Infection Prevention and Control

• Germs which are spread through stool can cause enteric symptoms such as diarrhea, abdominal cramps and nausea. These germs contaminate hands, food, water, objects and surfaces. The germs then enter the body through the mouth when children put contaminated objects into their mouth or eat the contaminated food.
• Some germs have the ability to survive on surfaces and objects for periods of time. Rotavirus, which is a common cause of diarrhea in children, may survive on surfaces for a long time. Contaminated hands, sink taps, toys and furniture all play a role in the spread of infections in child care centres.
• Germs which are spread through saliva and nasal secretions (e.g. COVID-19, influenza, croup, strep throat, common cold) can cause respiratory illnesses. These germs are primarily spread when people sneeze or cough.
• Germs which cause respiratory illnesses can survive on surfaces for long periods of time. The influenza virus can survive:
  • 24-48 hours on objects
  • 8-12 hours on cloth, paper and tissues
  • On hands for up to 5 minutes after touching a contaminated surface or object.
• Practicing good hand hygiene is the most effective way to prevent the spread of infections.

Routine practices are recognized strategies to prevent and control infection.  They are based on the principle that any person may be carrying an infection and their bodily fluids potentially contain illness-causing microorganisms.

Follow these routine practices to prevent transmission of infections:

• Wash your hands frequently and thoroughly with soap and water.
• Keep your immunizations up-to-date.
• Keep any open cut or sore (yours or a child’s) covered with a dry, clean bandage.
• Avoid contact with blood and body fluids. Use disposable gloves when giving first aid and discard gloves right after use. Wash your hands thoroughly immediately.
• If blood or a body fluid splashes in your eyes, you should immediately flush your eyes thoroughly and see your health care provider.
• Disinfect and sanitize surfaces that have been in contact with blood or body fluids with a 5000 ppm bleach solution for 10 minutes (one part bleach to 9 parts water).
• Never share personal objects such as toothbrushes. All personal objects should be labelled with proper names and have separate storage.
• Wipe or blow runny noses promptly; dispose of tissue immediately and wash hands with soap and water/hand sanitizer.
• Practice respiratory etiquette! Cover your mouth and nose with a tissue whenever you cough or sneeze. If a tissue isn’t within reach, cough or sneeze into your sleeve – on your upper arm, not into your hands.
• Stay home when ill.

Frequent hand hygiene is the best way to prevent the spread of germs and illness. Two effective methods are hand washing with soap and water or an alcohol based hand rub (ABHR) that contains at least 60% alcohol. ABHR should only be used under supervision in child care centres and it should not be used when hands are visibly dirty/soiled or when hands are wet.

If children are too young to wash their hands themselves, do it for them. Supervise older children when they wash their hands. Show the child how to wash their hands correctly if they do not know or have forgotten. Remind the child that washing hands will help to keep them from getting sick.

A large common basin for children to rinse hands after activities should not be used. Children should wipe hands with a paper towel then go to a sink and wash their hands with soap and running water.

Staff should wash their hands:

• When they arrive at work
• Before preparing or serving food
• After diapering a child, cleaning up messes, or wiping a nose
• After using the washroom
• After assisting a child in the washroom
• After sneezing or coughing
• Before leaving work and upon their arrival at home

Children should wash their hands (or have them washed):

• When they arrive at the child care centre
• Before they eat or drink
• After they use the toilet or have their diapers changed
• After sneezing or coughing. Teach children to cover their mouths when they sneeze or cough

Individual cloth towels may be used if each child has a clean one every time they wash their hands. Towels must go into the laundry after every use.

How to wash hands with soap

Follow these steps for the best results when washing your hands:

1. Wet hands and wrists with warm water
2. Lather soap and scrub hands for 20 seconds (or as long as it takes to sing Twinkle Twinkle Little Star)
3. Scrub between and around your fingers, nail beds, back of each hand, thumbs and wrists
4. Rinse thoroughly under running water
5. Dry hands well
6. Turn off water using a paper towel, if possible
7. Open door with paper towel, if possible

How to wash with an alcohol-based hand rub

Use alcohol-based hand rubs only if your hands are dry and aren't visibly dirty. Follow these steps for the best results:

1. Apply a quarter size amount of product to hands
2. Rub between and around fingers, palms, back of each hand, thumbs and nail beds
3. Continue to rub hands until they are dry

