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

大约50%的澳大利亚儿童在家庭以外接受护理。随着越来越多的妇女选择在生育后继续工作，在生命最初几年接受集体照料的儿童比例将继续增加。在发达国家，儿童保育出勤率已被证明是呼吸道感染和中耳炎最重要的可改变的风险因素。先前在九个达尔文儿童护理中心进行的一项研究表明，呼吸道感染、中耳炎、抗生素使用以及青霉素敏感和青霉素耐药肺炎球菌定植率很高。这项研究将评估简单的卫生措施对肺炎球菌定植率、呼吸道感染率、中耳炎率和肺炎球菌抗生素耐药性的影响。二十间幼儿中心将随机接受额外的训练和教育，以预防呼吸道感染的传播或常规护理。结果指标将包括肺炎链球菌和流感嗜血杆菌新感染的数量、报告的疾病以及通过每两周一次的视频记录和鼓室压检查记录的中耳炎和鼻涕的发生率。干预的有效性将在学年结束时（干预后9个月）进行评估，以避免与学校假期期间发生的儿童保育环境变化相关的偏见。随机分配接受常规治疗的中心将在研究完成时接受全面干预，所有中心将在6个月后重新评估。

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 .