ArticlePDF Available

Bacterial water quality in the personal bottles of elementary students

Authors:

Abstract

Samples of drinking water were collected directly from the personal water bottles of students at an elementary school in Calgary, Alberta. Total and fecal coliforms and heterotrophic bacteria were enumerated using membrane filtration and agar plate count methods respectively. The Canadian Drinking Water Quality Guidelines (CWQG) criterion was exceeded for total coliform in 13.3% of 75 samples. Fecal coliform and total heterotrophic criteria were exceeded in 8.9% (of 68 samples) and 64.4% (of 76 samples) respectively. The use of personal water bottles for students in elementary classrooms is not recommended.
Bacterial Water Quality in the
Personal Water Bottles of
Elementary Students
J.A. Oliphant,
BSc
1
M.C. Ryan, PhD, PGeol, PEng
2
A. Chu, PhD
1
ABSTRACT
Background: Samples of drinking water were collected directly from the personal water
bottles of students at an elementary school in Calgary, Alberta.
Methods: Total and fecal coliforms and heterotrophic bacteria were enumerated using
membrane filtration and agar plate count methods respectively.
Results: The Canadian Drinking Water Quality Guidelines (CWQG) criterion was
exceeded for total coliform in 13.3% of 75 samples. Fecal coliform and total heterotrophic
criteria were exceeded in 8.9% (of 68 samples) and 64.4% (of 76 samples) respectively.
Findings: The use of personal water bottles for students in elementary classrooms is not
recommended.
P
ersonal water bottles are commonly
used in schools and in the work-
place. An elementary school in
Calgary, Alberta recommended that stu-
dents keep personal water bottles at their
desks throughout the school day. In the
absence of official instruction regarding
bottle washing, some students brought
clean water bottles on a daily basis, while
others continually refilled the same water
bottle for months without washing it. The
objective of this study was to assess the
bacteriological water quality in personal
water bottles taken from the desks of stu-
dents at this school in Calgary.
METHODS
Sampling was conducted to collect repre-
sentative samples of water that the students
were drinking. Any available water present
in an individual student’s water bottle was
transferred into sterile (autoclaved at
230
o
C for 20 minutes) polypropylene bot-
tles for lab analysis. Three separate class-
rooms were sampled over a one-week peri-
od. In total, 76 samples were collected
directly from student water bottles, with
sample volumes ranging from 10 to 500
mL. In addition, source water samples
were collected from each of thee classroom
sinks and two drinking water fountains
located in the school hallways. All water
samples were stored at 4°C and analyzed
within 18 hours of collection.
Heterotrophic bacteria were quantified
using Heterotrophic Plate Counts (HPC)
1
on standard HPC plate count media.
Coliform bacteria were analyzed using
Standard Membrane Filtration (MF)
1
techniques and m-Endo (total coliform)
and m-FC (fecal coliform) media.
RESULTS
Significant levels of coliform bacteria were
found in water from the students’ personal
water bottles (Table I). Of the 76 samples
analyzed for total coliforms, 10 (13.3%)
contained >10 cfu/100mL. Fecal coliforms
were enumerated at >1 cfu/100mL in 6 of
68 samples analyzed (8.9%).
Heterotrophic bacteria concentrations
were also elevated. Heterotrophic plate
counts are used as an overall indicator of
the bacterial quality of water supplies.
Drinking water guidelines (>500 cfu/mL)
were exceeded in water collected from
La traduction du résumé se trouve à la fin de l’article.
1. Department of Civil Engineering, University of Calgary, Calgary, AB
2. Department of Geology and Geophysics, University of Calgary
Correspondence and reprint requests: M.C. Ryan, Department of Geology and Geophysics,
University of Calgary, Calgary, AB T2N 1N4, Tel: 403-220-2739, Fax: 403-284-0074, E-mail:
ryan@geo.ucalgary.ca
Acknowledgements: The authors thank the elementary school participating in this study, and Dr. T.
Lambert of the Environmental Health Division, Calgary Regional Health Authority, for his assistance
in water sampling.
