Infection Prevention & Control Measures
When implementing infection prevention and control (IPAC) measures, child care centre staff should conduct a risk assessment for all activities that considers:
- contamination of skin or clothing by microorganisms in the environment
- exposure to blood, body fluids, secretions, excretions and body tissues
- exposure to non-intact skin
- exposure to mucous membranes
- exposure to contaminated equipment or surfaces
- signs and symptoms of infection
Surveillance is an important part of infection prevention and control, and the key to identifying an outbreak.
- Observe children daily, monitoring for signs and symptoms of illness.
- Record the following information:
- attendance and absence of children and staff
- signs and symptoms of illness (observing children upon arrival to the child care centre)
- dates and times that the symptoms started (onset)
- time that the ill child was picked up from the child care centre
- dates of field trips, outings and special events
Hand hygiene refers to any hand-cleaning action and is an essential part of routine practices. Proper hand hygiene in child care centres can significantly reduce the incidence of diarrhoeal and respiratory illness.
Hand hygiene involves the removal of visible soil and transient microorganisms from the hands while maintaining good skin integrity. Intact skin is the body’s first line of defense against bacteria. Therefore, careful attention to skin care is essential. The presence of dermatitis, cracks, cuts or abrasions can trap bacteria and compromise hand hygiene. Dermatitis also increases shedding of skin and bacteria.
There are two methods of removing microorganisms on hands:
- Hand sanitizing with alcohol-based hand rubs (ABHR) containing 70% to 90% alcohol is the preferred method when hands are not visibly soiled. Using easily accessible ABHR in most settings takes less time than traditional hand washing. Use of ABHR is also more effective than washing the hands with soap and water when hands are not visibly soiled. Providing an ABHR product that contains an emollient (moisturizer) can significantly decrease “irritant contact dermatitis” under frequent-use conditions.
- Hand washing with soap and running water must be performed when hands are visibly soiled. The presence of organic material can reduce the effectiveness of alcohol in ABHR. The mechanical action of washing, rinsing and drying is the most important contributor to the removal of transient bacteria. If hands are visibly soiled and running water is not available (e.g., field trips), use a moistened towelette to remove the visible soil, followed by ABHR. Hand washing with soap and running water must be performed when hands are visibly soiled. This is because the presence of organic material can reduce the effectiveness of alcohol in ABHR.
A common barrier to hand hygiene compliance is the adverse effect(s) on the skin. ABHRs have been shown to be less irritating to skin than soap and water despite perceptions to the contrary. If an individual feels a burning sensation following the use of ABHR, it is generally due to pre-irritated skin. Allergic-contact dermatitis associated with ABHRs is uncommon. Non-alcohol-based waterless antiseptic agents are not recommended for hand hygiene in child care centres.
Child care centres must develop and maintain written policies and procedures for established hand hygiene program that includes:
- when to perform hand hygiene
- how to perform hand hygiene
- how products used for hand hygiene are selected (e.g., ABHR)
- how product dispensing containers are managed
- how hand hygiene compliance will be monitored and improved
Child care centres must implement a hand hygiene program that ensures:
- children are taught about proper hand hygiene
- children are supervised while using ABHR
- hand washing is carried out when hands are visibly soiled (use of ABHR is not appropriate when hands are visibly soiled)
- staff, visitors, parents and children practice hand hygiene upon arrival and/or entry into any room
Ensure staff practice hand hygiene:
- before preparing, handling or serving food
- before and after handling expressed breast milk
- before and after giving medication
- before initial contact with children or handling items in the room
- after toileting/diapering
- after coming in from outside
- after providing care involving blood, body fluids, secretions and excretions of children or staff, even if gloves were worn
- before and after glove use
- before and after handling animals
- after handling garbage
- whenever in doubt
Ensure staff support, assist and supervise children when practicing hand hygiene:
- after playing outdoors
- after using the washroom
- before eating
- before and after handling pets
- after sneezing or coughing
- before and after sensory play activities
- whenever in doubt
Each licensed room with a designated hand washing sink (IPAC sink) must be equipped with:
- running water
- liquid soap in a dispenser
- paper towels
- “Hand Washing” information sheet posted
Gloves are an excellent barrier device for reducing the risk of communicable disease transmission. However, gloves are not completely free of leaks, and tears/punctures can occur. Improper glove use, including re-using gloves, can contribute to the transmission of pathogens. Wearing gloves does not substitute proper hand hygiene.
