الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 101 |  |  |
| | | from | 101 | | |
Abstract
As a result of demographic and sociological changes, increasing numbers of children are attending DCCs. Day care centers provide a unique setting conducive to transmission of infectious agents, rendering the children attending them at higher risk for contracting infections than those cared for at home. Several factors account for this, including host factors and environmental factors.
Gastroenteritis and respiratory tract infections are the most common infections possibly transmitted to children attending DCCs. The most common modes of transmission include direct and indirect contact, droplet contact, airborne contact and less commonly common vehicle transmission (by ingestion).
Investigation and control of infections in DCCs can be challenging and complex with many individuals, agencies and responsibilities are involved. Infection control programs applied in DCCs involve training of caregivers on the following: hand washing, environmental cleaning and disinfection, standard diaper changing steps as well as food safety.
Objectives of the study
• To assess the knowledge of the caregivers in DCCs regarding risk of infectious diseases, their modes of transmission and IC practices.
• To assess the IC practices of the caregivers in the centers.
Subjects and methods
To carry out the study, a cross-sectional design was used. After obtaining the official approval of the MOSS, the researcher visited 59 DCCs in Alexandria (27 in East district, 12 in Middle district and 20 in Montaza district).
The target was caregivers in all the study settings (402) and their IC practices. The data collection tools included:
• Data collection sheet about the DCCs features, including: design, location, number of children, number of classrooms, presence of playground and source of drinking water as well as classrooms, bathrooms, kitchens and availability of IC logistics.
• A structured interviewing questionnaire to collect data regarding the caregivers’ knowledge about infectious diseases, modes of transmission and possible infection prevention and control measures.
• Observational checklist for the following IC practices: hand washing, use of PPE, waste disposal, diaper changing, environmental cleaning and preparation of feeds and meals.
Data entry- after coding- was performed by the researcher using SPSS program and descriptive statistics were used for summarization. A special scoring system was prepared and applied to assess the knowledge and practice of caregivers.
Results
1. Description of DCCs and their IC resources:
• The number of classes per DCC ranged from 2 to 7 classes, and 39% of them contained 3 classes while 28.8% contained 4 classes per DCC.
• The number of children per class ranged from 1 to 23 children and 55.9% of them had between 10 to 14 children per class.
• The number of water sinks ranged from 1 to 11 sinks and in about two thirds of DCCs (66.1%), there were 3 to 5 sinks. The number of children per sink ranged from 3 to 47 children, and 62.7% had less than 10 children per sink.
• The number of toilet seats ranged from 1 to 12 seats and more than two thirds (67.8%) of DCCs had between 3 to 5 seats. The number of children per toilet seat ranged from 3 to 65 and in about half (52.5%) of DCCs, there were less than 10 children per DCC.
• Regarding the presence of room for medical examination within DCCs, 61.1% of DCCs did not have such room. Stool analysis was required before admission in only 69.5% of DCCs and among them, only 31.7% repeated the analysis regularly.
• Regarding the classrooms, 98.3% were well aerated, and 94.9% were cleaned using disinfectant preparations.
• The bathrooms were cleaned more than once daily in 83.1% of the DCCs. The level of cleanliness was good in only 45.8% of them, while in 20.3%, it was poor.
• Regarding the kitchens, half of them (50.0%) had a fair level of cleanliness, while 34.5% had a good level of cleanliness. Almost all DCCs (96.6%) had a refrigerator for preserving the children’s meals. Among those DCCs, the level of cleanliness of the refrigerator was fair in 47.4%, and good in 35.1%.
• Alcohol-based products were present in 44.1% of DCCs, gloves were present in 45.8%, and aprons were only available in 20.3% of DCCs.
• Diaper changing room was not present in 8.4% of the DCCs. Most of the diaper changing rooms (79.6%) were cleaned more than once daily and more than half of them (55.6%) had hand washing facilities, while in 44.4% gloves were available inside the room.
2. Assessment of the caregivers’ knowledge regarding infectious diseases and IC:
• Regarding possible infectious diseases that could be transmitted to the children during attendance at the DCCs and their possible modes of transmission, respiratory tract infections were acknowledged by almost all caregivers (96.5%), GIT infections were acknowledged by more than half of them (53.5%), while 30.3% and 17.9% acknowledged ophthalmic and ENT diseases, respectively. None of the caregivers acknowledged that blood-borne pathogens could be transmitted through DCCs. As regards modes of transmission, 61.4% and 65.7% of caregivers knew that common vehicle and vectors were among the modes of transmission of GIT infections, respectively. A large proportion (91%) knew that droplet transmission was the main mode for contracting respiratory infections.
• Hepatitis B and C were acknowledged by almost one third (31.3% and 33.1%) of caregivers as examples of blood-borne infections transmitted in DCCs, while only 23.8% and 22.6% acknowledged hepatitis D and AIDS. About 40% knew that indirect contact was the main mode of transmission of HCV and HIV.