366 REVUE CANADIENNE DE SANTÉ PUBLIQUE VOLUME 93, NO. 5
SEPTEMBER – OCTOBER 2002 CANADIAN JOURNAL OF PUBLIC HEALTH 367
ELEMENTARY STUDENTS’ WATER QUALITY
64.4% of the bottles. These high het-
erotrophic counts may indicate the effect
of bacterial regrowth in bottles that have
remained at room temperature for an
extended period. Significant bacterial
regrowth has been shown to occur in treat-
ed, chlorinated water, when left at ambient
temperature for as little as 8-24 hours.
2
Bacterial levels from each of the five
source water samples were all under the
detection limits for both coliforms (i.e.,
<1 cfu/100mL) and heterotrophs
(<10 cfu/mL).
DISCUSSION
The findings suggest that significant bacte-
rial contamination can occur in individual
water samples originating from personal
water bottles. This study cannot identify
the origin of contamination, however the
most likely source of enteric bacteria found
in the students’ water bottles is the hands
of the students themselves. Inadequate and
improper hand washing after students have
used the bathroom facilities could result in
fecal coliforms in the classroom area. A
study conducted within a Houston, Texas
day-care isolated fecal coliforms from the
hands of 17% of staff and children, and
13% of classroom objects during routine
monitoring.
3
These rates increased signifi-
cantly during outbreaks of diarrhea.
Although the transmission routes of fecal
contamination in day-care centres may
vary from those in primary schools, conta-
mination of hands, taps and sinks was
shown to be a reliable predictor of diar-
rhoeal risk.
3,4
These same sources may
potentially be the main vectors of fecal
transmission from the environment to the
students’ water bottles in this study. A pre-
vious study conducted in a primary school
in Leeds, England indicated that hygiene
training significantly decreased the levels of
fecal streptococci isolated from the hands
of elementary children.
5
The results
obtained from this study suggest there is a
need to educate students about proper
hygiene practices in order to decrease the
spread of coliform bacteria.
Significant bacterial contamination
occurred in water collected from personal
water bottles. Since the source water
showed no significant levels of het-
erotrophic or coliform bacteria, we con-
clude that current practices pertaining to
personal water bottle care at this elemen-
tary school are not sufficient to ensure the
safe bacterial quality of the students’ drink-
ing water. Drinking directly from the
water fountains may be a safer alternative
to water bottles.
Further study with larger sample popula-
tions and sample replication is warranted
to further evaluate the risk of reusing per-
sonal water bottles.
REFERENCES
1. Greenburg AE, Clesceri LS, Eaton AD (Eds.),
Standard Methods for the Examination of Water
and Wastewater 20
th
ed. Washington, DC:
American Public Health Association,
1998;Sections 9215,9222B,9222D.
2. Geldrich EE, Nash HD, Reasoner DJ, Taylor
RH. The necessity of controlling bacterial popu-
lations in potable waters: Community water sup-
ply. J AWWA 1972;64:596-602.
3. Ekanem EE, Dupont HL, Pickering LK, Selwyn
BJ, Hawkins CM. Transmission dynamics of
enteric bacteria in day-care centers. Am J
Epidemiol 1983;118:562-72.
4. Laborde DJ, Weigle KA, Weber DJ, Kotch JB.
Effect of fecal contamination on diarrheal illness
rates in day-care centers. Am J Epidemiol
1993;138:243-55.
5. Kaltenthaler EC, Elsworth AM, Schweiger MS,
Mara DD, Braunholtz DA. Faecal contamination
on childrens’ hands and environmental surfaces
in primary schools in Leeds. Epidemiol Infect
1995;115:527-34.
