Infection Prevention & Health Safety in Early Childhood Centers

• Jen McCloud, RN, presented information in January 2025 regarding infection prevention and control in early child development centers

Infection Prevention and Control

• It is a set of practices to minimize the spread of infectious diseases among children and staff.
• Good hygiene, surface cleaning/disinfection, bodily fluid handling, and education on hand-washing/cough etiquette are included.
• It takes proactive measures to prevent germ transmission in childcare.
• It protects children and staff against illnesses.
• Hygiene and cleanliness should provide confidence in the facility.

Germs

• They are tiny living organisms that can be found everywhere.
• Germs include viruses, bacteria, parasites, and fungi.
• Most germs are harmless and beneficial to health, however some can cause infections and illnesses.
• Germs thrive in warm, moist places.
• Some germs survive inactive on dry surfaces for a long time.
• Some survive hours, while others survive days and weeks.
• They can become active when they come in contact with moist surfaces.
• Bacteria may cause cavities, urinary tract infections, ear infections, or strep throat and antibiotics are used to treat bacterial infections.
• Viruses spread easily and can cause colds, the flu, and very serious diseases like smallpox.

Germ Spread

• Germs can be spread via direct contact, such as shaking hands.
• Droplets caused by coughs and sneezes can spread germs when they land on any surface.
• Fecal-oral transmission can occur when one uses the restroom and fails to wash their hands afterward.
• Indirect contact such as the touching of toys, doorknobs, keyboards, sinks, and faucets, can also cause gem spread.
• Germs can remain in the air thus spreading and causing infection.
• Coughs and sneezes can travel approximately 6 feet.

Germ Transmission

• Germs are spread in Early Child Development Centers when hands touch people, objects, runny noses, toys, handled items, arms, sleeves, or shirts.
• Germs are spread in Early Child Development Centers on surfaces and diaper changing areas touched by staff's hands.
• Germs are spread in Early Child Development Centers through breathing in airborne droplets from coughing/sneezing.
• Germs are spread in Early Child Development Centers via surfaces that have come in contact with mucus, saliva, vomit, blood, or urine.

Germ Transmission Factors

• Crowding: More people in a space increases the likelihood of germ transmission.
• Unhygienic behaviors: Germs can spread if people don't wash their hands or don't cover their coughs and sneezes.
• Susceptibility of young children: Young children are more likely to get stick due to constantly touching their surroundings and other people.

Chain of Infection

• Next sick person (susceptible host): babies, children, the elderly, and people with weakened immune systems.
• Germs get in a susceptible host via the mouth, cuts in the skin, and/or eyes.
• Germs get around to people via contact such as hands, toys, and sand, and/or droplets when one speaks, sneezes, or coughs.
• Germs get out via the mouth (vomit, saliva), cuts in the skin via blood, or during diapering and toileting stool.
• Germs can be located in people, animals, food , soil, and water
• Germs can be bacteria, viruses, parasites, or fungi

Reducing Germs

• The number of disease-causing germs that enter the body should be at a manageable level that the body can manage.
• Preventative care from health professionals should be practiced.
• Healthful practices such as good nutrition, exercise, and sleep should be followed.
• Staying up-to-date on vaccines is important.

Break the Chain of Infection

• Handwashing for at least 20 seconds with soap and water should be reinforced, which effectively removes germs, dirt, and chemicals.
• Using a hand sanitizer with at least 60% alcohol can help staff and children avoid getting sick and spreading germs to others if soap and water are unavailable.
• Circulation: Increase air ventilation reduces the concentration of germs in the air and on surfaces.
• Doors and windows should be open to bring in fresh air when safe.
• Using fans (child safe) and air purifiers can aid in circulation.
• Surfaces and objects that are touched often, like desks, doorknobs, and toys should be cleaned and disinfected.
• Daily self-screening and screening of children should take place.
• Areas for diapers disposable pants, or soiled underwear should not use the floor for changing.
• Proper respiratory etiquette should be followed by covering coughs and sneezes with a tissue or the inside of the elbow, and washing hands after.
• Staying and/or keeping children home when one sees a child is ill is important.

