Design and modification of the day care environment.

Transmission of infectious disease in day care centers may be influenced by the design, construction, and maintenance of the physical environment. Microbiologic studies of the day care environments showed that bacteria of fecal origin were frequently present on the hands of children and staff members, on environmental surfaces, and in air. In all three types of samples, the prevalence of fecal contamination was inversely related to the age of the children associated with the source of the samples. The high proportion of children in diapers and staff members whose hands were contaminated was of particular concern from the standpoint of disease transmission. These findings suggested that readily available hand-washing facilities; segregation of infants, toddlers, and older children; and wash-ability of surfaces were factors that might reduce the role of environmental contamination in the transmission of disease in day care centers. Centers incorporating these suggestions have been designed and constructed. Particular attention was devoted to design concepts and the selection of surface materials for such critical locations as kitchens, toilets areas, and diaper-changing areas.