Received: June 28, 2001
Accepted: April 29, 2002
TABLE I
Summary of Results from the Bacteriological Analysis of Water from Elementary
Students’ Personal Water Bottles
Coliform Bacteria Heterotrophic plate counts
(cfu/100mL) (HPC) (cfu/mL)
Range Frequency (% Samples)* Range Frequency
(% Samples)*
Total Fecal
Coliforms Coliforms
<1 85.3 91.2 <10 15.8
1-10 1.3 1.5 10-500 19.7
11-100 0 1.5 501-5,000 7.9
101-1,000 4.0 1.5 5,001-50,000 11.8
>1,001 9.3 4.4 >50,000 44.7
Maximum 22,300 16,800 >400,000
# Samples 75 68 76
CWQG 00 <500
Total % exceeding CWQG 13.3 8.9 64.4
* Frequency values rounded to nearest tenth of a percent
Microbiological criteria in the Canadian Drinking Water Quality Guidelines (CWQG; which can
be viewed at http://www.hc-sc.gc.ca/waterquality) recommend a maximum criteria of zero total
coliform detectable per 100 mL, but tolerate up to 10 total coliform detectable per 100 mL in
recognition of sample variability. A guideline of less than 500 HPC is set because of possible
coliform inhibition, not necessarily because the heterotrophic bacteria themselves are pathogen-
ic.
bolded values exceed Canadian Water Quality Guidelines (CWQG)
RÉSUMÉ
Contexte : Nous avons recueilli des échantillons d’eau potable dans les gourdes à eau des élèves
d’une école primaire de Calgary (Alberta).
Méthode : Par filtration sur membrane et au moyen de tests sur plaque à la gélose, nous avons
déterminé le nombre total de bactéries et le nombre de coliformes fécaux et de bactéries
hétérotrophes.
Résultats : Le seuil fixé dans les Recommandations pour la qualité de l’eau potable au Canada eu
égard au nombre total de coliformes a été dépassé dans 13,3 % des 75 échantillons recueillis. Le
seuil pour les coliformes fécaux a été dépassé dans 8,9 % des cas (sur 68 échantillons), et celui
pour l’ensemble des bactéries hétérotrophes, dans 64,4 % des cas (sur 76 échantillons).
Constatations : L’emploi de gourdes à eau par les élèves du primaire est à éviter.
... From the first period, the total percentage from all ages and from all the schools (Fig. 3) used to refill the same plastic bottle was 12.66 ± 5.24%; while during the second evaluation period (Fig. 5), this was reduced to 4.48 ± 2.74%. This is due to the fact that during the second evaluation period, it was totally explained that usually if they used those plastic bottles without washing them, those will present several problems like high amount of bacteria like heterotrophic bacteria and total coliforms which usually are more than 10 cfu/100 ml (Oliphant et al. 2002). Those microorganisms (Oliphant et al. 2002) are the results of the absence of personal hygiene; like insufficient and inadequate hand washing after students have used the bathroom services could result in faecal coliforms in the schoolrooms. ...
... This is due to the fact that during the second evaluation period, it was totally explained that usually if they used those plastic bottles without washing them, those will present several problems like high amount of bacteria like heterotrophic bacteria and total coliforms which usually are more than 10 cfu/100 ml (Oliphant et al. 2002). Those microorganisms (Oliphant et al. 2002) are the results of the absence of personal hygiene; like insufficient and inadequate hand washing after students have used the bathroom services could result in faecal coliforms in the schoolrooms. ...
Article
Full-text available
Even though reducing waste is at the top of the waste hierarchy, no real decoupling between waste generation and consumption has been demonstrated. Several waste directives had been published from EU, but they have only brought minor changes within the key objective of reducing waste generation. Most efforts have been targeted towards greater amounts of recycling and better management of waste disposal. While these are necessary and socially beneficial goals, they are not adequate for the achievement of long-term sustainability goals. The purpose of this study is to understand students' knowledge, attitudes and behavioural changes in relation to the water plastic bottle of 500 ml. Understanding waste prevention behaviour (WPB) could enable schools' principals, local authorities and committees as well as decision makers to design and implement more effective policies for reducing the amount of specific waste streams that is generated. Students in a daily base bring their own water containers of 500 ml or buy water from the school as they do not feel safe to use other sources of water. Nine hundred ninety-eight refilling stainless steel water refilling bottles (SSWRB-of 600 ml) were shared to the students in four primary schools. The results indicated that the students are presented with different behaviours from class to class for many reasons; most of them are related with what their parents believe, and how themselves or the synergies between them reacts and affected.
