Thompson S C
Epidemiology and International Health Unit, Macfarlane Burnet Centre for Medical Research, Fairfield, Victoria, Australia.
J Paediatr Child Health. 1994 Jun;30(3):210-9. doi: 10.1111/j.1440-1754.1994.tb00621.x.
An increase in the number of preschool children cared for within groups in child care centres has been associated with increasing numbers of women in the workforce. Children at this age are at high risk for gastrointestinal diseases caused by a large number of enteric pathogens, and the risk is increased by the greater potential for person-to-person transmission within group care. This report considers the pathogens that may cause diarrhoeal illness in children, with particular reference to those that have been reported in formal day care settings. The major risk factors for transmission of these agents and a high rate of diarrhoeal illness in the child care setting include attendance of non-toilet-trained children, staff combining nappy changing and food preparation duties, large enrollment, low staff-to-child ratio, and poor hygiene and child handling practices. Investigations undertaken during an outbreak of diarrhoea have frequently used limited diagnostic testing, often suitable for identifying only bacterial and protozoal agents. Such limited investigations have tended to incriminate agents that have prolonged carriage and are easily identifiable in standard microbiology laboratories. Finding a pathogen in these circumstances needs to be interpreted with caution. Prevention and control measures include training and education in good personal hygiene, emphasis on the need for frequent handwashing, separation of change areas from food handling and eating areas, routine cleaning and disinfection of environmental surfaces and personal items, and exclusion of any child or child care worker with diarrhoea.
儿童保育中心集体照料的学龄前儿童数量增加，这与劳动力中女性数量的增加有关。这个年龄段的儿童因大量肠道病原体而极易患胃肠道疾病，且由于集体照料中人际传播的可能性更大，风险也会增加。本报告考虑了可能导致儿童腹泻疾病的病原体，特别提及那些在正规日托机构中报告过的病原体。这些病原体传播以及儿童保育机构中腹泻疾病高发的主要风险因素包括未接受如厕训练的儿童入园、工作人员同时承担换尿布和准备食物的职责、入园人数众多、工作人员与儿童比例低，以及卫生和儿童护理习惯不佳。在腹泻疫情期间进行的调查常常采用有限的诊断检测方法，这些方法通常仅适用于识别细菌和原生动物病原体。这种有限的调查往往会将携带期延长且在标准微生物实验室中易于识别的病原体归咎于此。在这种情况下发现病原体需要谨慎解读。预防和控制措施包括进行良好个人卫生的培训和教育，强调频繁洗手的必要性，将换尿布区域与食物处理和用餐区域分开，定期清洁和消毒环境表面及个人物品，以及排除任何腹泻的儿童或儿童保育工作人员。
