Improved Hygiene Measures for Australian Child Care Centres: A randomised controlled trial

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Roughly fifty percent of young Australian children receive care outside their home. As greater numbers of women choose to continue working after childbirth, the proportion of children exposed to group care in the first few years of life will continue to increase. In developed countries child care attendance has been shown to be the most important modifiable risk factor for respiratory tract infections and otitis media. A previous study in nine Darwin child care centres demonstrated high rates of respiratory tract infections, otitis media, antibiotic use and colonisation with both penicillin-sensitive and penicillin-resistant pneumococci. This study will assess the impact of simple hygiene measures on rates of pneumococcal colonisation, respiratory infection, otitis media, and pneumococcal antibiotic resistance. Twenty child care centres will be randomised to receive additional training and education in the prevention of spread of respiratory infection or routine care. Outcomes measures will include the number of new infection with Streptococcus pneumoniae and Haemophilus influenzae, reported illnesses, and rates of otitis media and nasal discharge documented by fortnightly examination with video recording and tympanometry. Efficacy of the intervention will be estimated at the end of the school year (9 months after the intervention) to avoid bias associated with changes in the child care environment that occur over the school holidays. The centres randomised to routine care will receive the full intervention at the completion of the study and all centres will be re-assessed 6 months .