- Gloves must be worn when it is anticipated that hands will be in contact with mucous membranes, broken skin, tissue, blood, body fluids, secretions, excretions, or contaminated equipment and environmental surfaces.
- Gloves must be single-use only.
- Hand hygiene must be practiced before putting on and after taking off gloves
- Gloves must be removed immediately and discarded into a waste receptacle after each use
- Gloves should be appropriate for the type of activity
- Refer to the Glove Use information sheet
To reduce hand irritation, use appropriate gloves when handling chemical agents; wear gloves for as short a time as possible; clean and dry hands before and after wearing gloves; and use gloves that are clean and dry.
Respiratory infections are spread easily in settings where people are in close contact. To prevent the spread of microorganisms that cause respiratory infections (e.g., influenza), proper respiratory etiquette should be taught to children and regularly practiced by staff, and visitors.
Respiratory etiquette includes:
- Staying home when ill with a respiratory infection.
- Minimizing airborne droplets when coughing or sneezing, by:
- Turning your head away from others and sneezing or coughing into your arm (e.g., “Cover Your Cough”).
- Maintaining a two-metre separation from others, when possible.
- Covering your nose and mouth with a tissue.
- Disposing of used tissues into the garbage immediately after use.
- Practicing proper hand hygiene immediately after coughing or sneezing.
Child care centre operators provide diapering and toileting program for children to help develop and encourage hygienic practices. However, diapering and toileting can pose a risk of disease transmission. It is important that child care operators and staff apply IPAC principles and Routine Practices during diapering and toileting routines. Hand washing sinks must be provided in diaper changing areas and washrooms. These sinks must be designated for hand washing and must be adequately supplied to allow staff and children to properly wash their hands. The diapering area must be separate from the food preparation area. Washrooms and diapering areas must be equipped with:
- Designated hand washing sink supplied with:
- running water
- liquid soap in a dispenser
- paper towels
- “Hand Washing” information sheet
- Single-use disposable gloves.
- Appropriate disinfectant.
- Surfaces constructed of smooth, non-porous, non-absorbent material that is easy to clean and disinfect and free of cracks or rips.
- Appropriate storage for personal hygiene items (e.g., diapers, creams, ointments, toothpaste, toothbrushes etc.).
- Garbage containers equipped with a leak proof plastic liner and a foot activated lid that is tight fitting.
- Washrooms, fixtures, materials and surfaces must be maintained in a sanitary condition:
- Sinks must be washed and disinfected at least daily (or as necessary) and must not be used for food preparation, rinsing soiled clothing or toy washing.
- Diapering surfaces must be disinfected after each use (even if a paper liner is used); to prevent cross contamination, surfaces should be used for diapering only (not drying toys).
- Personal hygiene items must be labelled and stored separately to prevent accidental sharing.
- Personal hygiene items must be dispensed in a manner that prevents cross contamination (e.g., if children are using toothpaste from the same tube, the toothpaste must be dispensed onto a paper towel and then applied to the brush).
Breast milk supports the optimal growth and development of infants, and is a complementary addition to a young child’s diet beyond one year. Safe handling, thawing, storage and administration ensures the quality of expressed breast milk (EBM) for breastfed infants and children, and minimizes the risk of infection to children and staff.
EBM is a bodily fluid and may contain microorganisms from the mother or from other sources. EBM is not sterile, and it is important to ensure proper temperature control and handling. Feeding the incorrect EBM to an infant or child can potentially lead to the transmission of disease, so labeling containers and supervision during feeding are important measures to avoid unintended consumption.
When handling, preparing and dispensing EBM child care operators:
- shall store EBM in a refrigerator at a temperature of 4ᵒ Celsius or colder, until used.
- shall thaw frozen EBM in a refrigerator and ensure it is used within 24 hours. Do not use a microwave to thaw EBM.
- shall ensure bottles and containers are properly labelled (date, name of infant/child and name of mother)
- shall supervise children drinking EBM from a cup to prevent unintended consumption by other children.