Immunizations

• All recommended vaccines and screenings provide children/adults with the best protection.
• Up-to-date immunizations and documentation are required to attend.
• Immune systems are strengthened through vaccines.
• Vaccinated individuals have a decreased risk of weakened immune system infections, like influenza, measles, and chickenpox, increasing the risk of other infections.

Vaccine Refusal

• Some children and adults cannot receive certain vaccines because of a medical condition.
• Some states allow refusal because of religious or philosophical beliefs.
• Appropriate documentation is required on file in either of these cases.

Cleaning

• Cleaning is done with soap, water, and scrubbing, which removes germs, dirt, and impurities from surfaces.
• Most types of harmful germs are removed from surfaces in the cleaning process (like viruses, bacteria, parasites, or fungi).
• Sanitizing reduces the number of germs on surfaces to levels that public health codes or regulations consider safe.
• Sanitizing is done with weaker bleach solutions or sanitizing sprays.
• Surfaces that come in contact with children's mouths, such as infant feeding items and toys should be cleaned before sanitization.
• Disinfecting is done with stronger bleach solutions or other chemical products that destroy any remaining germs on surfaces after cleaning.
• Clean surfaces before they are disinfected.
• Disinfecting is important when someone is sick or at higher risk of getting sick

Cleaning, Sanitizing, and Disinfecting Schedules

• Surfaces that need to be cleaned daily include infant and toddler toys, counter tops, door knobs and cabinet door knobs, drinking fountains, napping blankets if they're shared, toilets and sinks, and floors.
• Other daily cleaning tasks that can arise include wiping liquid spills and splashes, dusting furniture/items, vacuuming both sides of your carpet or rugs, and cleaning the fridge.
• Surfaces that should be cleaned and sanitized after every use include potty chairs isolation areas, diapering spaces, high chairs, and dining tables after meals and utensils.
• Areas that require weekly cleaning, sanitizing, and disinfecting include walls, refrigerators, books and bookshelves, older children's toys, art rooms and art supplies, nap mats and blankets, trash cans ,and cribs and bedding.
• Surfaces that need cleaning monthly and quarterly include:
  • Curtains, blinds, and windows.
  • Furniture, windowsills, and baseboards (deep cleaning).
  • Shelves, closets, storage containers (clean, wipe, and disinfect)
  • Plumbing (check for any leaks
  • Clean carpets (twice a year)
• Machine washable cloth toys, dress-up clothes, and play activity centers should be washed weekly
• Drinking fountains should be cleaned daily.
• Computer keyboards and phones should be cleaned after each use.
• Changing tables should be cleaned after each use.

Cleaning Chemicals

• CleanSmart Toy Disinfectant Spray is used to sanitize hard, non-porous food contact surfaces by spraying the surface and letting it stand for 60 seconds before air drying, which requires no rinsing.
• CleanSmart Toy Disinfectant Spray disinfects hard, non-porous surfaces through spraying and letting stand for 10 minutes before air drying.
• CleanSmart Toy Disinfectant Spray kills RSV; Flu; Colds; Strep; E. Coli; Salmonella; +more and has no harsh chemicals.
• Sani-Cloth Germicidal Disposable Wipes are used on hard, nonporous surfaces only.
• Sani-Cloth Germicidal Disposable Wipes disinfect surfaces through wetting them thoroughly and allowing them to remain wet for 2 minutes before letting air dry.
• A clean water rinse is required for food contact surfaces after using Sani-Cloth Germicidal Disposable Wipes which require wearing protective gloves.
• Contact with skin should be avoided with Sani-Cloth Germicidal Disposable Wipes and hands should be washed thoroughly with soap and water after handling and before eating.
• Sani-Cloth Germicidal Disposable Wipes kill multiple strands of bacteria, viruses, TB, Bloodborne Pathogens, and fungi and has harsh chemicals.
• All cleaning supplies should be kept out of the reach of children.

