Infection Prevention and Control

“Germs” is a common term used for bacteria, viruses, fungi, and some parasites. They are found everywhere. Some of germs help us to stay healthy. However, many different germs can lead to infection or disease. Infection from germs can be spread from person to person, or from the environment to person, which is called communicable disease. Germs can spread in many ways:

Through the air. Usually in droplets that are coughed, sneezed, or breathed into the air by a person who is infected. Some germs such as the common cold, influenza, and mumps travel short distances. Others, such as measles and chickenpox, stay in the air longer and can travel longer distances.
By contact. For some diseases this needs to be direct person-to-person contact with an infected person. In other cases, germs are spread by indirect contact – contact with an object that has germs on it. Some of the infectious diseases spread by contact are pink eye, impetigo, and norovirus.
Blood or body fluid. Some diseases can be spread through contact with blood or other infectious body fluids. When the infectious blood or body fluid contacts an area where it can enter the body, such as an eye, mouth, other mucous membrane, or broken skin, the disease can potentially be transmitted. Examples of the diseases spread in this way are HIV, hepatitis B, and hepatitis C.
Food or water. This is how food-borne illness occurs. Some of the diseases spread in this way are Salmonella, E. coli, and listeriosis.
By insects or animals. Some of the diseases spread in this way are Lyme disease, West Nile virus, psittacosis, and rabies.

Many germs spread in more than one way. For example, the influenza virus can be spread in droplets in the air or by contact with a tissue that someone with the flu has used to blow their nose.

It takes very few germs to cause an infection. Just because something looks clean does not mean that it is. Therefore, it is important for your child care to have policies and procedures in place that will protect the children and staff from becoming infected.

Routine Practices

We cannot always tell when someone has an infection. Some people may be infected with germs and not appear sick. However, they may still be able to pass the germs on to others. For this reason, routine infection control practices should be used with everyone, whether they appear sick or not.

Routine infection control practices help reduce the chances of an infection spreading from one person to another and are part of an effective infection control program.

Wash your hands. Handwashing is the best way to prevent the spread of infection. Proper handwashing reduces the spread of colds and influenza by as much as 40%.
Use disposable gloves when handling blood or body fluids, when cleaning cuts or scrapes, or when changing a child’s diaper. Wash hands with soap and water before donning gloves and after disposing the gloves.
Cover your mouth and nose with a tissue when you cough or sneeze. If a tissue is not handy, cough or sneeze into your sleeve, and not your hand.
Clean and disinfect diaper change areas between uses.
Keep toilets visibly clean.
Do not share personal items such as hairbrushes, toothbrushes, towels, facecloths, sippy cups, or hats.
Wash school or daycare laundry using detergent and warm water. The child’s soiled clothing can be put into a plastic bag, sealed with a knot, and sent home to be washed.

When there is an increase in cases of illness, contact the Health Unit’s CDC Program at 1-800-563-2808 ext. 5229. For additional steps to control the spread of disease, the Illness Surveillance and Outbreak Management page.

Using Gloves

Gloves help prevent hand contamination. However, the use of gloves is not a substitute for proper handwashing. Gloves are used to prevent or reduce the risk of transmission of germs from children to staff and vice versa. They prevent exposure to an infectious source by placing a barrier between the source and the skin.

Gloves should be worn when it is expected that the hands will be in contact with mucous membranes (eyes, nose, or mouth), broken skin, blood, body fluids, and contaminated equipment or surfaces.

Gloves should be made of sufficient quality to provide adequate protection. Gloves may not provide full protection as leaks, tears, or punctures can occur. Therefore, handwashing should take place before gloves are put on and after they have been removed.

Disposable Gloves

It is important to remember when gloves are being used, they must be changed frequently and always before the start of any new activity. Gloves must be discarded immediately in the garbage after a single use. Allergies to latex may discourage the use of disposable gloves.

However, disposable gloves are available in non-latex (vinyl) form.

Disposable gloves can be useful if they are worn at the following times:

To cover severe dermatitis, cuts, or open sores on a staff member’s hands—the staff member should have their sores covered with bandages

To care for children with severe dermatitis, cuts, or open sores—these children should have their sores covered with bandages

If there is a risk of exposure to blood or body fluids

To change a diaper after a child has had a bowel movement

Proper removal of gloves is important. If gloves are not removed properly, your hands and other objects can be contaminated and the whole purpose for wearing the gloves has been defeated.

Proper procedure for removing disposable gloves:

Grasp the glove at the base of the palm just below the cuff and pull the first glove inside out.

Reach inside the cuff of the second glove and slowly turn it inside out while removing it over the first glove.

Place the gloves in a garbage container lined with a garbage bag.

Wash your hands.

Household Reusable Rubber Gloves

This type of glove is used primarily to prevent hands from becoming dry and irritated from contact with soap, water, and disinfection solutions.

Separate reusable gloves should be assigned to the following applications:

Dishwashing by hand

Cleaning toys and general housekeeping

Cleaning washrooms and potties

Cleaning up large amounts of stool, urine, or vomit

To help identify the purpose of each set of gloves, store them in the area where they will be used and keep them out of the reach of children.