- discard any left-over EBM not consumed by the child
- must apply Routine Practices when handling EBM
- must practice hand hygiene before and after handling EBM
- must wear gloves while handling EBM (e.g., dispensing into a cup or from a container)
- must Contact Toronto Public Health (TPH) Communicable Diseases Surveillance Unit at 416-392-7411 immediately if a child consumes EBM intended for someone else
Increased rates of childhood infections are influenced by the physical environment. A study by Laborde et al. (1993) found that faucet handles were among the most contaminated sites in child care centres. For example, norovirus can live for long periods of time on surfaces and objects such as doorknobs and faucet handles. Microorganisms that can cause gastrointestinal illness are commonly found on surfaces in child care centres, especially in rooms where diaper-aged children are located.
Cleaning is the physical removal of foreign material (e.g., dust, soil, etc.) and organic material (e.g., blood, secretions, excretions, microorganisms, etc.). Cleaning physically removes rather than kills microorganisms. Cleaning is accomplished with warm water, detergent(s) and mechanical action (e.g., scrubbing). After cleaning an object, it is necessary to rinse with clean water to ensure detergent film is removed.
Disinfection, a process completed after cleaning, is the process of killing most disease-causing microorganisms on objects using chemical solutions.
Child care centres must develop, maintain and implement a policy and procedure on environmental cleaning and disinfecting that at a minimum, include the following components:
- Routine cleaning and disinfection schedule(s) for each room/area identifying the surfaces, equipment and items to be cleaned and disinfected, the frequencies of cleaning and disinfection (i.e. daily, weekly and monthly), and the person(s) responsible for that task.
- Directions on how and when a product is to be used (staff should be able to provide a description of the products used, contact times, proper dispensing and usage).
- Directions for cleaning and disinfection during an outbreak.
- Information relating to the cleaning agent(s) and disinfectant(s) used at the child care centre including:
- drug identification number (DIN)
- material safety data sheet (MSDS)
- Directions for where to securely store cleaning and disinfectant supplies.
All cleaning agents:
- shall be labelled
- shall be stored in a secure location, and inaccessible to children
Choosing a Cleaning Agent
The ease of cleaning is an important consideration in the choice of materials used in your centre. When choosing a cleaning agent consider the following:
- Furniture and equipment in your facility.
- Compatibility with other cleaning agents and disinfectants used in the centre (e.g., do not use chlorine bleach and ammonia together as it can cause harmful fumes).
Using a Cleaning Agent
Cleaning must be done as soon as possible after contamination. When using cleaning products, minimize mist while applying to avoid eye and respiratory irritation. It is important that the sequence or steps involved in the cleaning process be done in the correct order:
- Wear the appropriate personal protective equipment for the task.
- Clean in a progression from low-touch to high-touch surfaces and from top to bottom.
- If required, rinse surface(s) with clean warm water.
- shall be labelled
- shall be stored in a secure location, and inaccessible to children
- shall have a Drug Identification Number (DIN #), and a Material Safety Data Sheet (MSDS)
- must be used as per the manufacturer’s directions
- must have a predetermined shelf-life
- must have a recommended and short contact time
- must have an efficacy statement
- must not contain phenols because they can cause Hyperbilirubinemia (jaundice) if not rinsed properly
Choosing a Disinfectant
Using a ready-to-use/pre-mixed disinfectant is ideal compared to mixing chemicals on site. When choosing a disinfectant consider products that are:
- easy to use (e.g., clear label instructions)
- non-toxic or non-irritating at in-use concentrations
- broad spectrum
- not affected by environmental factors (e.g., disinfectant remains active in the presence of different soils or contaminants; does not react negatively with other cleaning products)
- compatible with a wide range of materials (e.g., wood, leather, etc.)
- economical or cost effective
- stable in concentrate or in diluted form, and therefore have a suitably long shelf life
Using a Disinfectant
- Read and follow all manufacturer instructions before use.
- Wear appropriate personal protective equipment.
- Clean the surface prior to disinfection. Remove visible dirt by scrubbing with detergents and warm water before disinfection or use an approved one-step disinfectant cleaner.
- Consider the type of microorganisms that can potentially be present on the surface to be treated (e.g., surfaces exposed to blood, skin, other bodily fluids).
- Use an appropriate disinfectant (i.e. type and concentration).