Staff Frequency

• Staff members should be more vigilant about precaution routines when there are outbreaks of illness in a particular classroom or the whole facility or in the community
• When there is known contamination of surfaces by contact with bodily fluids like mucus, vomit, fecal material, wound or eye discharge, or blood.
• When one can see visible soil/dirt.
• Following recommendations by the health department or the CDC about the need to be more vigilant to control certain infectious diseases.

Toys/ Objects

• Toys that cannot be washed and, if mouthed, cannot be sanitized, should not be used.
• Mouthed toys or toys contaminated by body secretions or excretions should be removed from the play area until they are washed, rinsed, sanitized, and air-dried or washed in a dishwasher for hard-surfaced toys.
• Machine-wash for clothed toys.
• Indoor toys should not be shared between groups of infants or toddlers unless they are washed and sanitized before using from one group to another.
• Teething toys and similar objects should be cleaned, and reusable parts should be sanitized between uses.
• Pacifiers should not be shared.

Bedding/ Clothing/ Cribs

• Sleep equipment and bedding should be used only by one child and washed before use by another child.
• Children who are noted for mild ill symptoms (coughing, sneezing) should be spaced at least 3 to 6 feet away from other children, when able.
• This spacing allows large coughed-out or sneezed droplets to fall to the floor rather than another child's sleeping space.
• Privacy (locked door) for toileting should not be offered until most children in the groups become capable of independent and proper toileting procedures (generally between 5-6)
• Teachers/caregivers should ensure children follow proper toileting behaviors.

Plan of care, observation and reporting of ill Children

• Staff should notify the Nurse of a child with 3, or more, mild symptoms (runny nose, cough, ear pain/tugging/pulling, etc.) or any one concerning symptom (new rash, difficulty breathing, lethargic, etc.)
• The nurse will assess and analyze their health status and provide interventions, and collaborate care as necessary.
• If child is to be sent home due to illness, the goal will be to keep the child separated from others when and if able.
• The Nurse, or a designated staff, will notify parents/guardians
• One should observe and report changes in behavior or appearance, such as sleepiness, or fatigue and decreased playfulness, or appetite.
• One should observe and report a runny nose, cough, or breathing trouble (fast breathing, flaring nostrils, belly breathing), along with new skin rashes or itchy skin or scalp, new bumps or bruises, and open sores or weeping skin rashes.
• Observe and report increased irritability, complaints of pain or not feeling well
• Also Observe and report vomiting, diarrhea, or stomach ache
• Notify if family reports that a family member has or has been exposed to a harmful communicable disease.
• Report signs of fever, such as flushed appearance or shivering.
• For the most accurate and consistent reading throughout the temperatures should be taken for the whole facility following one technique by the nurse only.
• The method chosen should fall to the person's skill taking the the temperature and the ability of the child to assist in the procedure.
• Taking a forehead temperature measure the heat waves coming off the temporal artery that runs across the forehead just below the skin and may be used on any age
• Ear temperatures can be used on children 6 months of age or older and it is dependent on the users ability to pull the childs ear back properly to obtain an proper reading.
• The child's activity level and sense of well-being are far more important than the temperature reading and any device used improperly will give inaccurate results.

Exclusion of Children

• Teachers or staff should notify the Nurse if a students health is compromised due to illness.
• The conditions or diagnosis for exclusion will meet 3 criteria determined by the Nurse and Education Director which include if condition is transmissible, harmful and excluding will reduce the spread of infection.

Promoting Wellness

• Being nourished supports the immune system, getting sleep and exercise promotes brain development and health including hygiene, outdoor play and safety for staff and children is important to the facilities well being.

Explore different routes of germ transmission, including direct and indirect contact. Learn about handwashing, vaccinations, and cleaning practices to minimize the spread of infection. Understand why children are more susceptible and how to break the chain of infection.