Salmonella outbreaks in childcare facilities are relatively rare, most often occurring secondary to contaminated food products or poor infection control practices. We report an outbreak of Salmonella Saintpaul at a pre-school facility in Ayrshire, Scotland with atypical clinical and epidemiological features.
(me learning to drive a tractor, about 4-years-old)
Following notification of the initial two cases, the multi-disciplinary Incident Management Team initiated enhanced active case finding and two environmental inspections of the site, including food preparation areas. Parent and staff interviews were conducted by the Public Health department covering attendance, symptomatology and risk factors for all probable and confirmed cases. Microbiological testing of stool samples and the facility water tank was conducted. Whole Genome Sequencing (WGS) was performed for positive stool samples at the national reference laboratory. Infection control measures were introduced iteratively due to the atypical progression of the outbreak.
There were 15 confirmed cases and 3 children admitted to hospital during the outbreak. However, 35.7% of cases reported extremely mild symptoms. The attack rate was 15.2%, and age of affected children ranged from 18 to 58 months (mean 35 months). All cases were the same Multilocus Sequence Type (MLST50). Epidemiological investigation strongly suggested person-to-person spread within the facility. Existing infection control practices were found to be of a high standard, but introduction of additional evidence-based control measures was inadequate in halting transmission. Facility staff reported concerns about lack of parental disclosure of gastrointestinal symptoms, particularly where these were mild, with 50.0% of cases having attended while symptomatic against public health advice. Voluntary two-week closure of the facility was implemented to halt transmission, following which there were no new cases. WGS results were unavailable until after the decision was taken to close the facility.
This is the first reported instance of a Salmonella Saintpaul outbreak at a childcare facility, or where person-to-person transmission is indicated. Clinicians should consider the influence of parental under-reporting on gastrointestinal outbreaks in childcare settings, particularly where perceived severity is low and financial or social pressures to attend work may reduce compliance. WGS cannot yet replace conventional microbiological techniques during short, localised outbreaks due to delays receiving results.
Apparently, that’s just a throw-a-way tag line, at the end of an abstract for a paper, but my observations say it’s the most important. Have paper towels, not bacterial blow dryers; have soap; and have vigorous running water, not a trickle-down (as effective in economics as in handwashing).
Each year millions of children are enrolled in center-based childcare. Childcare employees are tasked with handling over half the children’s weekly meals. Proper food handling practices are crucial in mitigating this high-risk population’s risk of foodborne illness. The purpose of this study was to identify childcare food handling employees’ (n = 278) perceived barriers and motivators to follow recommended food safety practices. Six important barriers and 14 key motivators to following recommended food safety practices were identified. Important barriers pertained to time restraints, workloads, and lack of understanding of the importance of following proper food safety practices. Key motivators were focused on children’s safety, available supplies, communication, and food safety training/information. Employee and facility characteristics were shown to influence perceived importance of barriers and motivators to following food safety practices. Childcare directors should review scheduling and job duties of employees as the majority of identified barriers focused on “work pace” and “time restraints.” Directors should also attempt to increase food safety communication through practical situational training, written food safety policies, and use of food safety signage to increase understanding of the importance of proper food safety practices. Ensuring proper supplies are available is necessary.
Childcare food handling employees’ perceived barriers and motivators to follow food safety practices
Early Childhood Education Journal, pp 1-9, 24 October 2017, Joel Reynolds, Lakshman Rajagopal
Arutz Sheva of Israel National News reports that on April 30, a report was received from the mother of an infant enrolled in an Emunah daycare in Jerusalem claiming infants and toddlers in one of the daycare’s classes were suffering stomachaches and intestinal disturbances.
According to Ynet, an investigation by the Jerusalem District Health Office found the problems had begun several days earlier, in the daycare’s 2-year-old class, when 15 of the class’s 24 children became ill and one was hospitalized.
In the infants’ group, 15 out of 18 infants became ill, and one was hospitalized.
Last Wednesday, the Health Office received the results of the various tests performed, and found that one of the sick children tested positive for salmonella.
A district health supervisor was immediately sent to the daycare, where they found that both breakfast and lunch were served hot and made on the premises. The supervisor also made a list of health hazards which the daycare will need to fix.
During the visit, the supervisor took samples of food stored in the daycare since April 28. Though the samples did not test positive for salmonella, they did test positive for several other pathogens.
If a kid stocks the lake with brown trout (in their undies), it’s a health and safety issue. There is a chance of cross-contamination in sinks and fecal matter flicking up into a worker’s eyes. So instead of putting it in the teeny tiny toilets, the childcare workers just bag the undies up, log and all, name them and put them with the other packages of joy for the parents to deal with upon pick up.
We should also spare a thought for those who live in warmer climates. There would be some serious fermentation going on in those plastic bags.
And in Washington State an 8-year-old girl received a package of animal poop, perhaps an anonymous form of bullying.
Oddly enough, there are some companies that specialize in these sort of deliveries.
When Jamie Villanueva’s daughter opened the package, she thought someone sent her chocolate ice cream.
