Improving Hygienic and Food Preparation Practices in Child Care Centers

NON-TECHNICAL SUMMARY: Child care centers (CCCs) are increasingly important in today's society. However, they represent significant sites for disease transfer between children, particularly foodborne illness and other enteric illnesses, where workers have diapering, food preparation and other responsibilities. Outbreaks have occurred fairly frequently in CCCs involving pathogens like Shigella, E. coli O157:H7 and norovirus, because the children may be carrying pathogens but remain asymptomatic and they have close contact for many hours in one setting. The purpose of the project is three-fold. First, to determine child care workers' knowledge, attitudes, perceptions, and behaviors toward food preparation, hygiene practices, and handwashing procedures through observational and self-reporting methods in selected CCCs in mid-Michigan. Second, to conduct microbiological analysis of swab samples taken in CCC settings to determine the degree of fecal contamination and to develop a risk assessment to determine the most risky areas of pathogen transmission to reduce the risk of norovirus and Shigella infections. Third, to create, implement, and evaluate an educational strategy and tools to enhance food preparation safety and other health hygiene practices among child care workers. Even though these CCCs are not totally representative of all CCCs in the USA, the information generated should be useful to prevent illness in many CCCs around the country. A multi-disciplinary team from three land-grant universities and two not-for-profit companies with experience in academic collaboration has been assembled to complete this project with expertise in microbiology, risk assessment, risk communication, media production, and evaluation. <P>

APPROACH: Efforts include acts or processes that deliver science-based knowledge to people through formal or informal educational programs. Examples include: formal classroom instruction, laboratory instruction, or practicum experiences; development of curriculum or innovative teaching methodologies; workshops; experiential learning opportunities; extension and outreach. <OL> <LI> To determine childcare the knowledge, attitudes, and perceptions of workers by: a) self-report survey of childcare providers to determine their attitudes, perceptions, and behaviors, and b) observation of childcare providers and children in the CCCs to determine their actual behaviors during a normal day. <LI> To conduct microbiological analysis of swab samples taken in childcare settings to determine the degree of fecal contamination by: 1) sampling each of the CCCs both in Years 1 and 3 of the study (before and after the educational program) with a total of 2720 samples and analyses, and 2) determining total coliform bacteria and generic E. coli counts, followed by enteric virus detection in E. coli positive samples. <LI> To develop a risk assessment by: developing mathematical models for Shigella (representing bacterial pathogens) and norovirus (representing enteric viruses) with sources and cross-contamination pathways among children and staff in CCCs in Years 1 and 2 of the project. These models will consider food, food contact surfaces, hands of childcare staff (gloves), immediate environment and the toilet/diaper change area with which staff or hands of children may come into contact, and build on the microbiological, survey and observational data collected in Year 1. <LI> To create, implement, and disseminate an educational strategy and tools by: giving the educational materials via in-person trainings at 10 sites conducted by members of the MSU research team with 10 other CCCs serving as controls. Effective communication campaigns for risk reduction and behavior change are based on needs assessment and formative research with members of the target audience, and working cooperatively with the state and national child care groups. The approach for the educational package will depend on the formative evaluation, but is expected to have some video with computer-based learning tools that could be documented for possible certification credit. <LI>To evaluate the effectiveness of the educational tool including its means of delivery by: assessing the functionality of the educational package among those for whom it was designed, providing recommendations for improved delivery of content aimed at improving hygienic and food preparation practices in CCCs, and evaluating the effectiveness of the educational tool by increasing proper handwashing and other hygienic behaviors and decreasing the number of pathogens in the environment. Part of the first two goals will be met through the educational evaluation in Objective 4. All three of the goals will also be accomplished through a second round of self-report surveys, observations, and microbiological testing to compare the 10 CCCs that received the training tool with the 10 CCCs in the control condition.