• Have separate classrooms or play areas for each group of children.
• Try to keep younger children, especially those in diapers, separate from older children.
• Ensure that staff members in charge of diapered children do not prepare food and do not serve food to children outside their group.
• Have a separate place to care for children who are ill until they are taken home.
• Ensure that your centre has adequate space and good ventilation to minimize the spread of airborne germs.
• Keep an empty basin for storing heavily soiled toys. Ensure that it is out of the children’s reach. Wash and sanitize the toys.
• For more information and recommended disinfectants see:
  • Childcare Setting Cleaning and Disinfecting Schedule [PDF] | Huron Perth Public Health
  • Child Care Environmental Disinfection Table [PDF] | Huron Perth Public Health

Diapering Area

• Establish a change area that is physically separated from the children’s activity area and the food preparation service area.
• Establish diaper stations beside a hand sink supplied with soap in a dispenser and disposable towels.
• Provide a changing surface that is approximately 1 metre high and covered with a smooth, moisture resistant, easy to clean material. A safety ledge at least 6 – 7.5 cm high is required.
• It is important to regularly inspect surfaces for rips, tears and holes, as germs can live on surfaces.
• Wash and sanitize the diapering table after each use.
• Provide a foot-operated plastic container with a tight fitting lid and lined with a plastic disposable bag for diaper collection. Be sure the container is not accessible to children, empty it frequently and clean and sanitize it at least weekly.

Diaper Changing Procedure

Never leave a child unattended on the change table.

• Wash hands with soap and water before each change.
• Use gloves.
• Assemble supplies within easy reach.
• Do not share skin care products that cannot be dispensed in a sanitary manner.
• Hold child away from your clothes as you place him/her on the clean change pad. Remove diaper. If safety pins are used, close each pin immediately and place out of child’s reach.
• Clean child’s skin with a moist disposable cloth, wiping from front to back. Remove all soil; don’t miss the skin creases.
• Wipe hands on a clean disposable cloth and place it in waste container.
• Diaper and dress the child.
• Wash the child’s hands and return him/her to play or sleep area.
• Dump soil from diaper in toilet. Avoid splashing. Place diaper, change pad (if disposable), and wash cloth in waste container lined with a plastic bag.
• Soiled clothing or cloth diapers should not be washed at your centre. Empty the solid material into the toilet and then place soiled items into a plastic bag to be sent home with the parents.
• Clean the change surface with soap and warm water. Rinse and wipe dry. Apply an approved high-level disinfectant and follow manufacturer’s instructions for contact time. See the Child Care Environmental Disinfection Table [PDF] for more information.
• Wash your hands thoroughly with soap and warm water.

Note: Use skin care products only if requested by a parent and only for the designated child. Be sure skin care products are labelled with the child’s name.

• Potty chairs should be made of smooth, non-absorbent, easy-to-clean material.
• Keep potty chairs in the bathroom, not in playrooms or hallways.
• Place potty chairs in a location where children cannot reach toilets, other potty chairs, or other potentially contaminated surfaces.
• Clean and disinfect according to the following procedures:
  • After use, put on disposable gloves and empty potty contents into toilet.
  • Rinse the potty in a sink reserved only for this use.
  • Wash and sanitize the potty-chair and the sink. Ensure high-level disinfectant is used (see Child Care Environmental Disinfection)
  • Discard gloves once cleaning is complete
• Wash your hands and the child’s hands.

• Supervise children during toilet procedures.
• Assist in teaching hygienic wiping procedures (front to back).
• Assist children with flushing waste.
• The staff members must thoroughly wash hands and assist the child with hand washing as well.

To reduce transmission of any germs, cots should be spaced at least 1 metre (3 feet) apart.

• Napping space and play area may be used interchangeably with each cot, mat or bed labelled.
  • Label each child’s cot and bedding.
  • All cots, beds, cribs, or mats should be maintained in good repair.
  • Wash liners and cots weekly or more if needed.

Cleaning is the physical removal of visible dirt and organic matter from objects using detergent, warm water and friction. Rubbing action creates friction, which is required to remove any surface dirt/organic matter from the surface.

Cleaning will physically remove some microorganisms (germs such as bacteria, viruses, parasites, moulds), however; it does not kill those that may remain on the surface.

Cleaning is an important first step in removing disease-causing microorganisms. If surfaces are not clean, dirt and organic matter can coat and protect germs and may cause further disinfection processes to be ineffective.

Disinfecting/sanitizing will greatly reduce the number of microorganisms from any surface. This process will destroy (kill) and reduce the number of microorganisms to an acceptable level. These processes do NOT sterilize items and all germs will never be removed.

This process can be achieved by using either high temperature water during the rinse cycle (e.g. commercial dishwashers at greater than 82°C/180°F) or chemical solutions.

Cleaning solutions such as soaps and detergents should be appropriate for the type of surface or items being cleaned. For example, products labelled as “bathroom cleaners” may not be appropriate for kitchen counters or other food contact surfaces.