“And when I saw it, my heart just sunk,” Villanueva said.
Her worst suspicious however, turned out to be true.
“So I opened it and inside it has feces,” Villanueva said. “A container of feces.”
The container came with a calling card from a company called “I Poop You.” According to its website it specializes in packaging and delivering animal waste as a joke.
“I get it. I have a sense of humor. I think it’s very clever of the company,” Villanueva said. “But it’s really inappropriate with children.”
There are several websites that offer poop delivery and there doesn’t seem to be any specific law against it.
Unfortunately no one in the public knows exactly where though.
According to the Columbia Tribune reported cases of shigellosis is more than 4 times the expected rate in the Columbia area, and most illnesses are linked to child care settings.
The Columbia/Boone County Department of Public Health and Human Services reports 25 cases of shigellosis, also called shigella, occurring in the past two weeks. Spokeswoman Andrea Waner said the department has averaged six cases a year for the past five years.
Waner said most of the cases involve children attending day care. The Missouri Code of State Regulations prohibits her from identifying the locations, she said.
Michelle Baumstark, spokeswoman for Columbia Public Schools, said the district had only one case, several weeks ago. The student was the sibling of a child who was in day care at a location where shigella was reported.
She said because school-age children are toilet trained there isn’t a big concern about the illness spreading in the schools.
A couple of years ago I collaborated with Clemson’s Angie Fraser on a set of USDA NIFA funded food safety and infection factsheets for childcare facilities including using exclusion of ill staff and children as an outbreak control measure. The sheets can be downloaded here and here. Angie just published a bunch of the observation work that led to the the factsheets in the American Journal of Infection Control (abstract below). The work provides some insight on how pathogens might move around a center.
An observational study of frequency of provider hand contacts in child care facilities in North Carolina and South Carolina
American Journal of Infection Control 43 (2015) 107-11
Angela Fraser, Kelly Wohlgenant, Sheryl Cates, Xi Chen, Lee-Ann Jaykus, You Li, Benjamin Chapman
Background: Children enrolled in child care are 2.3-3.5 times more likely to experience acute gastrointestinal illness than children cared for in their own homes. The purpose of this study was to determine the frequency surfaces were touched by child care providers to identify surfaces that should be cleaned and sanitized.
Methods: Observation data from a convenience sample of 37 child care facilities in North Carolina and South Carolina were analyzed. Trained data collectors used iPods (Apple, Cupertino, CA) to record hand touch events of 1 child care provider for 45 minutes in up to 2 classrooms in each facility.
Results: Across the 37 facilities, 10,134 hand contacts were observed in 51 classrooms. Most (4,536) were contacts with porous surfaces, with an average of 88.9 events per classroom observation. The most frequently touched porous surface was children’s clothing. The most frequently touched nonporous surface was food contact surfaces (18.6 contacts/observation). Surfaces commonly identified as high- touch surfaces (ie, light switches, handrails, doorknobs) were touched the least.
Conclusion: General cleaning and sanitizing guidelines should include detailed procedures for cleaning and sanitizing high-touch surfaces (ie, clothes, furniture, soft toys). Guidelines are available for nonporous surfaces but not for porous surfaces (eg, clothing, carpeting). Additional research is needed to inform the development of evidence-based practices to effectively treat porous surfaces.
Twenty-eight children and two adults accidentally drank bleach at a day care center in Jersey City on Thursday, according to officials.
The children, aged 3 and 4, were evaluated and taken from the day care center, Growing Tree II, to Jersey City Medical Center-Barnabas Health. The children were in stable condition and expected to be released to their parents, officials said.
“We don’t think the amount they ingested is significant,” said hospital spokesman Mark Rabson.
Hospital officials were not clear how or why bleach was ingested by the children and staff.
Dr. Steven M. Marcus, the executive director of New Jersey Poison Information and Education System, said such accidents are fairly common. Hotels, restaurants and other food service outlets are required to regularly sanitize certain areas, and often use bleach and water as the solution. Despite warnings by the poison center against it, workers will often put the solution in a container — such as a brand-name water bottle or gallon jug — that can be mistaken for water.
A childcare facility in Cavan remains closed for cleaning following an outbreak of E. coli over four weeks ago. In a statement to Northern Sound News, the HSE say there have been factors relating to the cleaning and the fabric of the crèche that have been outside of the control of the Health Executive and under the control of the crèche management.
The HSE was notified of the latest case of E. coli at the childcare facility in Cavan over one month ago. It followed a confirmed case of a similar infection in another child in the same facility in April. The Health Service Executive says no source was identified for the infection in the previous case.
The Health Service Executive says that they were notified of a case of E. coli in a child at the facility in county Cavan. It followed a confirmed case of a similar infection in another attendee at the same facility back in April. The HSE was notified of the latest case of E. coli in a child at this facility over three weeks ago. It followed a confirmed case of a similar infection in another attendee at the same childcare facility back in April. The Health Service Executive says no source was identified for the infection in the previous case.