Recommended hygiene practices are believed to reduce this risk. We investigated the impact of additional training and support on transmission of respiratory bacteria, hygiene practices, and rates of respiratory illness.
Methods: A cluster randomised, assessor-blinded, randomised controlled trial was conducted in 20 Australian child care centres. 10 centres (219 children) received a 2 hour evening training session followed by regular visits and support for 20 second hand washing, barrier nose-wiping, removal of contaminated toys, and non-touch sunscreen application. 10 centres (235 children) acted as controls. Nasal swabs, ear examinations, and telephone interviews occurred every 2 weeks for 6 months. Hygiene practices were observed on 4 separate occasions. New infection with S. pneumoniae (Spn) and H. influenzae (Hi) was defined as carriage of a serotype (Spn) or ribotype (Hi) that was not detected at the previous assessment. Childhood illness was reported by parent(s) for each day of the intervention period. The laboratory staff, the parents, and the observers of hygiene practice were not informed which centres had received the intervention.
Findings: Additional training and support for recommended hygiene practices resulted in modest changes in the proportion of hygiene practices consistent with the current guidelines (weighted mean difference 14%, 95% CI 9, 19). These changes are not associated with substantial reductions in the transmission of bacterial respiratory pathogens (adjusted incidence rate ratio, IRR 0.97 95% CI 0.88, 1.08) or respiratory illness (adjusted IRR 1.00, 95% CI 0.93, 1.08).
Interpretation: The transmission of respiratory bacteria in child care centres is frequent and not greatly affected by changes in modest changes in hygiene practices. When these results are combined with other similar studies, it is still feasible that these types of interventions will reduce rates of respiratory illness by a small amount (pooled adjusted IRR 0.94, 95%CI 0.88, 1.01).
(C) 2003 Lippincott Williams & Wilkins, Inc.