Effectiveness of a structured protocol for the prevention of acute respiratory tract infections in daycare centers: A quasi-experimental study

Table 1 Structured multimodal protocol for preventing respiratory tract infections in childcare centers

Time	Activity	Responsible personnel
07:00 a.m.-08:00 a.m.	Teachers conduct health screening for children aged 2-6 years, including temperature measurement and assessment for skin lesions, rashes, and oral abnormalities (e.g., erythematous throat, tonsillar swelling, oral ulcers), to identify potential respiratory infections. Children with suspected infection are referred to a designated healthcare facility. Those without signs of infection are instructed to wear a surgical face mask, perform hand hygiene using alcohol-based hand sanitizer, and attend classes as usual	Duty teacher
08:00 a.m.-11:00 a.m.	During class, teachers assess surgical face masks for contamination and replace them if soiled. Ensure that children wear surgical face masks at all times, except during meals and sleep. Require hand hygiene using alcohol-based hand sanitizer after activity changes or class periods. After restroom use, require handwashing with soap and water and followed by hand drying	Classroom teacher
11:00 a.m.-01:00 p.m.	Remove surgical face masks before meals and perform hand hygiene before and after eating. Surgical face masks are not required during sleep. After restroom use, require handwashing with soap and water followed by hand drying	Classroom teacher
01:00 p.m.-03:00 p.m.	During class, teachers assess surgical face masks for contamination and replace them if necessary. Ensure continuous surgical face masks use except during meals and sleep. Require hand hygiene after activity transitions and after restroom use	Classroom teacher
03:00 p.m.-04:00 p.m.	Clean and disinfect high-touch surfaces (e.g., doorknobs, shared toys) using disinfectants, dishwashing liquid, or soapy water	Housekeeping staff
After 04:00 p.m.	Indoor areas: Classroom floors and walls, and shared toys are cleaned once daily using cleaning agents or disinfectants; Outdoor areas: Cafeteria, playgrounds equipment, shared play equipment, and restrooms are cleaned once daily using cleaning agents or disinfectants	Housekeeping staff