Information Sheets for Child Care Centres

Infection prevention and control (IPAC) information sheets are available to help child care centre operators, staff and children prevent the spread of illness. They are not intended as a substitute for written policies and procedures. Information sheets should be posted in appropriate locations throughout the child care centre.

 

Always apply routine practices! Assume all blood and body fluids are potentially infectious. When cleaning up blood or body fluids, PPE must be worn.

  1. Immediately isolate the area around the spill.
  2. Assemble required cleaning and disinfecting supplies and materials prior to putting on personal protective equipment (PPE).
  3. Put on gloves. If there is a risk of splashing or spraying, put on gown, mask and eye protection.
  4. Inspect the area around the spill for splash and splatter.
  5. If broken glass or other sharp objects are present, use a brush and dust pan to pick them up.
  6. Using disposable paper towels, clean up spill and discard into a plastic lined garbage container with a tight fitting lid.
  7. Using soap, water and friction, clean the entire contaminated surface. Be sure to clean all blood and body fluids from surface prior to disinfection.
  8. Rinse area with clean water. After rinsing, dry area with disposable paper towel prior to applying disinfectant.
  9. Disinfect the area following manufacturer’s instructions for disinfectant. Ensure contact time is achieved.
  10. Remove PPE and dispose in a lined garbage container with a tight fitting lid. Refer to Public Health Ontario How to Remove Personal Protective Equipment.
  11. Perform hand hygiene.

Notes

If spill occurs on carpet, follow steps 1-10, then shampoo/steam clean carpet.

Download the Blood & Body Fluid Spills information sheet (also available in French).

You can stop the spread of infection by breaking any links in the Chain of Transmission.

Germs

  • Viruses
  • Bacteria
  • Fungi
  • Parasites

Breaking the chain:

  • Cleaning and disinfection
  • Hand hygiene
  • Treatment of ill individuals (e.g., antibiotics)

Where Germs Live

  • People
  • Animals
  • Food
  • Environment

Break the chain:

  • Improving air filtration and ventilation
  • Safely storing and handling food
  • Water treatment
  • Safety measures when interacting with animals or the environment
  • Staying home when sick

How Germs Get Out

  • Blood and body fluids (e.g., saliva, mucus, vomit)
  • Broken skin
  • During diapering and toileting

Break the chain:

  • Respiratory etiquette
  • Safely disposing of waste and contaminated items
  • Hand hygiene

How Germs Get Around

  • Contact
  • Droplets and aerosols
  • Vectors

Break the chain:

  • Hand hygiene
  • Respiratory etiquette
  • Wearing a mask, additional PPE
  • Cleaning and disinfection
  • Isolating ill children until they can be picked up

How Germs Get In

  • Eyes, nose, mouth
  • Respiratory tract
  • Gastrointestinal tract
  • Cuts in the skin

Break the chain:

  • Hand hygiene
  • PPE
  • Avoiding touching your mouth, nose or eyes with unwashed hands

Next At Risk Individual

Anyone! Some individuals may be more vulnerable than others, including:

  • Infants,
  • Pregnant people
  • Those with weakened immune systems

Break the chain:

  • Immunization
  • Nutrition
  • Recognition and protection of vulnerable individuals

Download the Breaking the Chain of Transmission poster (also available in French).

Steps for Cleaning and Disinfection

  1. Gather equipment, perform hand hygiene and don appropriate PPE.
  2. Clean the surface or object, using warm water, soap, and friction. Cleaning removes dirt and debris.
  3. Rinse the surface or object, using clean, warm water. Rinsing removes soap residue.
  4. Disinfect the surface or object. Follow manufacturer’s instructions to ensure that the disinfectant is used safely and effectively. Allow appropriate contact time. Disinfection kills micro-organisms left behind after cleaning.
  5. Rinse with clean water when required according to manufacturer’s instruction on the label.
  6. Allow to dry.
  7. Remove PPE and perform hand hygiene.
  8. Store newly cleaned and disinfected items in a manner that prevents contamination.

Most household chlorine (bleach) comes as 5.25% (50,000 mg/L or parts per million (ppm)) sodium hypochlorite, and requires preparation prior to use:

Making Disinfectant using Household Bleach (Chlorine)
(5.25% sodium hypochlorite)		 Indications & When to Use Contact Time
500 ppm

To make this concentration, mix 10 mL of bleach (chlorine) with 990 mL of water.

 “Everyday use”

Use this concentration on surfaces and items, such as toys, play mats, diaper change tables, and activity tables.

 A minimum of 2 minutes. Allow to air dry.
5000 ppm

To make this concentration, mix 100 mL of bleach (chlorine) with 900 mL of water.

 “Blood and Body Fluids”

Use this concentration on surfaces and items that have been contaminated with blood or body fluids.

 A minimum of 2 minutes. Allow to air dry.
1000 ppm

To make this concentration, mix 20 mL of bleach to 980 mL of water.

 “Outbreak Situation”

Use this concentration during an outbreak in the child care setting.

 A minimum of 2 minutes. Allow to air dry.