- During an outbreak, ensure the disinfectant is a broad spectrum, and effective against norovirus.
- Mix daily in a clean bottle. Never top-up disinfectants.
- Label each disinfectant bottle appropriately.
- Do not dip a soiled cloth into the disinfectant solution (no ‘double-dipping’).
- When using a disinfectant minimize mist when applying to avoid eye and respiratory irritation.
High-touch and Low-touch Surfaces
High-touch surfaces include sinks, faucet taps, toilets, railings, high chairs, feeding tables, plastic bibs, cribs, doorknobs, light switches and electronic devices that are touched frequently by hands. These surfaces require frequent cleaning and disinfection.
Low-touch surfaces include floors, walls and windowsills that are touched less frequently.
- Surfaces must be maintained in a sanitary condition.
- High-touch surfaces must be cleaned and disinfected daily and as necessary (e.g., when visibly dirty, when spills occur).
- Low-touch surfaces must be cleaned and disinfected as needed.
- Surfaces should be cleaned and disinfected more frequently during outbreaks.
Carpets and Floor Mats
Carpets and floor mats can be more heavily contaminated for prolonged periods than non-carpeted floors and can be a potential source of microorganisms during outbreaks. Child care centres that use carpets and floor mats must ensure that policies and procedures outline routine cleaning practices that include, at a minimum the following components:
- Carpets/floor mats are cleaned as often as necessary and promptly if a spill occurs.
- Shampoo/steam clean carpets in infant rooms every 3 months.
- Shampoo/steam carpets in non-infant rooms every 6 months.
- If carpets do not appear to be adequately cleaned, re-cleaning is necessary or replacement must be considered.
- Floor mats that cannot be adequately cleaned and disinfected should be promptly removed and replaced.
- Refer to the Blood and Body Fluids information sheet for instructions on how to clean and disinfect after a blood or body fluid incident.
Child care centres must develop, maintain and implement a policy and procedure for laundry practices that includes directions for the collection, transport, handling, washing and drying of soiled items. Improper laundering of bedding materials used in child care centres may increase the risk of disease transmission. Items such as bed sheets can harbour microorganisms that grow well in a moist and warm environment. However, disease transmission is rare if bedding materials are handled and laundered in a sanitary manner.
The following key points are necessary to reduce the risk of disease transmission associated with improper laundering of bedding materials. Child care centres must ensure the following:
- Children’s personal belongings (e.g., coats, hats and shoes) are stored separately, such as in individual cubbies.
- Soiled clothing is sent home for cleaning (do not rinse; roll and place items in a sealed plastic bag; solid stools are disposed of in the toilet prior to bagging clothes).
- Soiled items are kept separate from clean items in a covered container/bag.
- Bedding (sheets and blankets) is assigned to each child and laundered weekly or more frequently when soiled or wet.
- Cloth bibs are kept in a sanitary manner and laundered as necessary.
- Laundry is washed in an area separate from the kitchen.
Existing child care centres that launder in a kitchen area must ensure laundry is done at alternate times to food preparation. Surfaces must be cleaned and disinfected prior to food preparation and after laundering.
For new or renovating premises, TPH requires laundry facilities to be separate from any food preparation area. A utility sink should be installed in the laundry area.
Children may be scheduled for sleeping periods at child care centres as part of the daily routine.
- Children must be placed in a sleeping arrangement that minimizes the spread of respiratory infections (i.e., head to toe).
- Sleep equipment must be labelled and assigned to a single child.
- Sleep equipment must be cleaned and disinfected before being reassigned.
- Cots/Crib mattresses must be made of a cleanable material.
- Cots/Crib mattresses must be cleaned and disinfected when contaminated (soiled or wet).
- Cots must be cleaned and disinfected weekly and as necessary (when soiled).
- Sleeping equipment and bedding must be stored in a manner to prevent contamination (e.g., avoid contact with mats/bedding used by another child).
- Bedding (sheets and blankets) must be assigned to each child and laundered weekly, or more frequently when soiled or wet.
Toys and play-based learning are an integral part of a childcare program. Toys and sensory play are excellent methods by which to enhance children’s sense of touch, sight, taste, smell and hearing. However, toys are also excellent vehicles for the spread of disease-causing microorganisms.