... (Tatchou-Nyamsi-König et al., 2008) found that 1-2% of campylobacter jejuni cells adhered to polyethylene terephthalate, a widely used polymer for water bottles, which is the first step towards establishing a biofilm. Another study examined the bacterial counts of drinking water sampled from refillable water bottles at a public school (Oliphant, Ryan, & Chu, 2002). ...
... The five sources of water used to refill the bottles in the school were all tested at below the CDWQ criteria. Though contamination is thought to have originated from hands and mouths coming into contact throughout the day (Oliphant et al., 2002), much like in drinking water systems, the role that climate plays in mediating pathogen growth in these bottles remains unknown. Temperatures of a water bottle probably fluctuate much more and reach higher extremes than those of a drinking water system, since they are typically transported throughout the day and exposed to many different microclimates. ...
... A lack of options to easily clean reusable bottles was another important barrier cited by students as a reason for why they do not more regularly use a reusable water bottle. Bottles that are not cleaned regularly and thoroughly are problematic, as studies have shown that they can harbor potentially harmful microbial loads [52,53]. Even general awareness of this issue through personal experience with bottles that have a bad smell or look unclean is likely an important factor in driving water bottle behavior among college students without convenient and effective cleaning options. ...
Article
Full-text available
Plastic waste represents one of the largest environmental problems of the modern era and disposable water bottles comprise a substantial portion of that waste in the U.S. Colleges are in a unique position to create systems that foster sustainable behaviors among their constituents. Since 2015, Allegheny College has installed water refill stations, and initiated a free water bottle program and an awareness campaign to reduce single-use bottles on the college’s campus. Two surveys were distributed to the student body between 2018 and 2019 to assess the efficacy of those initiatives and learn about any barriers. Bottled water use has reduced significantly since 2014, with the majority of students stating that they most commonly drink water from refill stations while on campus. Demographic factors like income, sex, or place of origin were not related to the amount of bottled water consumption or type of water preference among students. The primary barrier to students eliminating disposable water bottle use was found to be a lack of water refill stations in dormitories. Research aimed at changing behaviors to benefit the environment should consider the barrier of convenience. This research provides a valuable lesson that can extend beyond college campuses and into public settings.
... Personal travel mugs allow users to avert perceived or actual risks of contamination of the container by previous users or service staff, and they could give users a sense of control over the level of hygiene (Frewer et al., 2005;Grunert, 2005;Nemeroff & Rozin, 2009). However, they may have considerable drawbacks in terms of actual risks: a substantial proportion of reusable cups and bottles in use show microbial contamination (e.g., Miko et al., 2013;Oliphant et al., 2002). They may also have drawbacks outside of the actual consumption situation in terms of psychological aspects of hygiene and disgust as well as convenience, because they require prolonged storage and handling of the soiled container (Egolf et al., 2018;Ertz et al., 2017). ...
Technical Report
Full-text available
This report was produced by PBM Sweden AB, and commissioned by the Swedish Environmental Protection Agency (EPA). It was directed by an April 2020 brief from the One Planet network, called Nudging for Oceans: Reduced plastic litter and microplastics. | Mismanaged plastics are a growing environmental challenge of global concern. Large quantities accumulate in our oceans, threatening our marine ecosystems, as well as in our air, soil and freshwater. To overcome one aspect of the plastics problem – plastic litter – and mitigate environmental pollution of land and sea, there is a need for further action and cooperation, both nationally, within the EU and globally. The habit of grabbing a coffee or other beverage on‑the‑go has grown significantly over the past decades, and this has led to a substantial increase in the consumption of single‑use disposable cups. Plastic cups and lids are among the top 10 items collected on the beaches globally. | In this report nudging is explored as a complement to traditional policies to reduce the use of single use plastics, such as regulation, economic incentives and information campaigns. Behavioural insights are used to develop different options to nudge consumer preferences from single‑use cups to more sustainable alternatives. Based on careful reviews and analysis of previous nudging projects, three green nudges are proposed to catalyze this shift. Once the COVID‑19 pandemic is largely behind us, we hope to be able to test the effectiveness of these nudges in real life by introducing pilot projects at coffee shops in several countries. | The project is part of the ongoing cooperation on behavioural insights for policy‑making within the UN One Planet network multistakeholder programme on Sustainable Lifestyles and Education. The nudging project was kicked off in Stockholm in February 2020 with a workshop on the practice of behavioural economics as an environmental policy instrument. Since 2018 the Swedish Government has assigned the Swedish Environmental Protection Agency to strengthen national and international cooperation for the circular and sustainable use of plastics. This project is one the projects funded under this initiative to date. | As members of the UN One Planet network and other roles, we foresee further cooperation and sharing of knowledge and experiences to accelerate the shift to sustainable consumption and production, according to the goals of Agenda 2030. By working together, we can make a global change and protect our ecosystems.
