: HA
authors.lastname: Voeten
authors.affiliation: 1 Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Vicki
authors.initials: V
authors.lastname: Erasmus
mesh_terms: D000328:Adult; D002656:Child Day Care Centers / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004435:Eating; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006235:Hand Disinfection; D063373:Hand Hygiene / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010988:Play and Playthings; D014038:Toilet Facilities; D055815:Young Adult