Preventing Spread Of Gastrointestinal Illness In Health Care Centers

Ruzanna Harutyunyan's picture

This letter is to inform you of a recent outbreak of E. coli O157:H7 in a child care center in your area. The center is working with the Cook and Will county health departments and has implemented control measures to prevent the spread of the disease, including testing of exposed attendees and staff.

E. coli O157:H7 infection causes a diarrheal illness that is often bloody. Cases typically experience abdominal cramping but fever is usually absent. Asymptomatic infections also can occur. Medical attention should be sought for any child with diarrhea lasting more than 24 hours. In some persons, particularly children under 5 years of age and the elderly, E. coli O157:H7 infection can cause a complication called hemolytic uremic syndrome (HUS). HUS affects the kidneys and typically requires hospitalization and extensive treatment. This complication occurs in approximately 5% to10% of persons with E. coli O157:H7 infection.

The E. coli bacteria, along with other bacteria and viruses that cause gastrointestinal illness, are transmitted by ingestion of contaminated food or from person-to-person transmission via the fecal-oral route. Personto- person transmission can occur when hygiene or hand washing is inadequate to remove invisible stool contamination on hands.

To prevent exposure and spread of bacteria and viruses between child care center attendees, the following measures are suggested:

· Exclude children from attending the facility until diarrhea ceases for at least 24 hours

· Encourage parents to seek medical attention for the child, when a child has diarrhea

· Teach the importance of basic hand hygiene and proper hand washing

· Implement and monitor routine and frequent hand washing (with soap and water) of children, at least at the following times:

o AS SOON AS children arrive

o BEFORE going home

o AFTER using the bathroom, sneezing, touching the nose, playing with a pet or other animal, playing outside, playing with toys that other children use, touching anything soiled with body fluids or wastes (such as blood, saliva, urine, stool, or vomit)

o BEFORE AND AFTER eating, cooking, or otherwise handling food

o ANYTIME hands look, feel, or smell unclean

· Wash hands of children too young to wash hands by themselves, followed by teaching children who are developmentally ready proper hand-washing technique and assist and supervise as needed.

· Hand washing (with soap and water) of parents and teachers routinely and frequently, at least at the following times:

o AS SOON AS they arrive

o BEFORE going home


o BEFORE AND AFTER eating or drinking

o BEFORE preparing, handling or serving food or bottles, giving or using medicine or ointments

o AFTER using or helping a child use the toilet, changing a diaper, touching any body fluids (by wiping a runny nose, for example), handling pets or pet objects (cages or leashes, for example), handling objects used by children, removing gloves used for any sanitary purpose, using a telephone, caring for or touching a child who is ill

o ANYTIME they go to another room in the school or child care center, or move to a different group of children

o ANYTIME hands look, feel, or smell unclean

· For thorough hand-washing:

o Wet hands under warm running water

o Lather both hands well and scrub vigorously for at least 15 seconds

o Rinse hands thoroughly under warm running water

o Dry both hands with a new single-use towel or automatic dryer

o For hand-held faucets, turn off the water using a disposable towel instead of bare hands to avoid recontamination of clean hands

· Ensure hand washing areas are stocked with soap and paper towels

· Consider using alcohol-based hand sanitizers in addition to hand washing (should not replace hand washing but is an additional means of hand cleaning). Sanitizers should be stored safely away from children and not used on hands with breaks in the skin, as it will cause stinging. Centers may wish to inform parents that they are recommending alcohol-based hand sanitizers for this time period.

· Obtain any needed educational materials about hand washing from your local health department

· Discourage use of common food bowls or shared servings of food items

· Exclude staff from work until diarrhea ceases for at least 24 hours o Staff who are food handlers or in sensitive occupations who have tested positive for E. coli O157:H7 or other enteric bacteria, are prohibited from performing their job duties until 2 consecutive stool specimens are negative (see current IDPH rules and regulations for complete list)

· Record reasons for absenteeism of children and staff

· Report any clusters of illness (two or more persons with the same signs and symptoms about the same time) to your local health department. More intensive measures may be required when outbreaks occur.