To the Editor.
—On evaluating the article "The Effect of Diaper Type and Overclothing on Fecal Contamination in Day-care Centers," by Van et al,1 we find flaws regarding the institution of controls.The researchers chose several environmental surfaces to culture, including diaper-pail handles and changing-table surfaces. Contamination of a diaper-pail handle, however, comes directly from the hands of the diaper changer for the most part and may not reflect effects of diaper type in relation to containability at all. Regardless of the diaper type used, it is the technique of the changer and the degree to which she or he directly contaminated her or his own hands that impacts on the amount of contamination present on a diaper-pail handle. Similarly, a changing-table surface may become grossly contaminated during the changing process, perhaps related to the amount of fecal material, the use and type of wet wipes, and the technique
Bradley S, Kilpatrick H, Silverman J. Diapers and Day Care. JAMA. 1991;266(17):2371. doi:10.1001/jama.1991.03470170059014