Hand Washing Compliance Rates in Early Childhood Care Centers

Hand washing compliance among caregivers working with children between infancy and 5 years of age can be greatly improved, according to research published in the American Journal of Infection Control.

Jennifer K. Henk, PhD, assistant professor of AFLS-Human Sciences at the University of Arkansas, and colleagues conducted an observational study of hand washing practice at an early childhood center in northwestern Arkansas to determine hand washing compliance and efficacy.

Two surveillance cameras were placed in each of the 10 classrooms at the facility, which cared for infants and children up to 5 years of age; 4 classrooms cared for infants 2-22 months old and were equipped with an additional hand washing sink near the diaper changing station. Cameras captured clear views of the classroom sinks used for adult hand washing. Ten hours of video footage for each of the 10 classrooms was captured on 10 days over the course of a month, with 1 2.5-hour time slot of video randomly chosen from each room; a total of 25 hours of video were watched by researchers and coded by the number of hand washing opportunities that were present.

Percentage of hand washing compliance was defined as “the number of times a person washes their hands divided by the number of hand washing opportunities;” compliance was defined as “the number of corresponding hand washing events over the number of hand washing opportunities.”

Across the 25 hours of footage selected, researchers identified a total of 349 hand washing opportunities, or roughly 14 hand washing opportunities per hour. The median number of caregivers present at any given time was 2 (range: 2-6); the median number of students was 1 (range: 0-5). Nearly 80 hand washing events took place, with an overall compliance of 22%. Compliance was highest among caregivers (30%), followed by paraprofessional aides (11%) and parents (4%).

Table. Personnel Hand Washing Compliance by Age Group

Age Group, y	Compliance, %
≤1	21
1-2	29
2-3	7
3-5	29

“[Hand washing] is an important component of reducing illness transmission among children in [early childhood centers], especially for the adults in charge of their care,” Dr Henk and colleagues concluded. “Our study shows the need to adopt creative strategies to increase compliance and efficacy, to mitigate the potential for cross-contamination via formalities, and to consider usage of current technology in assessing behaviors.”  

Reference

Clark J, Henk JK, Crandall PG, Crandall MA, O’Bryan CA. An observational study of handwashing compliance in a child care facility. Am J Infect Control. 2016(44):1469-1474. doi: 10.1016/j.ajic.2016.08.006