 

For more information on how to dilute chlorine (e.g., to 100 mg/L or ppm),
see the Public Health Ontario’s Chlorine Dilution Calculator.

  • Chlorine (bleach) is not a cleaning agent, and surfaces must be cleaned in order for bleach to be an effective disinfectant.
  • Chlorine (bleach) must be diluted using water only. Never mix chlorine with any other chemicals or cleaning products.
  • Chlorine (bleach) solution must be prepared daily, as it loses efficacy within 24 hours. Clearly label the container with chlorine concentration. Record the time that the solution was prepared.
  • As with all chemicals, chlorine (bleach) must be labelled and must be stored in a safe, secure location that is inaccessible to children, and away from heat and light.
  • Do not spray chlorine solution when children are present. Provide ventilation and minimize misting while applying.

Download the Chlorine (Bleach) Solutions for Disinfecting information sheet (also available in French).

  1. Collect the required supplies. If using diaper cream or ointment, dispense it onto tissue or applicator now.
  2. Perform hand hygiene. Put on a pair of single-use gloves.
  3. Clean the child’s diaper area.
  4. Discard soiled diaper, wipes and other used items. Remove and discard soiled gloves.
  5. Perform hand hygiene.
  6. Diaper and dress the child.
  7. Help the child to perform hand hygiene. Return the child to supervised area.
  8. Perform hand hygiene and put on a new pair of disposable gloves.
    Clean and disinfect the diaper changing surface.
  9. Remove and discard gloves. Perform hand hygiene again.

Notes

If diapering cream or ointment is needed, ensure products used are labelled with the child’s name, stored separately to prevent accidental sharing, and dispensed in a manner that does not contaminate the original patch (e.g., dispense onto a disposable applicator or paper towel when gathering supplies).

If the child’s clothing is soiled, place the soiled clothing in a securely tied bag and send home with child’s parents or guardian. Do not rinse or wash soiled clothing in the child care centre.

Download the Diaper Change Routine information sheet (also available in French).

Gloves must be worn when diapering or toileting, and when hands will be in contact with mucous membranes, broken skin, blood, body fluids, or contaminated surfaces or objects.

Remember, disposable gloves should be used with the idea of one pair for one task. Never clean or re-use disposable gloves.

Wearing gloves does not replace the need for hand hygiene! Hand hygiene must be performed before putting on gloves and after removing gloves.

Putting on gloves

  1. Choose gloves that fit well.
  2. Perform hand hygiene.
  3. Pull the glove over your fingers and make sure that it covers your wrist.

Removing single-use gloves

  1. Grasp the outside of the outside of one glove near the wrist. Peel away from palm towards the fingers, rolling the glove inside out. The removed glove will end up in the opposite gloved hand.
  2. Using your ungloved hand, slide your index finger under the wristband of the gloved hand.
  3. Pull the glove outwards and down towards the fingers, rolling the glove inside out. Avoid touching the outside of the glove, as this is the contaminated region.
  4. With this technique, the first glove that was removed should end up inside of the second glove. Dispose of both gloves immediately and safely in the appropriate container.
  5. Perform hand hygiene.

Download the Glove Use information sheet (also available in French).

  • When hands are not visibly dirty and when hand-washing station is not available, then a 70-90% alcohol-based hand sanitizer can be used. If hands are visibly soiled, use soap and water to clean hands.
  • People who are involved in food preparation should not use hand sanitizers but instead, wash their hands with soap and water.
  • Children must be supervised if using hand sanitizer to clean hands. Ensure children cannot access hand sanitizers independently.
  • Child care centres must ensure that alcohol-based hand sanitizer products are kept out of reach of children.

Follow these steps will help to kill germs in your hands:

  1. Apply sanitizer (minimum 70% alcohol-based). Apply enough to effectively cover all surfaces, including the backs of your hands, fingertips and under your nails.
  2. Rub hands together until hands are dry.
  3. Work sanitizer between fingers, back of hands, fingertips, under nails.
  4. Rub hands until dry.

Stop the spread of germs – Clean your hands!

Everyone should practice hand hygiene…

  • When they arrive at the child care centre, before entry into any room, and before they go home
  • After using the washroom or after a diaper change
  • After coming in from outdoors
  • Before and after eating, before drinking
  • Before and after handling animals, pet cages or other pet objects
  • After covering a cough, sneeze or blowing their nose
  • Before and after sensory play activities
  • Before and after touching their eyes, nose or mouth
  • Whenever hands are visibly dirty
  • Whenever in doubt

In addition, child care staff should practice hand hygiene…

  • Before and after preparing, handling or serving food, preparing bottles or feeding children
  • Before and after giving medication or applying ointment or lotion
  • After changing diapers, assisting children to use the toilet or using the washroom
  • After contact with broken skin or body fluids (e.g., runny nose, spit, vomit, blood, cut or open sore), even if gloves were worn
  • Before and after glove use
  • After cleaning, handling garbage or contact with contaminated surfaces

Remember! If hands are visibly soiled, do not use hand sanitizer but instead, wash your hands with soap and water.

Download the Hand Sanitizing information sheet (also available in French).

