Advice from the experts: Proper hand-washing keeps day care kids healthier, helps prevent germs from spreading

Q&A with Bobette Thompson, president, National Association of Child Care Professionals

Kids share lots of things, including germs. For child care professionals, teaching children about hand-washing is one of the most important steps to prevent germs from spreading. Joining us with some tips about the importance of hand-washing in day care settings is Bobette Thompson, president of the National Association of Child Care Professionals.

To help you make the healthiest choices when planning what will go into your stockpile, the American Public Health Association recently sought advice from Capt. Laura A. McNally, MPH, RD, FADA. McNally is a dietitian officer in the U.S. Public Health Service and chair of the Emergency Preparedness Task Force for the American Dietetic Association.

So why is hand-washing a top priority at day care centers?

When we have small children, they love to share everything, as you said. A small child can touch up to 300 surfaces in less than 30 minutes. So washing our hands and keeping those germs to a minimum are very important. Germs can live up to 72 hours on some surfaces.

Are there certain surfaces that seem to get touched more often than others in day care centers?

There are, and we are constantly disinfecting and cleaning things like tables, chairs, toys, especially for smaller children who tend to put things in their mouths. Once a toy has been mouthed we take them, disinfect them and let them air dry before they are brought back in for all the children to play with. And obviously toileting areas — diapering tables are disinfected every time a diaper is changed. We spend a lot of time every day in the early education environment just keeping it clean.

Up to 72 hours is a long time, and that tells me that infectious diseases must be an issue at day care centers.

We do have a lot of communicable things that go around, and you know you can pick them up anywhere, it’s not just their preschool. They can come from the cart at the grocery store or the handle at the restaurant. But once they come in, if we’re not aware of it, then it can be shared before we can identify and get that child removed from the population. And by then other children have been exposed to anything from a cold to the flu to a stomach bug. So we are very conscious and we really would appreciate if parents are very aware of their children and know if their child is lethargic or running a fever and that kind of thing, and if they are too sick then just don’t let them come, because they might be sharing. Or if they’re not sick with something communicable but are in a weakened state, they could possibly catch something that a child has that we haven’t identified yet.

What are the ages typically of children in day care, and are day care centers good places to teach about hand-washing?

In most states children can begin preschool at 6 weeks of age. A lot of programs start at 2 and they go up through prekindergarten. It’s the best place to teach, along with home, because we know that children learn from the time they are born and the earlier we get them in a habit the more likely it is to be a lifelong habit. We wash infants’ hands after we diaper them just so they are in that routine, and once they become toddlers we allow them to stand on a stool to see the process. We still wash them carefully for them, but by the time they are 2 they really are more independent. They can get the process. We put the soap in the sink down where they can reach it and we teach them the proper hand washing, which means they wash them in warm water, they use the appropriate amount of soap and they wash them for at least 20 seconds — and that’s the critical factor, the time that they wash their hands.

So what can child-care professionals do to encourage hand-washing and what kinds of techniques do they currently use? You mentioned the 20 seconds. That sounds like it could be something that could be fun for them.

Well, 20 seconds is a long time to a person, and they really don’t even have the concept of time. So what we have to do is things to help them realize how long that is. The American Public Health Association and Softsoap have teamed to invent a Get Ready timer that goes on top of the Softsoap bottle. When it’s depressed, soap comes out and a really cute little songs starts to play, and it plays for 20 seconds. So the child knows that when the song’s over, their hands are clean. They get two things: No. 1 they get clean hands, but two, children like to be able to control things, they like cause and effect, so it’s fun. So they want to do it more often, and then they get in the habit of doing it at the appropriate times during the day and that helps them all stay healthier.

Everyone knows that good habits start at home. Do you have any tips to help parents make proper hand-washing a lifetime habit for their children?

The best thing parents can do is role model. Children love to be just like mom and dad. So we need to teach the adults in our lives proper hand-washing and that 20-second rule, because we don’t often wash our hands for long enough either. If they will get these timers and keep them at home, and if they will use the timers when they wash their hands — let the children see that and then encourage them to do the same — then what we do at school, what we do at home, it’s consistent for the children and they get in that habit in their whole life. It’s a lot more fun for them if everybody’s on the same page and it makes sense.

So, in addition to encouraging and teaching proper hand-washing, what can day care professionals do to encourage other healthy habits?

We work with our families and the children and do lessons on healthy habits … things like a proper amount of sleep, drink lots of fluids, a healthy diet, fruits and vegetables — we make sure we are offering balanced diets in our programs. No sharing — although we try to teach children to share in our programs we ask that they not share food and drink. And that’s another thing. At home, if they’re used to sharing with mom and dad and somebody’s got a cold, then they’re sharing that too. So we try to really stress don’t share food and drink, especially in the cold and flu season. And we really encourage our parents that if their children are too sick, if they’ve got fever, unexplained rash, diarrhea, vomiting or any kind of colored discharge from their nose, they really probably should be seen by a medical professional or at least not brought into the group-care environment until that symptom is cured.

You had mentioned how many days children miss each year, and parents have to miss work.

Right. On average a toddler will get six to eight colds a year, and that can relate to up to 22 million missed school days because of illnesses. Parents — working parents — can average 17 missed work days because of their children’s illnesses. If we all wash our hands — parents, school children, everyone — we can effectively reduce the sick days from colds and flu up to 24 percent, and those from stomach bugs up to 51 percent, which is a lot of time that we can have parents being effective and children in learning and healthy, where they need to be.

So the key message is wash, wash, wash, right?

Wash your hands, wash your hands, wash your hands.

— Q&A conducted and condensed by Teddi Dineley Johnson, The Nation's Health

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