Evaluation of state early childhood education licensing policies with recommended sanitation and hygiene related practices: A multi-state policy evaluation

Abstract

Objective: Each year, an estimated 12.5 million children under age 5 utilize early childhood education (ECE) facilities. States have developed licensing regulations to ensure the safe operation of facilities, including requirements related to sanitation and hygiene practices. This study aimed to evaluate sanitation- and hygiene-related practices included in ECE regulations to assess their alignment with best practices outlined in Caring for Our Children National Health and Safety Performance Standards (CFOC). Methods: CFOC standards were reviewed, and 42 sanitation- and hygiene-related practices were identified. These recommended practices fell into five categories: toileting, diapering, cleaning, hand hygiene, and general hygiene. State regulations for all 50 US states were compared with recommended best practices from CFOC. Using a standardized codebook, two coders independently reviewed each state regulation and assessed how well it aligned with recommended best practices from CFOC using a 4-point Likert Scale (1 – Not addressed, 2 – Somewhat addressed, 3 – Mostly addressed, 4 – Fully addressed). Results: Across all sanitation and hygiene standards evaluated, 64% of standards were scored somewhat, mostly, or fully addressed in state ECE regulations, with 7% of standards scored as fully addressed. Standards in the diapering, toileting, and cleaning category were scored somewhat, mostly, or fully addressed more often compared to standards in the general hygiene and hand hygiene category. Conclusions: Few state ECE regulations fully addressed recommended sanitation and hygiene practices. As state regulations are updated, future studies can compare and evaluate licensing regulations alignment to recommended best practices for safe and hygienic operation of facilities.