Infections in child-care facilities and schools.

1. ChrisAnna M. Mink, MD* 2. Sylvia Yeh, MD† 1. *Clinical Professor of Pediatrics, UCLA, Los Angeles, Calif 2. †Associate Clinical Professor of Pediatrics, UCLA, Los Angeles, Calif After completing this article, readers should be able to: 1. Recognize the common infectious agents that cause outbreaks in group settings for children. 2. Describe the approaches for preventing outbreaks of infectious diseases in child care and schools. 3. Discuss tactics for managing children after exposures to specific common pediatric pathogens. In the United States in 2006, approximately 54% of the 23.7 million children younger than 5 years of age attended a child-care facility, and 55 million children attended school from kindergarten through 12th grade. (1)(2) Children cared for in child-care settings have an increased rate of infectious diseases. (3)(4) Prevention and control of infectious diseases among children in out-of-home group settings is a concern for families, staff, health-care practitioners, and the community. Several factors influence the risks for introduction and spread of infections in child-care settings. These factors include the personal hygiene and health status of the caregivers and the children (as well as their ages) and the condition of the facility (eg, environmental sanitation, space and quality, food-handling practices, policies for attendance, and ratio of children to caregivers). The characteristics of the infectious agent also are important variables that determine its potential to spread in a group setting. These factors include the organism's infectivity for the population, methods available for prevention (eg, vaccination), ability of the microbe to survive in the environment, and the mode of transmission. Modes of transmission include respiratory, fecal-oral, and contact with blood or body fluids. Other potential sources of infection are animals and fomites. ### Mechanisms for Prevention The optimal strategy for controlling infectious diseases is prevention. Standard precautions (Table 1) should be used routinely in caring for children of all ages in all group settings. (3)(4) The critical role of hand washing cannot be overemphasized. Additional measures include preventive health care for attendees …