Many chemical disinfectants are available. Chemical manufacturing labels with information and instructions should be read and followed carefully. For example, some commercial products require a final rinse with clean water after the appropriate disinfectant contact time in order to remove any excess chemical residues.

• The frequency of cleaning and disinfection depends on characteristics of the surface as well as what touches it.
• Surfaces that can carry many and more harmful germs should be cleaned and disinfected more often (e.g. washrooms, and surfaces frequently touched).
• Surfaces that come in direct contact with food should be cleaned and sanitized after each use.
• Surfaces that become contaminated with blood and body fluids should be cleaned and disinfected immediately.

Step 1: CLEAN

• Use a detergent/soap, water and a clean brush/cloth and apply a scrubbing action.
  • To remove dirt and organic matter. Cleaning must occur before disinfection.

Step 2: RINSE 

• Use clean water and a clean cloth and/or place under running water.
  • To remove soap residue, dirt and organic matter. Soap films can make disinfectant ineffective.

Step 3: DISINFECT

• Apply chemical to the surface at the appropriate strength for the appropriate contact time.
  • To destroy germs that may cause illness. Follow manufacturer’s instructions on product labels.

Surfaces considered most likely to be contaminated are those with which children are most likely to have close contact. These include:

• Toys that children put in their mouths and touch
• Crib rails
• Food preparation areas
• Sensory tables items
• Water play table
• Surfaces likely to become very contaminated with germs, such as diaper-changing areas and bathrooms.

Playdough cannot be sanitized and needs to be replaced on a regular basis.

Avoid direct contact with body fluids, as they all have the potential to spread germs. Germs in vomit and diarrhea may travel through the air, so it is important to clean up quickly.

Spill Kit

A spill kit should be prepared ahead of time that includes:

• Gloves (disposable)
• Paper towel
• Soap and detergent
• Plastic bags
• Disinfectant

Procedure

1. Wear disposable gloves.
2. Remove all visible material, working from the least to the most soiled areas, using paper towel or single-cloth. If you are cleaning up feces or vomit, be careful not to agitate the material so that virus particles do not become airborne. Put all material in a water-proof bag for disposal.
3. Clean the area using soap or detergent, again working from the least to the most soiled areas.
4. Disinfect the area using an approved high-level disinfectant following the manufacturer’s directions for procedures and length of time to leave on surface.
5. Discard gloves and other cleaning articles in a plastic bag.
6. Wash hands after removing the gloves.
7. Put on a new pair of disposable gloves.
8. Wash the non-disposable cleaning equipment (mops/buckets) thoroughly with soap and water and then rinse with an approved disinfectant.

• Have enough containers to store all the garbage that is generated between collection days.
• Choose durable plastic or metal containers with tight-fitting lids.
• Keep your containers covered and away from food storage and food preparation areas.
• The outside large container should be equipped with tight closing lid and the lid should be closed when it is not in use.
• Thoroughly clean and sanitize all containers with a 5000 ppm bleach solution for 10 minutes (one part bleach to 9 parts water) once a month or more frequently as needed (see Child Care Environmental Disinfection Table [PDF]).

When using household bleach (5.25%) chlorine to disinfect, it is sometimes difficult to achieve the correct level. The following steps will take you through mixing household bleach and water to use as a disinfectant.

Note: The bleach solution should be mixed daily to preserve the strength.

Low Level Disinfectant

• Utensils sanitization: 100 ppm for 45 seconds
• Environmental cleaning for 10 minutes
• 5 ml of bleach to 2.50 L of water.

Intermediate Level Disinfectant

• For daily environmental cleaning: 1000 ppm for 10 minutes
• 50 ml of bleach to 2.45 L of water

High Level Disinfectant

• Blood spills – major (One part bleach to 9 parts water): 5000 ppm for 10 minutes
• 50 ml of bleach to 2.45 L of water

To determine recipe and contact time for other percentages of sodium hypochlorite, refer to Public Health Ontario’s Chlorine Dilution Calculator.

• Sensory play tables can be a source of spreading infections from one child to another. Close supervision is essential.
• Have children and staff wash their hands before and after sensory play.
• Sensory play tables can be filled with water, sand, or food for indoor play.
• Sand and water play should be avoided for children with chicken pox.
• Cover sensory tables when not in use.
• Have children and staff wash their hands before and after sensory play

Note: Sensory play tables are not to be used during an outbreak of communicable disease due to the risk of disease transmission.

