Washoe county child care inspections

A D VA N C E M E N T O F T H E SCIENCE A D VA N C E M E N T O F T H E SCIENCE

Introduction Children in child care facilities can trans- mit communicable diseases to other chil- dren, staff, and family members. In addition, child care facilities have a known history of increasing a child’s risk of contracting dis- eases. The incidence of diarrhea, for example, has been shown to be significantly higher in children in child care facilities (Reves et al., 1993). Similarly, the use of child care facili- ties is a major factor contributing to trans- mission of respiratory tract diseases (Collet et al., 1991; Fleming, Cochi, Hightower, & Broome, 1987). Administrators of child care centers need to have effective infection con- trol procedures in place to prevent and con- trol outbreaks (Lee & Greig, 2008).

In 2007, the Washoe County Health Dis- trict and the Washoe County Department of Social Services responded to the increas- ing number of illnesses from outbreaks of

norovirus, influenza, and strep throat at child care centers by setting a goal to strengthen the Washoe County child care regulations on communicable diseases. Washoe County is located in northern Nevada and includes the cities of Reno and Sparks. The proposed regu- lations covered all licensed child care facili- ties in Washoe County. The Washoe County Health District also set a goal of developing an education, evaluation, and inspection pro- gram at child care facilities. Due to resource availability, however, the education, evalua- tion, and inspection program was only imple- mented at larger child care facilities licensed to care for 13 or more children.

Amending the Child Care Regulations Child care regulations are designed to pro- tect children by striving to prevent the risk of the spread of diseases (National Association for the Education of Young Children, 1997).

As a result of the collaboration between the Washoe County Health District and the Washoe County Department of Social Ser- vices, a number of communicable disease pre- vention requirements were adopted into the Washoe County child care regulations. These regulatory requirements were designed to reduce the number and severity of outbreaks and included 1) requiring exclusion of care- givers and children when they exhibit spe- cific symptoms; 2) requiring a hand-washing training program for children and caregivers; 3) requiring that caregivers monitor chil- dren’s hand-washing activities; 4) requiring specific hand-washing procedures be fol- lowed; 5) requiring a cleaning and sanitiz- ing schedule for specific items; 6) requiring additional steps to the diaper-changing pro- cedure, and 7) requiring all caregivers to take a Washoe County–approved communicable disease prevention course at least once every three years. Overall, the caregivers were very receptive and supportive of these proposed regulations. After a feedback period, these requirements were formally adopted in 2009.

The Education, Evaluation, and Inspection Program The education, evaluation, and inspection program at child care centers began on Feb- ruary 1, 2009. This program was designed to evaluate and provide educational feed- back on communicable disease prevention concepts to child care administrators. The program was also designed to familiarize the child care administrators with the symptoms of communicable diseases, such as diarrhea, vomiting, fever, cough, and sore throat. In

Abst ract From 2005 to 2008, Washoe County, Nevada, child care centers experienced an increase in illnesses from communicable disease

outbreaks. The number of ill children and caregivers from these outbreaks

went from 26 in 2005 to 266 in 2008, an increase of 923%. A clear need to

reverse this trend existed. Therefore, in 2009 Washoe County strengthened

its regulations for child care facilities by adding numerous communicable

disease prevention standards. In addition, in 2009 a two-year education,

evaluation, and inspection program was implemented at Washoe County

child care centers. Following the implementation of this program, a decline

occurred in the number of illnesses. The number of ill children and caregivers

from outbreaks went from 266 in 2008 to 13 in 2011, a decrease of 95%.

Jordan Wagner, RN Altru Health System

Sharon Clodfelter Renown Health

Preventing Diseases and Outbreaks at Child Care Centers Using an Education, Evaluation, and Inspection Method

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A D VA N C E M E N T O F T H E SCIENCE

addition, this education, evaluation, and inspection program was designed to deter- mine if any improvements in specific cat- egories of the administrators’ knowledge of communicable disease prevention concepts transferred into observed improvements in the child care centers’ communicable disease prevention practices.

Previous education and evaluation pro- grams have been effective in reducing ill- nesses. For example, hand-washing promo- tion is associated with significantly reduced absenteeism in school (Bowen et al., 2007). Hand-washing monitoring practices and hand-washing training programs also have played a role in reducing infections in chil- dren attending daycare centers (Carabin et al., 1999). Hand washing has proven to be one of the most important ways to limit the transmission of diseases in child care centers (Australian Government National Health and Medical Council, 2005). The critical role of hand washing to prevent disease transmis- sion cannot be overemphasized (Mink & Yeh, 2009). Hand washing alone, however, does not always appear to be sufficient to pre- vent the spread of disease at child care cen- ters. A hand-washing intervention program that resulted in an approximate threefold increase in hand washing among preschool children did not reduce illness absenteeism or overall absenteeism (Rosen et al., 2006). This suggests that a need exists for enhanced approaches for reducing illnesses in pre- school settings (Rosen et al., 2006).

Methods The methods involved a two-part evalua- tion process consisting of questionnaires and visual inspections. These questionnaires and inspections were conducted by environmen- talists who are registered as environmental health specialists both by the state of Nevada and by the National Environmental Health Association. The environmentalists’ train- ing included being able to implement health and safety laws as they pertain to child care centers. Their training also equipped them on how to communicate with the child care operators on when to suspect an outbreak is occurring, what interdiction measures to take when a suspected outbreak is occurring, and how to prevent outbreaks.