When clean, running water is available, wash hands with soap and water and dry thoroughly. In child care centres, children and staff should use a sink that is dedicated for the purpose of hand hygiene.

Assist and supervise children when performing hand washing.

Follows these steps for perfectly clean hands:

  1. Wet hands.
  2. Apply soap. Child care centres must use liquid soap from a dispenser.
  3. Lather for 15 seconds. Rub between fingers, fingertips, underneath nails, wrist, palms, back of hands.
  4. Rinse well under running water.
  5. Dry hands well with a disposable paper towel or an air dryer.
  6. Turn taps off with the disposable paper towel. This will prevent hands from being contaminated.

Stop the spread of germs – Clean your hands!

Everyone should practice hand hygiene…

  • When they arrive at the child care centre, before entry into any room, and before they go home
  • After using the washroom or after a diaper change
  • After coming in from outdoors
  • Before and after eating, before drinking
  • Before and after handling animals, pet cages or other pet objects
  • After covering a cough, sneeze or blowing their nose
  • Before and after sensory play activities
  • Before and after touching their eyes, nose or mouth
  • Whenever hands are visibly dirty
  • Whenever in doubt

In addition, child care staff should practice hand hygiene…

  • Before and after preparing, handling or serving food, preparing bottles or feeding children
  • Before and after giving medication or applying ointment or lotion
  • After changing diapers, assisting children to use the toilet or using the washroom
  • After contact with broken skin or body fluids (e.g., runny nose, spit, vomit, blood, cut or open sore), even if gloves were worn
  • Before and after glove use
  • After cleaning, handling garbage or contact with contaminated surfaces

Download the Hand Washing information sheet (also available in French).

  • Ensure all staff and children wash their hands before and after sensory play activities.
  • Do not eat or drink while participating in sensory play or arts & crafts activities.
  • All sensory play materials must be age-appropriate and safe for use by children.
  • Use tubs/bins/surfaces that have been cleaned and disinfected. Containers should be cleaned and disinfected after each use and prior to refilling.
  • Empty water play tub/bin (or individual bin) after each use. Once emptied clean and disinfect the tables.
  • Store reusable sensory materials in covered containers.
  • Discard used homemade play dough daily.
  • Play dough must be made from non-toxic materials.
  • Sand purchased for play tables should be labelled as play sand and must be silica-free.
  • Food sensory play items such as dry pasta or rice must be stored in labelled containers with tight fitting lids. These items should not be stored with food intended for consumption. Discard dry food products at least weekly or immediately if they become wet or contaminated.

Sensory play during an outbreak

  • SUSPEND communal sensory play during an outbreak until the outbreak is declared over by Toronto Public Health
  • Any sensory play items prepared and in use prior to an outbreak being declared must be discarded (e.g., play dough and dried food items). Clean and disinfect all sensory play tubs and bins
  • Advisable to stop sensory play during increased absenteeism

Notes

Examples of sensory play materials include:

  • Water, dry pasta, store-bought sand, play dough, clean snow, pine cones, twigs and leaves

Examples of sensory play materials not recommended:

  • Sand, gravel, soil and other materials obtained from outdoor locations that may be contaminated
  • Used meat trays, egg cartons and toilet paper rolls
  • Garden soil containing fertilizers, manure or other products containing possible fecal matter or chemicals

Information about toy and product safety can be found on the Government of Canada’s consumer Product Safety webpage.

For more information, please visit Toronto Public Health’s Infection Prevention & Control Measures webpage.

Download the Sensory Play information sheet (also available in French).

  1. Prior to assisting children to use the toilet, gather required supplies.
  2. Perform hand hygiene. Put on a pair of single-use gloves.
  3. Place the child on the toilet.
  4. Assist the child with cleaning themselves (if necessary). Discard diaper (if applicable). Ensure that any soiled clothing is rolled and placed into a securely-tied plastic bag or container. This bag must be sent home for laundering at the end of each day.
  5. Remove gloves. Perform hand hygiene.
  6. Help the child get dressed. After, help the child to wash their hands. Return child to a supervised area.
  7. Put on a new pair of disposable gloves.
  8. If using a potty, empty contents of potty into the toilet carefully to avoid splashing. Clean and disinfect the potty.
  9. Clean and disinfect the toilet seat and toilet ring insert, when visibly soiled.
  10. Remove and discard gloves. Perform hand hygiene again.

Download the Toilet Routine information sheet (also available in French).

Three-Compartment Sink/Bin Method

1st Sink: Wash with detergent

2nd Sink: Rinse with clean water

3rd Sink: Disinfect

Air dry

Notes

  • If using a two-compartment sink: washing and rinsing must be done in 1st sink.
  • A dishwasher may also be used to wash and disinfect toys.
  • Wear personal protective equipment (PPE).
  • Clean hands after removing PPE.
  • Rinse after required contact time with the disinfectant has been achieved, when required according to manufacturer’s instructions.
  • For mouthed toys, check products to confirm they are appropriate for use on food contact surfaces OR use a mechanical dishwasher. Mouthed toys must be thoroughly rinsed with water following disinfection.

Download the Toy Cleaning & Disinfecting information sheet (also available in French).