Toy Cleaning and Disinfection
Similar to environmental cleaning and disinfection, child care centres must implement a comprehensive toy cleaning and disinfection program which includes:
- policies and procedures
- dchedule(s) that identify toys to be cleaned/disinfected, frequencies of cleaning/disinfection (i.e. daily, weekly and monthly), and the person(s) responsible for cleaning and disinfecting
- toy cleaning and disinfection schedules and log sheets should be posted. The frequency of cleaning and disinfection varies depending on the age group and the amount of handling of toys:
- Infant (under 18 months): Frequently touched toys in infant rooms must be cleaned and disinfected daily (or more often as necessary).
- Toddler (18 – 30 months) & Preschool (>30 months – 5 years): Frequently touched toys in toddler and preschooler rooms must be cleaned and disinfected weekly (or more often as necessary).
- Kindergarten & School Age (5 – 12 years): Frequently touched toys in the school aged rooms must be cleaned and disinfected monthly (or more often as necessary).
When cleaning and disinfecting toys:
- If using a dishwasher to clean and disinfect toys, the dishwasher shall comply with the requirements of Ontario Regulation 493/17, Food Premises.
- Child care operators must wear appropriate personal protective equipment (e.g., rubber gloves).
- Toys must be cleaned and rinsed prior to disinfection.
- Disinfectant used must be safe and suitable for the intended purpose. The manufacturer’s directions for dilution and contact times must be followed.
- Toys must be cleaned and disinfected using the 3-compartment sink method or a dishwasher. The 2-compartment sink method is acceptable if washing and rinsing are done in the first sink. If no sinks are available then the 3 bin method is acceptable.
The following practices are necessary to reduce the risk of disease transmission to children when playing with toys and participating in sensory play activities:
- Children must practice hand hygiene before and after playing with toys or participating in sensory play activities.
- Playrooms must be provided with both ABHR and a designated hand washing sink (IPAC sink).
- Toys must be maintained in good repair and inspected for damage. Damaged toys that compromise cleaning and disinfection must be discarded.
- Toys must be easy to clean and be able to withstand frequent cleaning and disinfection.
- Toys used for water-play must not retain water as they can provide an environment for bacterial/mould growth.
- Toys that are mouthed or contaminated by body fluids must be cleaned and disinfected before handling by another child.
- Toy bins must be designated and clearly labelled for the storage of mouthed/dirty toys.
- Handle playdough and slime appropriately:
- Used homemade playdough and slime must be discarded daily.
- Unused homemade playdough/slime may be stored in the refrigerator for up to one week.
- Store-bought playdough/slime must be discarded according to manufacturer’s recommendations.
- Sensory play bins that contain dry materials must be cleaned and disinfected after they are dumped and before replenishing.
- Water play bins must be drained, cleaned and disinfected after each session. Choose water play bins that are easy to move, drain, clean and disinfect.
- Individual sensory play bins must be used when appropriate, such as when children are showing signs of illness (e.g. runny nose).
- Toy storage cupboards must be emptied, cleaned and disinfected as necessary.
- Toy storage areas must be monitored for pest activity.
- Indoor play structures (e.g., playhouses/climbers) must be cleaned and disinfected as often as necessary. A thorough cleaning of the entire play structure must be done according to schedule. Frequency of cleaning is determined by the age group using the play structure.
- Electronic devices must be cleaned and disinfected between users.
Sensory play materials
The following sensory play materials may be used:
- dry pasta
- purchased sand
- clean snow
- pine cones
The following sensory play materials must not be used:
- sand, gravel and other soiled materials obtained from outdoor locations
- meat trays, or soiled egg cartons and toilet paper rolls
- manure or other products containing possible fecal matter or chemicals
Gardening can be a wondrous experience for children of all ages. It can give children satisfaction from caring for something over time while observing the cycle of life. Involvement encourages healthy food choices while learning about plants and develops an appreciation for nature. It can be an exciting adventure and a great teaching tool. Involve children in the design of the garden to produce something unique and plan for adequate and accessible storage of tools and equipment.