After each use, ensure that the gloves are rinsed, cleaned, and disinfected. Then hang the gloves to dry before reuse.

Cough and Sneeze Etiquette

You can help stop the spread of germs that make you and others sick by practicing “cough and sneeze etiquette”.

Using a Tissue

Always cover your mouth and nose with a tissue when you cough or sneeze.

Throw the used tissue into a garbage can, and then wash your hands using either liquid soap and water or an alcohol-based hand sanitizer.

Using Your Elbow

If you do not have a tissue, cough, or sneeze into your elbow—not your hand.

Keep your hands away from your eyes, nose, and mouth.

Germs (on your hands) can enter your body through the mucus membranes of your eyes,nose, and/or mouth.

Poster: Cover your Cough

Cleaning and Disinfecting

Environmental Control

The facility’s environment may be a source or means for transferring infections. The environment includes, but is not limited to, high contact surfaces, equipment, furniture, all floors, walls, and ceilings. Regular cleaning and disinfection of equipment and high contact surfaces is needed to prevent the transmission of infectious agents.

Cleaning and disinfecting procedures and frequencies should be established for your child care. These procedures should be specific enough to point out the process, the products required and the frequency for cleaning and disinfection of equipment and environmental surfaces. The policies should also provide instructions for cleaning and disinfection during outbreaks.

Cleaning:

A cleaning step is required prior to disinfection to remove organics and debris from equipment, objects, and surfaces.
Cleaning involves the physical removal of organic matter and debris using soap and/or detergent followed by rinsing with clean water. It is conducted prior to disinfecting the facility.

Disinfection:

Disinfection is the inactivation of disease-producing microorganisms.

Disinfecting does not destroy bacterial spores. It is conducted after the equipment has been cleaned thoroughly for it to be effective. The level of disinfectant used will depend on the use and the type of equipment, surfaces and objects and the nature of contamination.

Principles for Routine Environmental Cleaning and Disinfection

A predetermined schedule must be followed for routine cleaning and disinfection of environmental surfaces.

All surfaces and equipment must be cleaned before disinfection can be performed. Disinfection can only take place after cleaning.

The level of disinfectant to be used will depend on the equipment or surface being disinfected. Refer to the chart below as a guide.

Disinfectant solutions must be mixed and used according to manufacturer’s instructions.

When applying a disinfectant to a surface, a certain amount of contact time is needed for the disinfectant to work. Follow the manufacturer’s instructions for contact time required.

Some disinfectants require a final rinse depending on the use of the equipment, object, or surface. Read the product label to determine if a final rinse is required.

Damp (rather than dry) dusting or sweeping should be done whenever possible.

Ensure cleaning and disinfection is carried out from the least soiled areas to the heaviest soiled areas.

Disinfection Charts*

Lower Level Disinfection Chart

Disinfectant	Concentration	Recipe	Contact Time	When to use
Chlorine (bleach) 5% to 6% sodium hypochlorite	100 ppm	1 tsp bleach with 10 cups of water	10 minutes	General disinfectant products for everyday use
0.5% Accelerated Hydrogen Peroxide	Follow manufacturer’s instructions	Follow manufacturer’s instructions	Follow manufacturer’s instructions	General disinfectant products for everyday use

Higher Level Disinfection Chart

Disinfectant	Concentration	Recipe	Contact Time	When to use
Chlorine (bleach) 5% to 6% sodium hypochlorite	5000 ppm	¼ cup bleach with 2¼ cups water	10minutes	Use during gastroenteritis outbreaks

*Please note: Manufacturer’s instructions take precedence.

Resources

A one-page PDF version of the Cleaning and Disinfection information

Information sheet on Accelerated Hydrogen Peroxide (APH).

Guidelines for Cleaning and Disinfecting

Kitchen

Counters: clean before and after each use

Food contact surfaces: clean and sanitize before and after each use

Sinks: clean and sanitize after each use

Bathroom

Diaper table: clean and disinfect after each use

Potty: clean and disinfect after each use

Toilet: clean and disinfect daily and when soiled

Sinks: clean and disinfect daily and when soiled

Floors: clean and disinfect daily and when soiled

Sleep Room

Bedding: launder weekly, between children, and when soiled

Cribs: clean and disinfect weekly, between children, and when soiled

Playpens: clean and disinfect weekly, between children, and when soiled

Sleep mats: clean and disinfect weekly, between children and when soiled

Floors

Smooth: vacuum or sweep daily, wash weekly, and when dirty

Carpet (infant rooms): vacuum daily, clean using steam or hot water every month

Carpet (all other rooms): vacuum daily, clean using steam or hot water every 3 months

Miscellaneous

Cleaning cloths: launder after each use

Water play equipment: clean and disinfect after each use

Fountains: clean and disinfect daily

Toys

Choose toys that are washable, sturdy, and too large to be swallowed to prevent choking.

Choose toys that can be cleaned and disinfected.

Stuffed toys should be machine washable.

Clean toys when visibly dirty and at least once a week.

Clean toys daily if toys are used a lot, or if there is illness in the child care.

