When implementing infection prevention and control (IPAC) measures, child care centre staff should conduct a risk assessment for all activities that considers:
Surveillance is an important part of infection prevention and control, and the key to identifying an outbreak.
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:
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:
Child care centres must implement a hand hygiene program that ensures:
Ensure staff practice hand hygiene:
Ensure staff support, assist and supervise children when practicing hand hygiene:
Each licensed room with a designated hand washing sink (IPAC sink) must be equipped with:
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.
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:
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:
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:
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:
All cleaning agents:
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:
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:
Using a ready-to-use/pre-mixed disinfectant is ideal compared to mixing chemicals on site. When choosing a disinfectant consider products that are:
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.
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:
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:
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.
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.
Similar to environmental cleaning and disinfection, child care centres must implement a comprehensive toy cleaning and disinfection program which includes:
When cleaning and disinfecting toys:
The following practices are necessary to reduce the risk of disease transmission to children when playing with toys and participating in sensory play activities:
The following sensory play materials may be used:
The following sensory play materials must not be used:
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:
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:
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:
The following animals are not recommended for children and must not be housed in or allowed to visit any child care centre:
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:
Child care centre operators must collect and record the following information for visiting animals (e.g., travelling animal shows):
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:
Refer in Ministry of Health and Long-Term Care’s document Recommendations for the Management of Animals in Child Care Settings, 2018.
Store animal enclosures appropriately to prevent cross contamination and reduce the risk of disease transmission. Animal enclosures:
The following key points are necessary when cleaning and disinfecting animal enclosures:
The following key points are necessary to prevent injury or illness, and ensure safe interactions between children and animals:
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.
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.
If the skin is not broken, clean the wound with soap and water, apply a cold compress and sooth the child who was bitten.
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
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:
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 adapted from Caring for Kids, CPS, http://www.caringforkids.cps.ca/handouts/biting_in_child_care, accessed July 2015