Soil quality should always be considered when planning a garden as it can be contaminated with biological (microorganisms), chemical (pesticides/herbicides, lead and other heavy metals) and physical hazards. People can be exposed to these contaminants in the soil through ingestion (eating soil), skin exposure and inhalation (breathing). Young children may accidentally ingest more soil than older children and adults because of their frequent hand-to-mouth contact placing them at an increased risk of exposure to soil contaminants.
For more information on soil quality, collecting and interpreting soil samples see our soil and gardening guidelines: From the Ground Up: Guide for Soil Testing in Urban Gardens.
When planning a garden it is important to consider previous and current land use practices of neighbouring properties in the immediate area. The following gardening practices as per TPH’s soil and gardening guideline aims to reduce exposure to soil contaminants. Some actions to consider include:
- identifying sources of potential soil contamination
- building a raised bed garden (child sized plots) or use planters or pots
- protecting soil from animals (e.g., wire mesh, fencing)
- using pasteurized garden soil or compost
- washing hands after gardening
- washing produce thoroughly
- peeling root vegetables before eating
- eliminating stagnant water to prevent mosquito breeding sites
Pests such as mice, rats and cockroaches pose a potential health risk, as they are known to carry disease and can trigger or worsen asthma symptoms in some individuals. Every child care centre must implement and follow an integrated pest management (IPM) program. IPM consists of a multi-pronged approach which focuses on pest prevention. Core principles of IPM involve eliminating pests’ access to food, water and shelter. Child care operators must:
- provide adequate pest control
- notify/consult a licensed pest control operator if any pest activity is observed in the premises
- follow the IPM principles of eliminating pests’ access to food, water and shelter, which include, at a minimum:
- cleaning all rooms (especially food preparation areas), closets, cupboards and storage areas regularly
- inspecting the exterior structure of the building.
- eliminate pest access into the building by repairing/replacing screens or by plugging holes, cracks and other entryways
- addressing structural issues inside the facility
- ensuring clutter and accumulation is reduced inside and outside the facility to eliminate places where rodents/vermin can live
- ensuring food and sensory play materials (e.g., dried pasta) are stored in labelled plastic containers with tight fitting lids
- monitoring for pest activity such as live or dead rodents/vermin and/or their feces
- ensuring that pest control reports can be made available to the Public Health Inspector upon request
- documenting dates/times of pest control services provided
Interaction with animals can provide a valuable learning experience for children. However, bringing animals and children together has potential risks. Infants and children, particularly those less than 5 years of age, have an increased risk of infection that can cause serious illness. This is due to their developing immune systems and frequent hand-to-mouth activities. Child care operators and other adults may also be at increased risk. These risks include exposure to zoonotic diseases (e.g., Salmonella and E. coli), injuries (e.g., bites, bruises, and scratches), and allergies. Zoonotic diseases are transmitted from animals to humans through direct and indirect contact. Visiting and resident animals may be a source of a number of zoonotic diseases from pathogens such as bacteria, viruses, parasites, and fungi.
Dogs, cats, rabbits, birds, rodents (e.g., mice, hamsters, rats, gerbils, guinea pigs) and fish are permitted in child care centres. In order to prevent injury or illness to children and staff:
- dogs and cats shall be fully immunized against rabies
- dogs and cats must be up-to-date with other applicable vaccinations and medications and be on a flea, tick and intestinal parasite control program
- animals must be trained and be in good health
- animals must have an appropriate temperament to be around children and show no signs of disease
- pet birds (e.g., budgies, parakeets) are strongly discouraged in child care centres
Animals Not Recommended for Child Care
The following animals are not recommended for children and must not be housed in or allowed to visit any child care centre:
- exotic animals (e.g., hedgehogs, monkeys)
- wild/stray animals (e.g., bats, raccoons, stray dogs or cats, squirrels)
- inherently dangerous animals (e.g., lions, cougars, bears)
- venomous or toxin-producing animals (e.g. venomous or toxin producing spiders, insects, reptiles and amphibians)
- ill animals or animals under medical treatment
- young animals (e.g., puppies and kittens less than 1 year old)
- animals that have been fed raw or dehydrated foods, chews, or treats of animal origin within the past 90 days
- birthing or pregnant animals
- animals from shelters unless they have been in a stable home for at least 6 months
- aggressive animals
- animals in estrus (i.e., animals in heat)
