Brady Michael T
College of Medicine, Section of Infectious Diseases, Ohio State University and Columbus Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
Am J Infect Control. 2005 Jun;33(5):276-85. doi: 10.1016/j.ajic.2004.11.007.
Provision of some form of child care outside of the home is certainly not a new phenomenon. In the past, most out-of-home care was provided by a relative, a friend, or someone who had a specific relationship with the family of the child. The frequency of utilization of child care centers for out-of-home care and the different formats of out-of-home care services has increased within recent decades and will vary by geographic location. Also, there is an increased utilization of temporary child care such as "mother's day out" or baby-sitting services provided at churches, grocery stores, and other places. Child care centers represent special risks for transmission of infectious agents because young children exhibit high susceptibility to many community-acquired viruses and bacteria; they lack developmental understanding required for good hygiene; and they frequently receive antibiotics (appropriately and inappropriately). Infections acquired in child care centers can significantly impact the health of the children who acquire the infection and also result in significant economic impacts on the child's family, particularly if 1 or more of the parents has to lose time from work. In the United States, it is estimated that families who have children in child care lose 13 days of work per year for all types of infections. Interventions that have proven valuable for reducing infections within child care centers include the following: (1) formal written policies for infection control within the child care center, (2) formal education of child care center staff concerning infection control practices (needs to be repeated; preferably on a recurring basis), (3) good hand hygiene by both staff and children, (4) appropriate cleaning of contaminated surfaces, (5) separation of food preparation and diaper changing, (6) exclusion of certain ill children, (7) cohorting ill children when exclusion is not possible, (8) ensuring adequate age-appropriate immunization of child care attendees and staff, and (9) optimal ratios of children to staff.
在家庭之外提供某种形式的儿童保育服务当然不是一个新现象。过去，大多数家庭外保育服务由亲戚、朋友或与孩子家庭有特定关系的人提供。近几十年来，用于家庭外保育的儿童保育中心的使用率以及家庭外保育服务的不同形式有所增加，并且会因地理位置而异。此外，诸如在教堂、杂货店和其他场所提供的“母亲节外出”或保姆服务等临时儿童保育服务的使用率也有所增加。儿童保育中心是传染病传播的特殊风险场所，因为幼儿对许多社区获得性病毒和细菌表现出高度易感性；他们缺乏良好卫生习惯所需的发育理解；并且他们经常接受抗生素治疗（无论是否恰当）。在儿童保育中心获得的感染会对感染的儿童的健康产生重大影响，也会对孩子的家庭造成重大经济影响，特别是如果父母中有一方或多方不得不请假。在美国，据估计，孩子在儿童保育中心的家庭每年因各种感染而损失13个工作日。已证明对减少儿童保育中心内感染有价值的干预措施包括以下几点：（1）儿童保育中心内正式的感染控制书面政策；（2）对儿童保育中心工作人员进行关于感染控制措施的正规教育（需要重复进行；最好定期进行）；（3）工作人员和儿童都保持良好的手部卫生；（4）对受污染表面进行适当清洁；（5）将食物准备和换尿布区域分开；（6）排除某些患病儿童；（7）在无法排除患病儿童时将他们集中安置；（8）确保儿童保育中心的儿童和工作人员进行适当的适龄免疫接种；（9）保持最佳的儿童与工作人员比例。
