Preventing illnesses in child care

Child care centres must develop, maintain, and implement written policies and procedures to promote an effective, efficient and consistent approach to infection prevention and control.

A policy is a plan or course of action used to guide an organization to create decisions. A procedure is a series of steps that need to be taken to accomplish something.

Writing effective policies and procedures

• Consult credible sources and write policies and procedures that are specifically suited to meet the needs of your centre.
• Provide detailed steps to effectively manage a situation by answering who, what, when, where, why and how.
• Inform and train staff on all policies and procedures to ensure staff follow them and respond efficiently.
• Periodically review policies and procedures to ensure they are relevant and accurate.

Public health requires polices and procedures on the following topics.

Managing communicable diseases and outbreaks

• Observing and recording symptoms of illness upon arrival and throughout the day.
• Isolating, cohorting, excluding and re-admitting children and child care staff.
• Reporting communicable diseases, an unusual increase in symptoms or suspected outbreaks to Peel Public Health.
• Communicating illnesses and outbreaks to parents or guardians.

Infection prevention and control

• Hand hygiene
• Cleaning and disinfecting toys, furniture, equipment, and high-touch areas
• Routine procedures for cleaning–up blood and body fluids, and recording incidences
• Diapering and toileting
• Sensory and water play tables
• Management of medical devices
• Immunization records for staff and children
• Preventing occupationally acquired infections
• Management of animals in child care

Emergency situations such as fires, power outages, sewage back-up, no heat, no water or water interruption must be planned for in advance. Child care providers must be prepared and have a contingency plan with required supplies that can be implemented immediately. Identify steps and actions to follow and include contact information for any personnel involved. A public health inspector is available to assist and review your plan as needed.

Call Peel Public Health to report your emergency. A public health inspector will complete a risk assessment to ensure measures are in place to continue operation.

Review food safety resources for fires and power outages.

Frequent hand hygiene is the single most effective way to reduce the spread of illness.

Children should wash their hands:

• When they arrive at the centre and before they go home
• Before eating, drinking, using water tables
• After a diaper change, using the toilet
• After playing outside, handling pets, cages or other pet objects
• After sneezing or coughing into hands
• Whenever hands are visibly dirty

Staff should wash hands:

• When they arrive at the centre and before they go home
• Before handling food, preparing bottles, feeding children
• Between handling raw and cooked food
• Before giving or applying medication or ointment to a child or self
• After changing diapers, assisting a child to use the toilet, using the toilet
• After contact with body fluids (e.g., runny noses, spit, vomit, blood)
• After handling pets, pet cages or other pet objects
• After cleaning, and removing gloves
• After handling garbage
• Whenever hands are visibly dirty

Alcohol-based hand rub

Alcohol-based hand rubs (also called hand sanitizer) containing 70% to 90% alcohol can be used when hands are not visibly soiled.

Alcohol based hand rubs can be a fire hazard and harmful if swallowed. To reduce the risk, staff should assist and supervise children when using the hand rub. Avoid touching eyes, nose or mouth until hands are dry.

Disposable glove use

Single-use disposable gloves offer adequate protection against pathogens and chemicals. Use gloves that are comfortable, durable, and fit well. Gloves do not replace handwashing. Staff must wash their hands before putting gloves on and immediately after removing gloves.

Staff should wear disposable gloves:

• to clean up blood, vomit, urine, and stool.
• when they have cuts on their hands.

Respiratory etiquette

Respiratory infections spread easily in child care. Children and staff should cover their mouth and nose with a tissue when coughing or sneezing, or cough and sneeze into their flexed elbow. Throw away used tissues and immediately wash hands.

Childcare centre staff need to follow infection prevention and control practises when changing diapers to prevent disease transmission. Diapering areas must be separate from feeding and food preparation areas.

Diapering areas must be equipped with:

• Designated handwashing sink supplied with potable hot and cold running water, liquid soap in a dispenser and paper towels. Portable sinks are not permitted.
• Single use disposable gloves.
• Dedicated cleaner and disinfectant.
• Diapering surface that is made of smooth, non-absorbent, and easy to clean material.
• Foot-activated garbage container with a disposable liner.
• A copy of the diapering procedure.