- rabies reservoir species (i.e., bats, skunks, racoons, foxes)
Animals Not Recommended for Children Under Five Years of Age
The following animals are not recommended for children less than five years of age and must not reside in or visit facilities that share staff or programming areas with children under five years of age:
- reptiles (e.g., turtles, snakes and lizards)
- amphibians ( e.g., frogs, toads, and salamanders)
- live poultry (e.g., chicks, ducklings and goslings) including hatchery equipment
- farm animals (e.g., calves, goats and sheep)
Child care centre operators must collect and record the following information for visiting animals (e.g., travelling animal shows):
- date of visit
- name of animal owner(s)
- owner contact information
- animal(s) name and species
- proof of animal health documentation (see appendix 2.B Veterinary Care Statement for Animals Visiting Child Care Centres in the Ministry of Health and Long-Term Care’s Recommendations for the Management of Animals in Child Care Settings, 2018)
- description of the group of children/room(s) visited
- any additional guests in attendance (e.g., volunteers, parents)
- records should be kept on-site for one year and made available to Public Health Inspectors or parents/guardians who may request them
Child care centre operators may choose to house an animal in their centre. Child care centres must develop a resident animal care plan which includes:
- a listing of the staff members responsible for providing care for the resident animal, including times when the child care centre is closed
- the animal’s daily requirements, including feeding and exercise
- daily health screening of the animal for signs of infection/injury
- animal bathing and cleaning requirements
- enclosure cleaning/disinfection schedule and procedure
- designated location for the animal enclosure (separate from children’s eating and sleeping areas)
- contact number for the resident animal’s veterinarian
- annual completion of Veterinary Care Statement for Resident Animals in Child Care Centres.
Refer in Ministry of Health and Long-Term Care’s document Recommendations for the Management of Animals in Child Care Settings, 2018.
Cleaning, Disinfecting and Storing Animal Enclosures
Store animal enclosures appropriately to prevent cross contamination and reduce the risk of disease transmission. Animal enclosures:
- shall be kept separate from food preparation/children’s eating areas
- must be kept separate from sleep equipment/children’s sleeping areas
The following key points are necessary when cleaning and disinfecting animal enclosures:
- Assemble all required cleaning and disinfecting supplies.
- Put on gloves and protective outer garments (e.g., apron).
- Remove animal to a temporary holding area.
- Dispose of food, droppings, bedding material, etc. in a garbage bag.
- Clean animal enclosures, food containers, toys, etc. with soap and water, using a scrub brush to remove dirt. Rinse thoroughly with fresh water.
- Sinks used for food preparation and sinks used by children must not be used for cleaning animal enclosures and related items.
- Disinfect items with appropriate product following manufacturer’s instructions.
- Rinse items thoroughly, if needed to remove chemical residue, and dry.
- Use fresh bedding material, food, water, etc. when preparing the enclosure and before returning the animal to the enclosure.
- Clean and disinfect area(s) surrounding the enclosure and the animal’s temporary holding area.
- Sinks used during the cleaning must also be cleaned and disinfected after use.
- Discard single-use gloves or clean and disinfect reusable rubber gloves.
- Perform hand hygiene.
Child and Animal Interaction
The following key points are necessary to prevent injury or illness, and ensure safe interactions between children and animals:
- Operators shall report animal bites immediately to TPH by calling 416-338-7600 during business hours or 311 after hours.
- Operators must be educated as to which animals are permitted.
- Operators must supervise all contact between animals and children.
- Operators must teach children the humane and safe procedures to follow when in close proximity to animals:
- Treat animals gently and calmly. Never hurt, tease, frighten, surprise, or corner an animal.
- Avoid chasing and/or kissing animals.
- Never disturb an animal that is eating or sleeping.
- All children and staff who handle animals must practice hand hygiene (wash hands or use alcohol-based hand-rub) after contact with animals, their feed, toys, bedding and/or their environment.
- Children should avoid touching animal food and feces.
- Children should avoid eating or touching their face during and after animal contact.
- Animals must be housed within some barrier (e.g., enclosure) that protects the children.
- Animals must be prohibited from entering a food preparation area.
Occupational health and safety involves health and safety aspects in the workplace. The Ministry of Labour (MOL) directly oversees and enforces all matters relating to occupational health and safety. As such, the MOL employs Infection Control Practitioners in order to review requirements and provide consultation on IPAC issues in the workplace. As a result, occasional audits of “Health Care Facilities” are conducted.
