Steps to Preventing Spread of Gastrointestinal Illness in Child Care Centers and Day Care Homes

Guidelines to follow to Prevent Diarrhea caused by E.coli

Author: Epidemiology & Communicable Disease Staff/Saturday, January 26, 2013/Categories: Norovirus, Educating the Public, Disease Prevention and Control

Rate this article:

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. Person to-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: 
    • AS SOON AS children arrive 
    • BEFORE going home 
    • 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)  
    • BEFORE AND AFTER eating, cooking, or otherwise handling food  
    • 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.
    • AS SOON AS they arrive.
    • BEFORE going home 
    • BEFORE AND AFTER eating or drinking 
    • BEFORE preparing, handling or serving food or bottles, giving or using medicine or ointments 
    • 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  
    • ANYTIME they go to another room in the school or child care center, or move to a different group of children 
    • ANYTIME hands look, feel, or smell unclean
  • For thorough hand-washing: Wet hands under warm running water 
    • Lather both hands well and scrub vigorously for at least 15 seconds 
    • Rinse hands thoroughly under warm running water 
    • Dry both hands with a new single-use towel or automatic dryer 
    • 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  
    • 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. 

Resources for hand hygiene can be found at and  These recommendations do not supersede the 
Illinois Licensing Standards for Day Care Centers (
If you have any questions concerning this matter, please contact Epidemiology & Communicable Disease 
Program at Will County Health Department by calling (815) 727-8481. Thank you for your cooperation in this matter.

Number of views (11488)/Comments (0)

Epidemiology & Communicable Disease

Epidemiology & Communicable Disease

The mission of the Epidemiology and Communicable Disease Program is to protect and promote the health of Will County residents.
Epidemiology News
Please Don't Feed The Animals

Please Don't Feed The Animals

Wild Animals Can Carry Dangerous Diseases

If you live in Will County, you have probably seen deer, coyotes, foxes, and other wildlife frolicking not far from your home. Local population growth has reduced animal living space and forced wildlife to seek shelter in, or very near residential communities.  Lee Schild D.V.M. believes animals and humans can still coexist peacefully, but he knows that humans need to make sure wild animals don't get too close.

SITUATION AWARENESS BRIEFING: Deadly MERS Virus Hits Uncomfortably Close To Home

International Travel Brings Dangerous Diseases to Our Doorstep

Middle East Respiratory Syndrome (MERS), a potentially fatal virus which has now sickened hundreds in 12 countries and carries a fatality rate of more than 30 percent. In 2012, health officials from the Arabian Peninsula reported the first cases of what is now called Middle East Respiratory Syndrome (MERS), a potentially fatal virus which has now sickened hundreds in 12 countries and carries a fatality rate of more than 30 percent.

Influenza Activity in Illinois is Now Confined to Local Outbreaks

Influenza Has Peaked According to the CDC

This article contains updates to the article posted February 20, 2013.

According to the CDC, the influenza outbreak that was so widespread during much of the winter has peaked and activity has decreased in most parts of the U.S. During the latest reporting period (the week ending March 3-9), there were no states reporting high influenza-like activity. According to the latest Overview of Influenza Surveillance in the United States, Illinois has gone from reporting high flu incidence to reporting only localized outbreaks. 

Health Department Recommending Flu Shots for the Unprotected

It's Not Too Late for a Flu Shot!

Most area students are returning to the classroom this week, and the Will County Health Department will be watching. Illinois is one of nearly 40 states currently experiencing widespread influenza activity and the Health Department will be monitoring school attendance to help gauge the severity of the local problem. If current trends continue, the 2012-2013 flu season could be memorable. 

Community-Associated  MRSA Information for the Public

Community-Associated MRSA Information for the Public

Frequently Asked Questions About MRSA

What is Staphylococcus aureus (staph)?

Staphylococcus aureus, often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people. Approximately 25% to 30o/o of the population is colonized (when bacteria are present , but not causing an infection) in the nose with staph bacteria.