Date of Award


Document Type


Degree Name

Master of Science (MS)

Legacy Department

Food, Nutrition, and Culinary Science

Committee Chair/Advisor

Fraser, Angela M

Committee Member

Barron , Felix

Committee Member

Jiang , Xiuping


Introduction: Children between the ages of 37 and 54 months enrolled in child-care facilities (CCFs) are reported to be 2.3 to 3.5 times more likely to experience an acute gastrointestinal illness (AGI) than are children cared for in their own home. Identifying potential risk factors for the transmission of enteric pathogens in CCFs is essential to the prevention of AGI.
Methods: A convenience sample of CCFs in North Carolina and South Carolina was recruited to participate in this study. A survey was administered to all CCF directors to collect information about facility characteristics, meal preparation, staff training, hygiene policies and procedures, and the health status of staff and children. In each facility, the sanitary conditions of two classrooms (infant [0-11 months old] room, toddler [12-35 months old] room, or combined [3-5 years old] room) and the food preparation area were assessed. Floor plans of all audited classrooms were also prepared. Trained data collectors used iPods to record hand-touch events of one child-care provider (CCP) for 45 minutes in each of the audited classrooms. Follow-up telephone interviews with the CCF directors were conducted to collect information about the use of hand sanitizers, surface sanitizing practices, carpet and rug cleaning practices, and flooring materials.
Results: Forty (40) CCFs (31 child-care centers and 9 day-care homes) participated in the study. Of 10,134 hand-touch events observed in 51 classrooms, 4,563 occurred on porous surfaces; 4,024 occurred on nonporous surfaces; and 1,547 occurred on bare-skin with average of 198.7 hand-touch events per provider. The overall handwashing and diaper-changing compliance rates in both states were 3.5% and 8.8% respectively. Forty-nine percent (25/51) of audited classrooms had handwashing sinks adjacent to the diaper-changing area. About 55% (28/51) of classrooms had hands-free trash cans adjacent to the diaper-changing area. Disposable sheets were used on diaper-changing surfaces in only 8.8% (3/34) of diaper-changing events. About 41% (13/32) the temperature inside the food preparation refrigerator was at 41¡F or lower. About 83% (25/30) of facilities reported using chlorine bleach solution to disinfect a surface.
Conclusions: Low handwashing compliance (3.5% [5/142]) with the CDC handwashing guidelines and low diaper-changing compliance (8.8% [3/34]) with the CDC diaper-changing guidelines were observed in this study. Child-care providers had frequent contacts with children's clothes (an average of 34.2 times per observation), food-contact surfaces (an average of 18.6 times per observation), and children's hands (an average of 9.8 times per observation). The mean hygiene score of 51 classrooms was 7.7 out of 8. The mean hygiene score of 32 food preparation areas was 7.3 out of 10. Improvement in maintaining temperature of refrigerator at 41¡F or lower is needed. Sanitation practices varied among facilities, which may indicate a need of universal hygiene and sanitation standards for CCFs.

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