Although child care centres are not defined under the Health Care and Residential Facilities Regulation, the MOL has set precedent by applying this regulation to work settings where IPAC is a key component of that work setting. Operators may be required to report staff cases to the MOL.
Additionally, the Health Protection and Promotion Act (HPPA), as well as sections of the Ontario Public Health Standards requires local public health units to investigate and alert the MOL with respect to occupational health hazards.
In order to comply with occupational health and safety legislation, activities in the child care centre may require the use of personal protective equipment (PPE) (e.g., gloves, mask, eye protection, and safety boots). Examples of activities that may require the use of PPE include handling hazardous chemicals such as those used for making your daily disinfection solutions. It is important to note that IPAC measures will also ensure compliance with occupational health and safety legislation (e.g., labelling hazardous chemicals). As well, it is important to ensure chemicals are stored out of reach from children and separate from food.
- Wear appropriate PPE for the type of activity (e.g., rubber gloves for cleaning and disinfection versus medical-type gloves for diaper change).
- Follow manufacturer’s instructions for using PPE.
- Ensure appropriate PPE is available for use by staff when required.
- Ensure proper donning (putting on) and doffing (taking off) techniques are practiced.
Biting incidents can occur among young children in child care centres during play or if they become upset. Most bites do not break the skin and are unlikely to cause infection. In addition, the risk of Hepatitis B, Hepatitis C or HIV transmission in child care settings is extremely low. When bites do break the skin, both children involved in the incident need proper assessment and management.
Information for Child Care Centres
Be Prepared Before a Bite Happens
- Ensure your facility has written policies for managing child and employee exposures to blood and body fluids, including bites
- Ensure staff have received training for the proper care of bite wounds
- Ensure first aid equipment is readily available
- Ensure staff are immunized against Hepatitis B
If the skin is not broken, clean the wound with soap and water, apply a cold compress and sooth the child who was bitten.
If the Skin is Broken
- observe both children to see if there was any blood involved
- allow the wound to bleed gently without squeezing
- clean carefully with soap and water and apply first aid as per your policy
- inform the parents of both children as soon as possible (preferably within two hours of the incident)
- advise both children’s parents to contact their health care provider regarding post-exposure immunization and advice
- provide Toronto Public Health’s Biting Incidents – Information for Parents to the parents involved in the biting incident
- if either child has hepatitis B, C or HIV, report the incident to Toronto Public Health as soon as possible and ensure confidentiality of the children and parents is respected
Information Adapted from: A bite in the playroom: Managing human bites in child care settings, DL Moore, Canadian Pediatric Society, Paediatr Child Health 2008; 13 (6): 515-519, Feb 1 2014
Information for Parents
For incidents where a child has been bitten and their skin has been broken, parents and/or caregivers should monitor the wound for the next few days. If the wound becomes red or swells, take your child to their healthcare provider again.
If your child’s skin is broken, take your child to your family healthcare provider.
Your family healthcare provider will:
- review your child’s tetanus immunization status and update it as necessary
- start Hepatitis B vaccine series unless your child has already received the Hepatitis B vaccine series (normally given in Ontario in grade 7)
- contact Toronto Public Health immediately if your child has Hepatitis B, C or HIV to allow for confidential follow-up and counselling of the other child involved
Information adapted from: A bite in the playroom: Managing human bites in child care settings, DL Moore, Canadian Pediatric Society, Paediatr Child Health 2008; 13 (6): 515-519, Feb 1 2014
Tips to Reduce Biting Incidents
- Teach your child not to bite. When your child is old enough to understand, teach that biting hurts and can be dangerous to them and to the person they bite
- Do not pretend to bite your child or let your child bite you in play. Do not bite your child back if they bite as this will teach them to bite
- Reinforce a “no biting” rule at all times
- Young children are still learning self-control. Show your child how to express anger with words like “no” or “I don’t like that” instead of with biting
- Redirect or distract your child if you see a problem developing with a playmate
Information adapted from Caring for Kids, CPS, http://www.caringforkids.cps.ca/handouts/biting_in_child_care, accessed July 2015