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Wipe and Wash: Outwitting Germs in Child Care |  |
Most child care providers know and accept the fact that many illnesses will spread among the children and the staff every year. Providers often manage to attend to children with a wide range of illness in their centers and homes; from a child with mild symptoms such as a sore throat to a child with potentially more serious symptoms such as difficulty breathing or a severe rash covering parts of the child's body. No matter what precautions providers take, children will get sick, and some children will get sick while in the child care setting. However, through education on child and general health issues, providers can lessen the frequency of illness in their homes and centers. Providers can use the information to educate not only themselves and the children in their care, but also to educate all of the families using their services. The following guide is designed to help providers understand how germs are spread and how to alleviate and minimize the spread of germs in their homes and centers.
How Infections and Viruses are Spread
Infections and viruses are spread in a variety of ways. Some are spread through direct contact with an ill person while some are spread through the air as in the case of nose and throat discharges like sneezing and coughing. Some diseases are spread through contact with blood from an infected person while others are spread through fecal-oral transmission. Although it may seem as though the spread of infection at or in child care settings is commonplace and inevitable, there are many precautions that child care providers can take to protect themselves and the children in their care from infection.
Strategies to Protect
Yourself and Children from Infection
One of the most effective ways for providers and children to stay healthy is
also the easiest and least expensive. Regular and thorough handwashing is the
best way to lessen the chances of catching a cold or a more serious communicable
disease that may require prescription medication and visits to physicians.
Experts recommend washing vigorously with soap and warm water for no less than
15 seconds each time. The more often everyone's hands are washed throughout the
day, the less likely it is that staff and children will become ill or pass
illness along to others. Using regular liquid soap and a paper towel (or a clean
hand towel for each person) is the most effective way to kill germs on your
hands. Teaching children to wash their hands regularly is not only required of
providers, but will benefit the health and wellness of everyone in the child
care setting. Although antibacterial soaps and cleansing products are very
popular among consumers, it is unlikely that they offer any additional benefit
to users. In fact, antibacterial products may be contributing to the production
of more powerful and dangerous strains of bacteria. These new strains of
bacteria are becoming resistant to antibiotics, making it increasingly difficult
to treat common infections. Additionally, the American Academy of Pediatrics
does not recommend the use of sanitizing hand gels/rubs to be used in place of
handwashing in child care centers. Although many of these rubs are marketed to
busy child care providers, regular handwashing with warm water and soap remains
the most effective way to clean hands.
Steps to effective handwashing:
Turn water off using a paper towel instead of your bare hands. Turning the taps off with your bare hands will allow germs and bacteria to re-infect your hands.
Providers must wash their hands:
Upon arrival to the center
Before and after meal times and before handling any food
Before giving medication to a child
Before and after diapering a child
After using the toilet or assisting a child using the toilet
Handling body fluids from sneezing, coughing, wiping or blowing noses, or from open sores
After handling raw or uncooked foods, especially raw meats and poultry
After
handling pets or other animals
After playing in the sandbox with children
After coming into contact with detergents or bleach while cleaning the center
After
handling garbage
Children must wash their hands:
Upon arrival to the center
Before and after meal times
After being diapered or after using the toilet
After sneezing or coughing into hands
After handling pets or other animals
After playing outside
Before and after playing in water with other children
More and more often, children are being taught by caregivers to sneeze and cough not into their hands, but into the inside of their upper arm. With this method, children are less likely to contaminate their hands with germs when they sneeze and cough. With this simple change of habit, children and caregivers can lessen the chance of infecting others with their germs.
Teaching children to sneeze and cough into their upper arm minimizes the amount of germs that find their way onto children's hands. At the same time, cleaning and sanitation of children's toys and equipment on a regular basis is also very beneficial to everyone's health in the child care setting.
Children often are, and should be encouraged to participate in hands on activities while in child care. While this is developmentally appropriate for children, providers must also be aware that when young children play, toys and equipment will become soiled. Many providers do not have a schedule in place for the cleaning of center toys and equipment beyond what is required by licensing. Centers can develop their own schedules for washing toys based on the developmental levels of the children in care and the frequency of use of the toys and equipment.
Providers
caring for very young children (who tend to mouth toys and materials) may choose
to wash toys several times each week.
Older children likely do not need to have their toys and materials washed quite
as often.
Child care centers can use a mechanical dishwasher that meets the standard for
cleaning and sanitizing dishes and often find that this is the most effective
and quickest way to clean toys. If a center does not have this type of
dishwasher, another method of cleaning toys is to put them in a tub of warm,
soapy water. Let them soak for several minutes, then scrub them with a clean
dish scrubber. After rinsing, soak the toys in a tub of disinfecting solution
for at least 2 minutes. Then let the toys air dry completely before making them
available to children.
The recommended, and least expensive sanitizer for child care settings is household bleach. Household bleach comes in 2 strengths, 5.25% hypochlorite or 6.00% hypochlorite, both of which are safe for child care settings when measured according to licensing instructions. Because bleach solution loses its strength throughout the day, mix a new batch every morning.
