The relationship of staff to the incidence of diarrhea in day-care centers.

Sixty randomly selected day-care centers in Houston, Texas, were surveyed for cases of diarrhea by weekly telephone calls during the period October 1980 to May 1981. Visits to each day-care center were made upon enrollment and again to collect self-administered questionnaires which had been mailed to the staff of each center. During the eight-month survey, 986 cases of diarrhea were reported, with an average day-care center incidence of 1.15 cases per 100 person-weeks of observation. A significant positive correlation (p less than 0.05 to p less than 0.01) was found between the incidence of diarrhea in a day-care center and each of the following variables reported by the day-care center staff: the average frequency of diapering, the average frequency of working with children less than two years of age, the average frequency of meal preparation, the average frequency of serving food to the children, and the percentage of staff who both diaper and either serve food or prepare meals daily. Day-care centers which accepted children less than two years of age had a 3.55-fold higher incidence of diarrhea compared with centers which did not accept children less than two years of age. Day-care centers in which one or more staff members prepared meals, served food, and diapered children on a daily basis had a 3.28-fold higher incidence of diarrhea compared with centers in which staff did not combine on a daily basis the duties of diapering children with either meal preparation or food service. The results suggest that staff members may play a role in the transmission of diarrhea in day-care centers through diapering, meal preparation, working with children less than two years of age, or a daily combination of diapering and either meal preparation or food service.