At least 20 cases of E. coli have been associated with the National Western Stock Show, which was held in Denver, Colorado from January 10 to January 25, 2009, according to the Colorado Department of Public Health and Environment. Because the vast majority of these cases are children and many of them attend child care, health officials expect this number to rise.

“Because young children often put their hands and toys in their mouths, preschools and day care centers can quickly become hot zones for E. coli.,” stated Fred Pritzker, nationally-recognized food safety lawyer.

Chris Urbina with Denver Public Health stated that this strain of E. coli is particularly toxic and can cause hemolytic uremic syndrome (HUS), particularly in young children. HUS is a severe illness that can cause kidney failure, pancreatitis, brain damage, heart damage and damage to other organs. The mortality rate for HUS is from 5-15%.

The Colorado Department of Public Health and recommends the following for child care centers:

• Report any cases of bloody diarrhea (even if there is only one) to your local public health agency or to CDPHE immediately.
• Report any increase in the number of children or staff with diarrhea who attend your facility to your local health department or to CDPHE immediately.
• Children or staff must not attend childcare while ill with diarrhea.
• If it is known that a child/staff member with diarrhea attended the stock show, or if the facility took a trip to the stock show, the child/staff member should be referred to his/her health care provider for follow up and stool testing before returning to class. That stool test must be negative and the diarrhea must have resolved before the child/staff member can return to child care.
• Any child/staff member with bloody diarrhea, regardless of whether he/she went to the stock show should be referred to his/her health care provider for follow up and stool testing before returning to class. That stool test must be negative and the diarrhea must have resolved before the child/staff member can return to child care.
• If a child/staff member has diarrhea that is not bloody and did not attend the stock show, then the child/staff member is not required to provide a negative stool specimen, however diarrhea must be resolved before returning to child care.
• Children and staff who are diagnosed with E. coli O157 must have two stool specimens that are negative for E. coli O157 or shiga toxin before returning to child care.
• Children should not attend child care while they have diarrhea. Children who are diagnosed with E. coli O157 must have two stool specimens that are negative for E. coli O157 or shiga toxin before returning to child care.
  

Antibiotics are generally not recommended for E. coli O157 infection and may be associated with development of hemolytic uremic syndrome (HUS).

There are also sanitation measures that can be taken to help prevent disease. The best way for preschool and day care workers to prevent the spread of E. coli O157:H7 is to wash their hands. Bacteria can easily hide under a fingernail or anywhere on the hand that was not thoroughly washed with soap and water for at least 20 seconds. It is especially important that preschool and day care workers wash their hands after using the restroom, changing a diaper, preparing food, or feeding a child.

Other basic sanitation measures that preschools and day care centers are expected to maintain include the following: 1) clean and disinfect diapering area and potty chairs after each use; 2) clean toilets, sinks and toys at least daily; 3) cook all hamburger and ground beef until it reaches an internal temperature of at least 160 degrees Fahrenheit; 4) do not allow children to drink unpasteurized milk or fruit juices; 5) wash and disinfect all cutting boards, knives, utensils and dishes that have been used for raw meat or poultry before using them with fresh produce and other uncooked foods; and 6) do not let children serve or prepare food for other children.