Water play can also be a good medium for spreading infections. The following will reduce the spread of infection:

• Have children and staff wash their hands before and after water play.
• For infants and toddlers, individual water containers (such as plastic basins) are recommended.
• Use individual containers for all children rather than a shared communal water play table; they are more easily sanitized between use and are less likely to spread illnesses.
• Use municipally chlorinated water for water play. Do not add bleach, vinegar or other disinfectants to the play water.
• Choose tubs with smooth, non-porous and non-corrosive surface with rounded edges and corners for easy cleaning.
• Fill the water play tub with clean tap water just before use.
• Change the play tub water at least once each day and more often if necessary.
• Clean and sanitize all toys used in water play tables after each use.
• Have children and staff wash their hands before and after sensory play

Note: A child with a skin infection should not be allowed to play with other children at a shared water play table. Water play tables are not to be used during an outbreak of communicable disease due to the risk of disease transmission.

Sanitizing procedure:

1. Empty the water and thoroughly scrub all surfaces of the tub with detergent.
2. Rinse off the detergent with clean water.
3. Apply a sanitizer solution following the manufacturer’s directions OR use an intermediate (200 ppm) bleach to water solution.
4. Sanitize for at least 1 minute of contact time or whatever the manufacturer recommends.
5. Allow the water table to air dry.

• Using prepackaged daycare appropriate, seal and labelled sand (silica free) in the sandbox ensures that there are no harmful organisms in the sand that may affect the children while they are playing. Spraying the sand with a bleach and water solution does not effectively disinfect it.
• Do not use regular soil or potting soil.
• Do a visual check of the sandbox daily before use. This ensures that there is no contamination of the sand by food or other objects.
• Do not allow eating or drinking of snacks/food while children are playing in the sandbox. This can lead to children ingesting the sand and other contaminants.
• Replace sand on a regular basis.
• Have children and staff wash their hands before and after sensory play

Note: Do not use sandboxes during the outbreaks of communicable disease.

• Install a secure cover on outdoor sandboxes when not in use.
• Check sandboxes and sand in play areas daily for animal droppings, broken glass, or other hazardous items before children go outside to play.
• Scrape or rake out droppings and surrounding sand, place in a plastic bag and discard in the garbage.
• The eating of soil and sand by children can lead to a serious health hazard known as toxoplasmosis. The effects of this disease can range from brain injury to pneumonia and death. Discourage children from consuming or placing any articles contaminated with sand in their mouth. Ensure that pregnant staff are not changing the sand or removing feces from the sandbox.
• Have children and staff wash their hands before and after sensory play

• All toys used in sensory play tables should be cleaned and disinfected at least once per week, or more often if required.
• Clean and disinfect sensory tables with an intermediate level disinfectant at least once per week and more often if required following the sensory play (see Child Care Environmental Disinfection Table [PDF]).
• Have children and staff wash their hands before and after sensory play

• Have children and staff wash their hands before and after using the table.
• Use only dry food materials in play tables. If the food material becomes wet, it must be discarded and replaced.
• Discard and replace food which is contaminated.
• Clean area beneath the play table daily. Discard any material which is spilled on the floor. Spilled material must not be placed back in the sensory table.
• Discontinue use of food items used in the play table in the event of a rodent or insect infestation.
• Keep sensory tables covered when not in use.
• Ensure dry food items used in the sensory tables are kept no longer than one week and then discarded.
• Ensure all toys used in the sensory tables are cleaned and disinfected at least once per week, or more often if required.
• Clean and disinfect sensory tables at least once per week and more often if required. (see Child Care Environmental Disinfection Table [PDF]).
• Supervise children around the sensory tables containing beans, corn, etc. as they may be a choking hazard for children.
• Have children and staff wash their hands before and after sensory play

• Ensure all materials used for crafts are non-toxic, including markers and glue.
• Avoid materials that may be choking hazards such as balloons and Styrofoam.
• If there is no label or enough information to decide whether it is safe, contact the manufacturer. The company’s phone number or address should be on the label. Also, ask for a copy of the Material Safety Data Sheets (MSDS). The MSDS gives specific information about flammability, toxicity and ingredients.
• Ensure egg cartons and trays previously used to store food items (e.g. Styrofoam meat trays), as well as toilet paper rolls, are not used for crafts, as these items cannot be properly cleaned and disinfected.
• Discard grains and cereal products after one week of use. If they become wet, discard immediately.
• Discard playdough after one week of use, sooner if necessary.
• Have children and staff wash their hands before and after sensory play

Cleaning and disinfecting are important to infection prevention and control in a child care setting. Some pathogens can live for hours, days or even weeks on toys, equipment and other surfaces. To reduce the spread of pathogens in your child care centre, please consult the following guides:

• Childcare Setting Cleaning and Disinfecting Schedule [PDF] | Huron Perth Public Health
• Child Care Environmental Disinfection Table [PDF] | Huron Perth Public Health