Diapers, wipes, and skin care products

• Provide bins to store diapers, wipes, creams and ointments and label them with the child’s name.
• Use product that is supplied by the parent and labeled with the child’s name.
• Use a single use applicator or a new pair of disposable gloves to dispense cream and ointment to prevent contamination.
• Do not rinse or wash soiled cloth diapers and clothing. Put soiled cloth diapers or clothing into a securely tied plastic bag and send home with parents for laundering at the end of the day.

Toileting

• Provide potty chairs and toilet seat inserts that are made of smooth, non-absorbent, and easy to clean material.
• Clean and disinfect potty seats after each use and store off the floor.

Cleaning with soap and water removes dirt and grease that can hide and protect germs from disinfectants. Cleaning will greatly reduce the number of germs that may be on surfaces. After cleaning, disinfecting will kill most of the germs that were left behind.

Choose a cleaner that is appropriate for the furniture and equipment, easy to use and compatible with the disinfectant used at the centre. Choose a disinfectant that is easy to use, non-toxic and effective against Norovirus.

Follow a cleaning and disinfecting schedule.

Using and storing cleaners and disinfectants

• Read and follow manufacturer’s instructions for product use.
• Wear appropriate personal protective equipment.
• Clean surfaces before disinfecting.
• Some products are cleaners only, some are disinfectants only and some can be used for both. Review the product label to understand how the product can be used.
• Approved disinfectants have a DIN (Drug Identification Number), a medical device license or NPN (Natural Product Number) except for chlorine bleach.
• Chlorine bleach and water solution is approved for use. Refer to the disinfection chart for mixing instructions.
• Apply disinfectants to cover surfaces evenly and completely.
• Label each cleaner and disinfectant bottle.
• Keep cleaners and disinfectants away from children’s reach but easily accessible to staff.

Cleaning blood and body fluids

Blood and body fluids, such as vomit, stool, and urine, can carry germs. Staff can get exposed to blood and body fluids during routine duties and when spills or accidents occur. Refer to cleaning–up blood and body fluids poster.

Peel Public Health recommends that all child care centres provide a spill kit to clean-up blood and body fluids. The spill kit includes at a minimum a pail, disposable gloves, disposable paper towels, 5.25% bleach solution, and a procedure for cleaning up. Post the procedure in a convenient area for easy access.

Cots and bed linens

• Cots and mattresses must be non-absorbent and easy to clean.
• Label cots and cribs with an identifying label (e.g., child’s name, assigned number).
• Store cots and linens in a clean area and keep them out of the way of everyday activities.
• Clean and disinfect cots, cribs, and mattresses at least once a week and when they are soiled.
• Launder linens at least once a week and when soiled, or if a child accidently uses another child’s cot or crib. Use the hottest setting on the clothes dryer.

Face cloths and hand wipes

• Use reusable fabric face cloths and hand wipes only once and place them in a laundry basket out of children’s reach. The laundry basket must be non-absorbent and easy to clean.
• Replace cloths when they become torn or worn.

Toothbrushes

• Choose a toothbrush with a small head and soft bristles.
• Clearly label all toothbrushes with the child’s name.
• Do not allow sharing or borrowing. If a child uses another child’s toothbrush or if two toothbrushes come in contact, throw them away and give the children new toothbrushes.
• Replace toothbrush every three to four months or sooner if the bristles look worn and absent or after illness.
• Dispense toothpaste in a manner to prevent contamination. For example, place a separate drop of toothpaste on a paper towel for each child, then use a toothbrush to scoop up the toothpaste.

Toothbrush storage

• Store rinsed toothbrushes in an upright position to air dry. Do not store in closed containers or plastic sandwich bags.
• Use non-absorbent and easy-to-clean holders. Cloth and cardboard holders are not acceptable.
• Arrange holders side by side to ensure toothbrushes are not stacked on top of each other.
• Cover the bristles of the toothbrush with a ventilated cover if using toothbrush covers.

Dress-up clothing

• Launder weekly or more often if necessary.
• Do not use during an outbreak.

Gardening

• Visually inspect the garden before use to check if there are unwanted items such as dead animals, animal droppings, needles, etc.
• Supervise children during gardening activities.
• Outdoor gardens should be in areas safe for children.
• Choose appropriate gardening tools and gloves for children.
• Use soil that does not contain manure (which could expose children to harmful bacteria).
• Consider buying organic or non-treated seeds.
• Avoid using chemical pesticides and/or herbicides.
• When planting outdoors, follow these sun protection guidelines.
• Children and staff must wash their hands with soap and water after gardening.

