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Approximately 60% of U.S. children aged five and younger spend time in child-care settings. Such environments increase the risk of diarrheal disease, including diseases caused by enteric pathogens. To describe adherence to sanitation standards in classrooms and food preparation areas in child-care facilities, the authors conducted site visits in 40 North Carolina and South Carolina child-care facilities. Audits in up to two classrooms (rooms providing care for infants and toddlers) and the kitchen were performed using a form similar to a regulatory inspection form. Audit data were used to calculate indices to describe adherence to sanitation standards and were based on state environmental health regulations for child-care centers, the Food and Drug Administration's Food Code 2009, and guidance from food safety experts. Most facilities participating in the authors' study adhered to sanitation standards within the classroom; however, deficiencies with regard to sanitation in food preparation areas and refrigerator operating temperatures were noted. These results provide insight into possible risk factors for enteric disease transmission in child-care facilities
