Efficacité d'un programme de contrôle des infections et des contaminants de l'environnement dans les garderies

The primary objective of this study was to assess the effectiveness of a hygiene programme in reducing the incidence of respiratory and diarrheal diseases in toddlers attending day care centres (DCCs). A randomized field trial was conducted in 52 DCCs in Quebec. One or two toddler groups in each DCC were followed between September 1st, 1996 and November 30, 1997. Absences for any reasons and the daily occurrence of colds and/or diarrhea in toddlers were recorded on calendars by the DCC educators. Questionnaires to the DCC director and on-site visits were used to measure potential confounding variables. The number of fecal coliforms (FC) on children's hands, on educators' hands, in the sandbox and in the playarea of each DCC was measured during three unannounced visits. Participating parents were asked to record on a 15-month calendar the occurrence of colds and diarrhea in the child and the actions taken when s/he was ill. Overall, 1,729 children were followed in 47 DCCs for a total of 153,643 child-days. The incidence rate of diarrhea was significantly reduced by the effect of monitoring alone (IRR = 0.73, 95% BCI = 0.54, 0.97) but not significantly reduced by the intervention whereas the intervention had an effect in reducing the IR of upper respiratory tract infections (URTI) (IRR = 0.80, 95% BCI = 0.68, 0.93) but the monitoring did not. Monitoring also had a significant effect in reducing the level of bacterial contamination on children's and educators' hands. Overall estimates of the IRs of respiratory and diarrheal infections based on parents' data were higher than those based on educators' data (difference of 0.81 episode of diarrhea and 2.2 episodes of URTI per child-DCC year-at-risk). During the 6-month pre-intervention period, the average direct, indirect and total costs per child due to the study illnesses were $132.06, $235.58 and $367.64, respectively. These results indicate that both a hygiene intervention program and monitoring alone play a signif