Results of an Observational Study of Child Care Centers in Pennsylvania: Varying Approaches to Health and Safety

Objective: Exploring several health and safety practices in child care centers (CCCs) in Pennsylvania (PA). Design and Methods: A prospective observational study of a convenience sample of CCCs was done. On-site evaluations included direct observation of hand washing behaviors, infant sleep position, playground equipment safety, and an assessment of safety policies. Results: Evaluations were done at 134 sites. The director's median time in her current position was 2.5 years; 32% of the providers worked at the site less than one year. Sixteen (12%) sites had consulted a doctor on health policy development. Of 114 food preparation or consumption observations, 88 (77%) of the adults and 100 (92%) of the children washed their hands; and, of 181 diapering or toileting observations, 78 (83%) of the adults and 103 (95%) of the children washed their hands. Staff placed 67% of infants on their backs for sleep. Safe playground surfacing was observed surrounding 10 (21%) indoor and 52 (57%) outdoor equipment areas. Overall, suburban, non-profit, parent funded centers performed better than urban, for profit, state funded centers—except for sleep positioning when the opposite association was observed.