... At the end of Day 2 the contamination is anyway higher than in the case of PET or PLA bottles, but lower than in the previous case. Various previous studies (Oliphant et al., 2002;da Silva et al., 2008;Sun et al., 2017;Mills et al., 2018) have shown that refillable drinking water was less safe or could be contaminated with bacteria that could harm human health. Reusable drinking water bottles are consistently humid and are easily contaminated via the user's hands and mouth, which are not devoid of microorganisms, especially the normal microbial flora of the skin and mouth. ...
Article
Nowadays, the most important tool to evaluate the environmental impact of both petro-plastics and bioplastics is the life cycle analysis (LCA). LCA determines the overall impact on the environment by defining, calculation and analyzing all the input and output directly related to production, utilization, and disposal of a product or a process. In this work, a LCA (cradle to grave) of bottles for drinking water was developed on three scenarios: polyethylene terephthalate (PET) bottles, as conventional packaging material for outdoor drinking water, polylactic acid (PLA) bottles, as alternative and innovative biodegradable packaging and aluminum bottle, as reusable and almost infinitely refilling packaging. As a result of LCA, ten impacts categories have been accounted for, among which the global warming potential (GWP, measured as kgCO2 eq), the eutrophication potential (EP, measured as kgPO4 eq.), human and eco-toxicity (HTP and ETP, measured as kg 1,4-DB eq.). The average drinking water consumption in Italy has been estimated in 1.5 liters per day, corresponding to three 500 ml-plastic bottles and 1 refillable aluminum bottle. LCA has been firstly applied to a single bottle production and use, then to the daily and annual bottles consumption. PET bottles production and use assure the lower environmental impacts compared to PLA bottles, burdened by agricultural phase for corn cultivation, and to aluminum bottles, when the every-day washing with hot water or water and soap is comprehended. Moreover, including the end-of-life options into the analysis, PET recycling permits to reduce up to about 30% the GWP, whereas PLA composting does not lead to any GWP savings. In this study, aluminum bottle has been considered reusable for 2.5 years. The microbiological quality of water in one-way PET and PLA bottles has been compared with the refillable bottle rinsing with hot water and soap and only hot water, highlighting that the level of contamination is alarmingly increased in the latter case.
... The high percentage of bottled water samples outside of the guidelines may be due to inefficient disinfection processes by the purification plants. The introduction of microorganisms might also occur during the processing or handling of water (29) or from a lack of stringent treatment of containers before filling with the purified water (27). Therefore, frequent monitoring by *Guideline that establishes that purified water bottled must not exceed the limit of 2 log CFU/mL (100 CFU/mL) of AMB and the presence of TC must not be detectable in any 100 mL (<1.1 MPN/100 mL). ...
