Analysis: 'Be obsessive about handwashing' in E. Coli aftermath

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Early years settings may soon face stricter guidelines on exposing young children to animals that can harbour dangerous bacteria. Melanie Defries hears the arguments.

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The Department of Health is considering issuing new guidelines on open farm visits for young children following an outbreak of E. Coli infection that has been linked to four petting farms across the country.

Health experts called for the current guidelines to be revised after 79 cases of E. Coli 0157 were traced to the Godstone Farm and Playbarn, a children's farm in Epsom, Surrey, which has closed while an investigation into the outbreak is carried out. At least 12 children have been hospitalised.

Officials have also closed the Horton Park Children's Farm in Epsom, Surrey, which has the same owners, after an environmental health inspection found its hygiene arrangements to be unsatisfactory.

Three petting farms in other areas, the World of Country Life, in Exmouth, Devon, the White Post Farm in Nottinghamshire and the Big Sheep and Little Cow farm in Bedale, North Yorkshire, have also closed as a precautionary measure after the Health Protection Agency found a potential link between the farms and a handful of local E. Coli cases.

Higher risks

E. Coli is a commonly occurring bacteria found in the intestines of warm-blooded animals, including humans, and excreted in faeces. Several strains exist, many of which are harmless. But some strains can cause illness, including E. Coli 0157, the one behind the current outbreak and which first appeared in Britain in the 1980s.

The symptoms of E. Coli 0157 infection include diarrhoea, which may contain blood, and in more serious cases, kidney and blood complications. Two young children who visited the Godstone Farm are reported to have suffered kidney failure since contracting the disease.

Professor Hugh Pennington, emeritus professor of bacteriology at the University of Aberdeen, and Professor Ron Cutler, an expert on infectious diseases, have both called for the current guidelines on young children's visits to open farms to be reviewed or for greater 'controls' to be introduced.

Professor Cutler told Sky News, 'The trouble today is that often children don't get to touch live animals and when they do, maybe the actual conditions in which they touch them aren't as good as they ought to be. We have to put some sort of logical controls in.'

He added that zoos should think about giving people nailbrushes to make sure their hands are truly clean after a visit.

Professor Hugh Pennington told Nursery World, 'E. Coli is a difficult bug to understand, because we are the only species that gets the disease. The risks of E. Coli are different for each age group and young children are more likely to develop complications, such as kidney failure.

'If a child gets infected there is no medicine that we can apply to alter how the infection moves - antibiotics actually increases the chance of complications. Very young children are not only more susceptible to E. Coli, but they are also more likely to touch animals and then put their hands in their mouths.'

He added, 'We need to look at how these children can be accommodated on farm visits. Perhaps farms could have areas where children can see the animals but can't touch them. As there is a greater risk for young children, it does make sense for the Government to consider publishing specific recommendations for the under-fives.'

A Department of Health spokesperson confirmed that the Advisory Committee on Dangerous Pathogens has been asked to review the current guidance and will advise on the need for any additional precautions, but stressed that the risk of infection from E. Coli O157 could be dramatically reduced through thorough handwashing.

FARM NURSERIES

Early years settings that are based on farms or that regularly visit open farms to help children learn about animals have expressed frustration at the prospect of new guidelines for the under-fives.

Martin Cooper, owner of Coneygarth Farm Day Nursery, in Haxey, South Yorkshire, a setting that is based on the site of a commercial farm, said, 'Just a few months ago all the headlines were about swine flu, and nurseries and schools were going to have to close because of an epidemic. This month it's E. Coli.

'While I agree that we have got to protect children, and that young children are more at risk, I think that we also need to be careful not to overreact and protect children too much. I think we need to look at the issue sensibly and work out what the real risk of contracting E. Coli is.'

Mr Cooper's views were echoed by Patricia French, the co-owner and manager of Dimson Day Nursery, in Gunnislake, Cornwall, which is based on a purpose-built smallholding and has a range of animals including pigs, sheep and ponies.

Ms French warned against any knee-jerk response to the current outbreak. She said, 'The benefits of learning about animals and the environment far outweigh the risks, and the Government needs to look at the bigger picture. You have to put the risk of contracting E. Coli into context and think of the millions of children who have visited farms or touched animals and who have not caught the disease.

'Preventing the under-fives from petting animals would be wrapping them up in cotton wool, which doesn't do anyone any good. Children need to be given strategies to deal with different things. At our nursery they are taught that you wash your hands after you touch animals. It is a learning tool.'

Ms French added, 'We will never know exactly what happened to cause this outbreak. For example, were the parents ensuring that their children washed their hands after touching the animals?'

David Harrison, the co-owner of the Red Hen Day Nursery in Legbourne, Louth, which is located on a farm, also questioned whether a lack of awareness about the importance of handwashing could have contributed to the E. Coli outbreak.

He said, 'We have never had any cases of E. Coli, but then we have always been extremely vigilant about children washing their hands - it's second nature to the staff and children here. Rather than changing the guidelines for the under-fives, the focus should be on making sure that parents understand the importance of handwashing.'

Foundation Stage teacher Carol Copley, from Our Lady and St Patrick's Catholic Primary School in Maryport, Cumbria, takes her class on weekly trips. She says, 'I have got quite good relationships with some of the educational farms around this area. When I first heard that the Department of Health may change the guidelines on petting farms, I felt sad for the businesses who work so hard so that children can experience the animals. They will lose a lot of business, as so many of their visitors are aged under five.

'One farm I visit provides activities that do not involve touching the animals. Perhaps that is the way forward. It will be a shame if children are not able to touch the animals but better than not seeing them at all. We can only listen to what the experts say and go from there.'

EXTRA VIGILANCE

Meanwhile, childcare and health experts have warned early years settings to be extra vigilant when visiting open farms.

Purnima Tanuku, chief executive of the National Day Nurseries Association, said, 'It is essential, as current guidance stresses, to ensure that children wash their hands thoroughly after touching animals and that staff are alert to ensure that children do not put their hands near their mouth after petting animals.

'If nurseries are planning a trip to the farm they should ensure that they have checked current guidance and carried out a full risk assessment. It is also important that children do not have soft toys with them when they are near animals, and to try to avoid the use of dummies when animals are being touched.

'Although E. Coli infection is unlikely if proper hygiene practices are followed, staff should also be alert for any symptoms in the children, such as diarrhoea and sickness, in the days following a visit, and make parents aware that while every precaution will be taken, they should be alert for symptoms too.'

Professor Hugh Pennington added, 'Childcare practitioners will have to be extremely careful if going on farm visits, as E. Coli can spread through settings and to the children's siblings. Nurseries have to be almost obsessive about handwashing. They will need to have really good staff ratios on farm visits so that there is no chance of a child doing something that he or she should not be doing.'

REFERENCE

'A doctor's diary ... E. Coli' (Nursery World, 24 September 2009)

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