Indoor sandboxes

• Use sand that is pre-packaged, sealed, and labelled “play sand.”
• Ensure children wash their hands before and after using the indoor sandbox.
• Keep food away from the sandbox.
• Air dry wet play sand overnight.
• Sandbox toys must be rustproof, non-breakable, and easy to clean.
• Clean and disinfect the sandbox when replacing the sand.
• Replace sand at least monthly, or more often if required.
• Do not use the sandbox during outbreaks.

Outdoor sandboxes

• Sandboxes should be visually inspected and raked during daily playground check.
• Replace sand at least seasonally, or more often if required.

Sensory and water play tables

• Choose a table that is easy to move, clean and disinfect.
• Provide a cleaning and disinfecting procedure
• Ensure children wash their hands before and after sensory and water play.
• Cover sensory play tables when not in use.
• Do not use group water and sensory play tables during an outbreak.
• Clean and disinfect the water table, individual bins and toys after each play session and the sensory basin when the materials are changed.

Sensory materials

• Discard sensory items (paper, play doh, slime, feathers etc.) after a maximum of five uses, or if visibly soiled or wet.
• Discard cereal, rice, pasta, beans and other food products weekly. If the food product becomes wet, it must be discarded and replaced.
• Check natural items such as pinecones and leaves to make sure they are visibly clean and bug-free.
• Previously used items such as toilet paper rolls, egg cartons and Styrofoam food trays cannot be used for crafts.

Wading pools

• Use and operate wading pools safely. Be sure to comply with the Ontario Pool Regulation.
• Ensure diapered children are wearing swim diapers.
• Do not use a wading pool during an outbreak. A sprinkler can be used instead of a wading pool to reduce the risk of exposure to potentially harmful bacteria, viruses, and parasites.

Child care centres may have animals visiting or living at the centre. For more information refer to the recommendations for the management of animals in child care.

Report all animal biting or scratching incidents to Peel Public Health to assess the risk of rabies infection. You are legally required to report any incident of an animal biting a person to Peel Public Health.

Food handlers in child care must follow requirements of the Ontario Food Premises Regulation 493/17 that outline food storage, food temperatures, food service equipment, food handler hygiene, and structural and building maintenance requirements.

If you are opening or planning to open a new child care centre submit an application for child care centre plan review and review the inspection checklist to prepare for your public health inspection.

Certified food handler

Child care centres must have at least one certified food handler (or supervisor who has completed certified food handler training) on-site during meal prep and serving times.

Peel Public Health offers a food handler certification course and home study exam for people who prepare food in food premises and for those interested in working in food premises. In this course, you will learn about safe food handling practices and prepare for the food handler certification exam.

Register for food handler certification.

Find out about other certified food handler training, as listed on the Ministry of Health’s website.

Sick kitchen staff

• Sick kitchen staff cannot work until they are well.
• Staff with symptoms of respiratory illness must not handle food until they are symptom free for at least 24 hours, and 48 hours for gastro-intestinal illness.
• Public health may require unwell staff to be off work for longer periods based on the illness.

Food handling

• Child care staff who diaper children cannot work in the kitchen or do any food preparation during the same shift.
• Kitchen staff who also have cleaning duties outside the kitchen cannot perform cleaning duties until after they have finished their food-handling tasks. For example, staff can prepare food in the morning and clean in the afternoon.
• Preparing snacks in the kitchen, not in the classroom.
• Discard contaminated food immediately. Food can get contaminated by sneezing, coughing and/or spitting on food.

When children serve themselves, they must:

• Wash their hands before eating.
• Always be supervised while eating.
• Use clean utensils for self-serving.

During outbreaks, do not let children serve themselves food.

Catering and special event meals

• Record the temperatures of hazardous food when it arrives at the centre and again prior to serving. Hot food must be delivered and kept at 60°C or higher, and cold food at 4°C or lower.
• Food must be from an inspected facility. Check the inspection results posted by the health unit where the caterer’s kitchen is located. View Peel health inspection results.
• Home prepared food is not permitted. Food for special events such as birthdays must be prepared at the child care centre or purchased from an inspected food premises, such as a grocery store or bakery.

Expressed breast milk and infant formula

• Wash hands before and after handling expressed breast milk and infant formula.
• Store in a refrigerator at a temperature of 4° Celsius or colder, until used.
• Label bottles and containers (date, name of infant or child and name of mother)

Refer to feeding your baby for more information about bottle feeding breast milk or infant formula.