Article
The aim of this work was to begin to determine the microbiological quality of bottled water samples obtained from small purification plants located in Morelia, Michoacan, Mexico. Various microorganisms were taken into account, including nontuberculous mycobacteria (NTM) species. All 20 samples analyzed were positive for aerobic mesophilic bacteria. Eleven (55%), 6 (30%), and 2 (10%) water samples were positive for total coliforms, fecal coliforms, and Escherichia coli, respectively. In total, 18 (90%) of the water samples exceeded the maximum allowed limit stipulated by Mexico's official guidelines, establishing that purified water must not exceed the limit of 2 log CFU/mL (100 CFU/mL) of aerobic mesophilic bacteria and the presence of total coliforms must not be detectable in any 100 mL (<1.1 most probable number/100 mL) of sample. Five (25%) of the purified water samples were positive for NTM. The findings clearly showed that most of the purified bottled water samples had unsatisfactory microbiological quality and some harbored NTM associated with human illness. Therefore, the study as a pilot points to a need for Mexican health authorities to perform frequent monitoring of purified water producers to verify compliance with standards regarding microbial safety.
... We also recommend that water plant workers be checked continuously regarding their habits of hygiene, because they might be carriers of disease causing-enterobacteria. In parallel, the lack of stringent treatment of containers prior to their being filled with the purified water might represent another possible reason (Oliphant et al., 2002) to explain the high number of AMB and FC which we found in our study. Mexico's Official Guideline (NOM-041-SSA1-1993) stipulates that "the washing and disinfection of 20L containers must be done with sanitizing solution" but it does not specify the required type of sanitizer or at what concentration these agents should be used. ...
... At the end of Day 2 the contamination is anyway higher than in the case of PET or PLA bottles, but lower than in the previous case. Various previous studies (Oliphant et al., 2002;da Silva et al., 2008;Sun et al., 2017;Mills et al., 2018) have shown that refillable drinking water was less safe or could be contaminated with bacteria that could harm human health. Reusable drinking water bottles are consistently humid and are easily contaminated via the user's hands and mouth, which are not devoid of microorganisms, especially the normal microbial flora of the skin and mouth. ...
Article
It is well-known that in beet sugar technology the purification of raw juice is achieved using milk of lime produced from calcium carbonate. For several years now, researchers have been trying to find alternative processes to eliminate the use of milk of lime by utilizing new technologies based on microfiltration, chromatographic separation and cooling crystallization. With the aim of giving the industry all the information necessary to make a choice, a direct comparison between the cooling crystallization of traditional thick juice and of microfiltered and softened raw juice produced in the same West European sugar factory was made. A four-stage crystallization scheme was used. Both the quality of sugar and the total crystallization yield through proper mass balances was accounted for. Whereas in case of conventional syrup one EU-No. 1 and one EU-No. 2 quality sugars were obtained, only one EU-No. 2 quality sugar was obtained for microfiltered raw juice. A particular aspect taken into consideration was the morphology of the crystals obtained from these two types of juices which, of course, was related to the different non-sucrose compounds contained in them. For the cooling crystallization tests, a small pilot plant was utilized.
... 8,10 Bottles also require regular cleaning to avoid bacterial contamination. 10,33 School nutrition staff can play an important role in maximizing the impact of widely available free drinking water in schools by conducting individual-and/or school-level interventions to promote water consumption. ...
Article
This study examined the availability of free drinking water during lunchtime in US public schools, as required by federal legislation beginning in the 2011-2012 school year. Data were collected by mail-back surveys in nationally representative samples of US public elementary, middle, and high schools from 2009-2010 to 2011-2012. Overall, 86.4%, 87.4%, and 89.4% of students attended elementary, middle, and high schools, respectively, that met the drinking water requirement. Most students attended schools with existing cafeteria drinking fountains and about one fourth attended schools with water dispensers. In middle and high schools, respondents were asked to indicate whether drinking fountains were clean, and whether they were aware of any water-quality problems at the school. The vast majority of middle and high school students (92.6% and 90.4%, respectively) attended schools where the respondent perceived drinking fountains to be clean or very clean. Approximately one in four middle and high school students attended a school where the survey respondent indicated that there were water-quality issues affecting drinking fountains. Although most schools have implemented the requirement to provide free drinking water at lunchtime, additional work is needed to promote implementation at all schools. School nutrition staff at the district and school levels can play an important role in ensuring that schools implement the drinking water requirement, as well as promote education and behavior-change strategies to increase student consumption of water at school.