To mix a disinfecting bleach solution, use ¼ C. bleach to 1 gallon fresh water, or 1 T. bleach to 1 quart water, or ¾ teaspoon bleach per 1 C of water. A disinfectant must be in contact with items and toys long enough to kill the germs. The minimum time for the bleach solution to be in contact with a surface (called "contact time") is at least 2 minutes. A disinfecting solution is appropriate for:
Diaper changing areas
Bathroom sinks, toilets
Clean up of blood or body fluid spills
Cleaning toys
Cleaning equipment such as phones and tables and chairs
Countertops
Floors
For sanitizing purposes, the recipe for bleach solution is 1 T. bleach to 1 gallon fresh water. The minimum contact time to sanitize surfaces is at least 2 minutes. A sanitizing solution is appropriate for:
Submerging eating utensils that have been washed thoroughly with detergent
Submerging other kitchen items; cups, plates, bowls, that have also been washed with detergent
As effective as handwashing and proper sanitation of toys and center equipment is in killing germs, these are not the only ways to prevent the spread of disease and infection. Up-to-date immunizations for both providers and children is crucial and is required by the Bureau of Regulation and Licensing. Immunization schedules for children can be obtained at the local Public Health Department or through a local clinic or doctor's office.
If a child is unable to be immunized because of a health condition, the child's doctor must provide a written statement documenting the reason why the child is exempt from the immunization requirement. If immunizations are not given because of the families' religious beliefs, then a waiver signed by the parent must be retained on file at the child care center. With assistance from a health professional, the provider should notify the parent of the risk of the spread of preventable disease.
Being informed and educated about blood borne pathogens is another way child care providers can reduce the risk of serious infection for themselves and for children. The possibility of coming into contact with infections like Hepatitis B, HIV and Hepatitis C resulting from exposure with another person's blood or body fluids can be frightening. Fortunately, according to the American Academy of Pediatrics, the American Public Health Association, and the Maternal and Child Health Bureau in their joint publication, Caring for Our Children, the risk of contact with blood containing these viruses is low in the child care setting. With proper precautions in place, providers can dramatically lessen the chance of infection from blood or body fluid spills.
Universal Precautions is the term used to describe the steps people must take to protect themselves from infections resulting from contact with blood or bodily fluids. All staff working in a child care setting must receive training on blood borne pathogens and Universal Precautions at the onset of employment.
Universal Precautions means that every incident in the child care setting where blood and/or bodily fluids are involved, are treated by staff as though an infection is present in those substances. Therefore, every staff must wear gloves and any other protective barriers needed, which may include protective eyewear and aprons, every time they attend to an injured or ill child or staff where blood, urine, vomit, or stool are present. Universal Precautions also require that staff disinfect every surface that may have been contaminated by these fluids.
When spills of blood or bodily fluids occur, the procedure to clean the area effectively is as follows:
The staff person handling the situation must first put on disposable gloves.
Use
disposable paper towels to wipe up as much of the visible material as
possible, then place the soiled towels and any other soiled materials in a
plastic bag that has been securely tied or sealed.
If the spill occurs on a hard surface, the entire area must be disinfected
immediately with a solution approved by Licensing, typcially this is a ¼ C.
bleach to 1 gallon water solution.
If the
spill occurs on carpeting, blot the area with paper towels immediately, then
spot clean the area with a detergent-disinfectant rather than a bleach
solution. Additional cleaning with a carpet shampooer or steam cleaner may
be necessary.
When cleaning of the area is completed, put contaminated gloves into a
plastic bag, then securely tie the bag and discard it.
Staff must then wash their hands and the hands of any children involved in
the incident very thoroughly.
Education of
staff and follow-through of health routines in child care settings is the best
defense against infectious disease. Armed with up-to-date knowledge, providers
can successfully stop many infections from spreading throughout child care
centers and homes. By carefully following the health and safety requirements of
the Bureau of Regulation and Licensing and by fully utilizing the strategies and
recommendations in this guide, providers can look forward to fewer colds,
viruses and outbreaks of infection in their child care settings.
For More Information:
Wisconsin Child Care
Improvement Project
2109 S. Stoughton Road, Madison WI 53716
www.wccip.org Click on "Health and
Safety"
Bureau of Regulation and
Licensing, Wisconsin
1 W. Wilson Street, Room 534
Madison, WI 53708-8916
www.dhfs.state.wi.us Click on
"Licensing"
American Public Health
Association
800 I Street, N.W. Washington, DC 20001-3710 Phone: 202-777-2742
www.apha.org Click on "News Room" or
"Public Health Links"
American Academy of
Pediatrics 141 Northwest Point Blvd. Elk Grove Village, IL 60007-1098
www.aap.org
Caring for Our Children (2002) American Academy of Pediatrics, American Public Health Assoc. Health Resources Service Administration National Resource Center for Health and Safety In Child Care www.nrc.uchsc.edu
National Child Care
Information Center
243 Church Street, NW 2nd Floor
Vienna, VA 22180 Phone: 800-616-2242 www.nccic.org
Centers for Disease Control
and Prevention (CDC) 1600 Clifton Road NE Atlanta, GA 30333
800-311-3534
www.cdc.gov
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