Environmental contamination in child day-care centers.

Enteropathogens associated with outbreaks of diarrhea in day-care centers are spread by the fecal-oral route through contaminated hands or environmental objects. This prospective study was undertaken to determine the prevalence of fecal coliform contamination in day care. Ten rooms in six centers housing 121 children less than 2 years of age were studied for 13 weeks (February to May 1988). Inanimate objects (n = 1,275), toy balls (n = 724), and hands (n = 954) were cultured 1-3 times per week. Fecal coliform contamination was common and was greater (p less than 0.05) for objects, toy balls, and hands of children in toddler compared with infant rooms. In five rooms in which clothes were worn over diapers, there was a significantly lower prevalence of fecal coliform contamination of toy balls (p less than 0.005), inanimate objects (p less than 0.05), and hands (p less than 0.001) when compared with rooms in which overclothes were not worn. Occurrence of diarrhea was significantly associated with increased contamination of hands (p = 0.001). Stool and environmental isolates from individual rooms had the same plasmid patterns, which were unique to each center. In summary, fecal coliform contamination of environmental objects and hands of children and caregivers in day-care centers is common; toy balls can serve as sentinels of contamination; fecal coliform contamination can be significantly decreased by use of overclothes; and Escherichia coli strains from stool showed the same plasmid patterns.