• Regarding the best IPC measures, personal and hand hygiene were acknowledged by 81.3% of the caregivers, food sanitation was acknowledged by 71.6%, and vaccination was acknowledged by 64.4% of them. Only 33.3% and 23.6% knew that obligatory absence of sick children and health education respectively, were among the control measures of infectious diseases in DCCs.
• As regards the SP, about three quarters (76.4%) of caregivers did not know what term SP implied. Hand washing was acknowledged by 61.9%, use of PPE was acknowledged by 57.9%, vaccination was acknowledged by 55.2% and environmental cleaning was acknowledged by 55.2%.
• As regards their knowledge about the right technique of hand washing, as well as the moments of hand washing, most caregivers (85.8%) claimed to know the right hand washing technique. The majority of them (86.1% and 90.8%) reported that hands should be washed before and after meals, 73.4% reported that they should be washed after changing diapers, 37.8% and 40% reported that hands should be washed before and after helping children with their activities, 26.4% reported that they should be washed before leaving DCC, while only 18.7% and 14.9% reported that hands should be washed upon arrival to DCC and while moving to care from one child to another respectively. About half of the caregivers (47.5% and 53.3%) knew that aprons and gloves were among PPE, while less than one third (29.9%) agreed to the goggles.
• Most (81.8%) caregivers knew the cleaning schedule of the DCC, while only 41.9% stated that spillages of body fluids should be handled by using disinfectants. Regarding the cough/sneezing containment; almost all caregivers knew that the best method was to use tissues.
• Regarding the best way of waste disposal, 54.7% acknowledged the use of covered containers. Most (86.8%) caregivers knew that the ideal food preservation method was in the refrigerator, while 11.7% reported that each child should keep his/her own meal with him/her.
• Regarding the level of knowledge about infectious diseases, their modes of transmission and IC, most (87.3%) caregivers had a fair level of knowledge, 10.2% had poor level of knowledge, while only 2.5% had good level of knowledge. Age, job and level of education were all statistically associated with the level of knowledge.
3. Assessment of the caregivers’ IC practices:
• Regarding caregivers’ practices, in less than two thirds of the observations (61.9%) jewelries and rings were not removed before hand washing, and the guidelines of the right hand washing technique were not followed in 85.7%. Regarding the use of PPE, in half of the observations (50.6%) gloves were used, and among those observations, the gloves removal technique was correct in only 2.2%. In more than two thirds of the observations (70.1%) caregivers wore uniforms, while wearing aprons was observed in only 22.3% of them. In three quarters of observations (75.1%), waste was disposed of in a covered container.
• Regarding diaper change, in almost all the observations (99.8%) hands were not washed before changing diapers, while they were washed after changing diapers in 95.8% of the observations. In more than the half of the observations (57.1%), the used diapers were disposed of in specific containers that were only used for diapers. During handling spillages, the guidelines were followed in nearly two thirds (62.8%) of the observations.
• Regarding food preparation, in more than two thirds (70.2%) of the observations, caregivers washed their hands before meal preparation while in only 16.1% of the observations plastic aprons were used. In about two thirds (67.3%) of the observations, hands were washed before serving meals to children. In all observations fresh meals were prepared and labelled cups and plates with the children’s names were used for serving the meals. In about two thirds (67.8%) of the observations, food hygiene was kept and clean tools were used in 91.5% of the observations. In almost all observations (99.2%), food was kept in the refrigerator while in less than two thirds (60.1%) the source of the water used for preparing meals and feeds was from filter or bottled water.
• Almost half of the sample (48.5%) had fair practice score percent, 30.6% had poor practice score percent and only 20.9% had good practice score percent. District, age, job and level of education statistically associated with the level of practice.
In conclusion, caregivers’ knowledge about infectious diseases and IC practices were satisfactory regarding certain points. They were unsatisfactory regarding ophthalmic and ENT infections blood-borne viral infections and their modes of transmission, SP, hand washing, PPE, handling spillages of body fluids, vaccination and antibiotic use. Most caregivers had fair level of knowledge.
Caregivers complied with many IC practices. They did not comply with others including the right technique of hand washing, donning and doffing gloves, hand washing before changing diapers, and before preparing and serving meals, disposal of used diapers. Caregivers’ practice score was poor to fair.
Recommendations
The main recommendations included:
• Implementation of Rotavirus vaccine, HAV vaccine, Hib Vaccine into the EPI, obligatory immunization of caregivers with seasonal influenza vaccine and HBV
• Ongoing education of caregivers about infectious diseases and IC practices.
• Provision of guidelines for DCCs and regular monitoring and supervision of DCCS with large number of children or poor level of cleanliness.