Sticher Benjamin, Bielicki Julia, Berger Christoph
Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zürich, Switzerland.
BMC Health Serv Res. 2018 Jan 15;18(1):25. doi: 10.1186/s12913-018-2831-5.
In childcare centres, temporary exclusion of ill children, if their illness poses a risk of spread of harmful diseases to others, is a central approach to fight disease transmission. However, not all ill children need to be excluded. Previous studies suggested that childcare centre staff have difficulties in deciding whether or not to exclude an ill child, even when official ill-child guidelines are used. We aimed to describe, quantify and analyse these ambiguities and discuss potential solutions.
For this cross-sectional study, we sent postal surveys to 488 childcare centre directors in the Swiss Canton of Zurich, where no official ill-child guideline is in place. We asked for exclusion criteria for ill children and ambiguities faced when dealing with ill children. We checked whether existing guidelines provided solutions to the ambiguities identified.
249/488 (51%) directors responded to the survey. The most common exclusion criteria were fever (87.4%) and contagiousness (52.2%). Ambiguities were mostly caused by conjunctivitis (23.7%) and use of antipyretic drugs (22.9%). Roughly one third of the ambiguities identified could have been resolved with existing guidelines, another third if existing guidelines contained additional information. For the last third, clear written directives are difficult to formulate.
Written recommendations may help to clarify when an ill child should temporarily be excluded. However, such a guideline should cover the topics antipyretic drugs and teething and have room for modification to local circumstances. Collaboration with a paediatrician may be of additional benefit.
在儿童保育中心，如果患病儿童的疾病有传播有害疾病给他人的风险，暂时将其排除是防治疾病传播的核心方法。然而，并非所有患病儿童都需要被排除。先前的研究表明，即使使用官方的患病儿童指南，儿童保育中心的工作人员在决定是否排除患病儿童时仍有困难。我们旨在描述、量化和分析这些模糊之处，并讨论潜在的解决方案。
在这项横断面研究中，我们向瑞士苏黎世州的488名儿童保育中心主任发送了邮政调查问卷，该州没有官方的患病儿童指南。我们询问了患病儿童的排除标准以及处理患病儿童时面临的模糊之处。我们检查了现有指南是否为所识别的模糊之处提供了解决方案。
249/488（51%）名主任回复了调查。最常见的排除标准是发烧（87.4%）和传染性（52.2%）。模糊之处主要由结膜炎（23.7%）和使用退烧药（22.9%）引起。所识别的模糊之处中，大约三分之一可以通过现有指南解决，另外三分之一如果现有指南包含更多信息则可以解决。对于最后三分之一，很难制定明确的书面指示。
书面建议可能有助于明确何时应暂时排除患病儿童。然而，这样的指南应涵盖退烧药和出牙等主题，并留有根据当地情况进行修改的空间。与儿科医生合作可能会有额外的益处。