Chapter
Nature of waterInfluencing factorsLabellingShelf-life, batch coding and traceabilityHygiene practices
Article
Full-text available
Gastro-intestinal diseases continue to be a major health problem in primary schools in the UK. This study, which took place in 20 primary schools in the Leeds area, investigated the presence of faecal indicator bacteria on children's hands and environmental surfaces. Faecal streptococci were used as an indicator of faecal contamination. A handwashing knowledge score was developed for each child. Those children with good hygiene knowledge had less faecal contamination on their hands (relative risk: 1·4. 95% CI = 1·09–1·81, P = 0·005). Those schools with higher hand counts were more likely to have had a reported outbreak of gastroenteritis in the past. Values of the Townsend Deprivation Index, an indicator of deprivation, were compared with the hand results and those schools in high deprivation areas had higher hand counts. Of the swabs taken from surfaces in the toilet areas and classrooms, the carpets in the classrooms were the most frequently contaminated surfaces.
Article
The waters in some of the community water-supply systems in the US often contain a myriad of microorganisms that carry past the disinfection barrier. Although the majority of those that survive and flourish are not pathogenic, the situation presents a potential danger. Here is an article on the sort of organisms that contribute to the trouble, with a description of factors relating to propagation of the species.
Article
Ekanem, E. E., H. L. DuPont (U. of Texas Medical School at Houston, Houston, TX 77030), L. K. Pickering, B. J. Selwyn and C. M. Hawkins. Transmission dynamics of enteric bacteria in day-care centers. Am J Epidemiol 1983;118:562–72. The role of fomites in the transmission of diarrhea in day-care centers was evaluated. During a nine-month period (December 1980–August 1981), inanimate objects and hands of children and staff in five Houston day-care centers were cultured monthly and again during outbreaks of diarrhea. Air was sampled from the classrooms and bathrooms using a single-stage sieve sampler. When a diarrhea outbreak occurred, stool specimens were collected from III and well children and from staff in the affected rooms. Multiple pathogens accounted for 3 of 11 outbreaks. The rates of isolation of fecal coliforms from hands and classroom objects on routine sampling were 17% (22/131) and 13% (8/64), respectively. During outbreaks of diarrhea, fecal conforms were recovered with significantly greater frequency from hands (32%; p < 0.005) and from classroom objects (36%; p < 0.005). There was no difference in the level of fecal contamination in the toilet areas during outbreak and nonoutbreak periods. Shigella was not isolated in the study; salmonella was Isolated on one occasion from a table during an outbreak of salmonellosis. Contamination of hands, communal toys and other classroom objects appeared to play a role in the transmission of enteropathogens in day-care center diarrhea outbreaks and helped to explain the presence of multiple pathogens among those affected.
Article
Contact spread of enteropathogens in day-care centers is supported by the recovery (presence vs. absence) of fecal coliforms from hands and day-care center fomites. This prospective study was conducted to determine what, if any, quantitative measures of fecal coliforms predict the risk of diarrhea among day-care center attendees. Diarrheal illness without concomitant respiratory symptoms was monitored among 221 children aged < 3 years in 37 classrooms (24 day-care centers) through biweekly parental telephone interviews from October 1988 to May 1989 in Cumberland County, North Carolina. The risk of diarrhea was expressed as new episodes/classroom-fortnight. Contamination was expressed as the log10 fecal coliform count per unit of surface area, per toy, and per child and staff hands. Significant predictors of diarrheal risk were any hand contamination (p = 0.003) and the number of contaminated moist sites (hands, faucets, and sinks) (p = 0.006). After adjusting for the child/staff ratio using weighted multiple regression, the authors found that classrooms with either any hand contamination (p = 0.0015) or contamination on all moist sites (p = 0.015) had a significant twofold increased rate of diarrhea compared with classrooms without contamination. This was the first study to demonstrate an increased risk of diarrhea associated with fecal contamination and the frequent sink contamination in day-care centers.