Remove toys from circulation that children have put in their mouths or that have other body fluids on them until they can be cleaned and disinfected.

When cleaning toys, check them for sharp, jagged edges or small pieces that can be easily broken off. If toys cannot be fixed, throw them away.

To Clean Hard Toys

It is important to clean and disinfect all toys, especially toys that may have been placed in children’s mouths. Each toy should be cleaned and disinfected before being placed back into circulation. You may choose one of these three options to clean hard toys:

Plastic toys that can withstand heat can be cleaned and sanitized in the dishwasher. A sanitizer cycle must be equipped on the dishwasher. The heat of the sanitizer cycle is hot enough to disinfect the toys.

Plastic toys that can be submerged in a sink or bucket must be cleaned with dish soap and water. Rinse with warm water. Disinfect the toys with an approved disinfectant and soak for the appropriate contact time. Allow toys to air dry.

For toys that are frequently touched and cannot be submerged, wipe rather than soak these toys. Clean toys with dish soap and water using a clean cloth. Wipe dry. To disinfect, wipe toys with a clean cloth soaked in a disinfectant or use a commercial disinfecting wipe. Allow toys to air dry.

To Clean Stuffed Toys

Clean stuffed toys in a washer with laundry soap.

Dry stuffed toys in a dryer on a normal setting.

REMEMBER: There are many disinfectants available for use. Make sure the disinfectant is safe for children. Follow the manufacturer's instructions when you use it. Some disinfectants may require a final rinse. Read the label!

Cleaning Spills

Hard Surfaces

Wash your hands. Wear gloves. Use paper towels to soak up and remove most of the spill.

Place soiled paper towels directly into a plastic garbage bag.

With a mop or cleaning cloth, clean the soiled area with detergent and water to remove any visible dirt or body fluids.

After cleaning, disinfect the area using a high-level disinfectant.

If you use a commercial disinfectant, follow the instructions on the label.

Close the bag using masking tape (to prevent it from being opened), deposit in garbage.

Remove gloves and other personal protective equipment, deposit disposable items in the regular garbage, clean and disinfect reusable personal protective equipment such as goggles or protective clothing.

Wash your hands.

Carpet and Upholstery

Wash your hands. Wear gloves.

Do not use a vacuum.

Blot up spill with paper towels.

Place soiled paper towels directly into a plastic garbage bag.

Apply a household detergent or disinfectant to cover the spot. Let sit for 30 minutes.

Blot up excess liquid with paper towels and dispose of them, per step 4.

Reapply detergent or disinfectant and let dry overnight.

Close the bag using masking tape (to prevent it from being opened), deposit in garbage.

Remove gloves and other personal protective equipment, deposit disposableitems in the regular garbage, clean and disinfect reusable personal protective equipment such as goggles or protective clothing.

Wash your hands.

Steam clean carpet and upholstery, if necessary.

Replace heavily soiled carpets and upholstery that cannot be effectively cleaned and disinfected.

Cleaning Equipment

Wash your hands.

Wear gloves.

Wash mops, cloths, and brushes in hot, soapy water and rinse. Ensure that all visible dirt is removed.

Soak mops, cloths, and brushes in a high-level disinfectant following the manufacturer’s instructions.

Disinfect the mop handle by cleaning and then wiping with a high-level disinfectant.

Clean and disinfect reusable personal protective equipment.

Clean and disinfect surface areas and sinks where you have cleaned equipment.

Remove gloves, deposit in regular garbage or clean and disinfect, and wash your hands.

Blood and Body Fluids

Body fluids include:

Urine

Feces (including diarrhea)

Saliva

Blood

Discharge from the nose

Vomit

It is a good idea to have a “spill kit” ready to be able to clean up spills of blood, vomit, diarrhea, or other body fluids that can carry infection.

Remember: Clean first, then use a high-level disinfectant.

A preassembled spill kit should contain:

Garbage bags

Masking tape

Disposable gloves (non-latex)

Paper towels

Detergent

A high-level disinfectant

Bucket

Cloths

Brushes

Personal protective equipment (goggles, protective clothing)

In case of a spill of blood, vomit, diarrhea, or any other body fluid:

Wear disposable gloves or household rubber gloves that can be cleaned and disinfected.

Follow handwashing procedure prior to putting on and after removing gloves
Use other personal protective equipment as required, for example, using goggles and protective clothing if there is a risk of splashing.

Splash of Blood or Body Fluid

Protocol For a Child Getting Splashed

Do not panic. The risk of serious infection is low.

Wash skin well with soap and water and rinse thoroughly.

Contact the parents.

Take the child to the nearest hospital emergency department as soon as possible.

Protocol For a Staff Member Getting Splashed

Do not panic. The risk of serious infection is low.

Wash skin well with soap and water and rinse thoroughly.

Report to your supervisor immediately. If you cannot do this, leave a message for your supervisor.

As soon as possible, go to the nearest hospital emergency department.

For follow-up counselling, see your health care provider or occupational health services department.

Note: A splash of blood or body fluids can occur in the eyes, nose, or mouth.

Guidelines for Diapering

Germs are everywhere but grow particularly well in body fluids such as urine and stool contained in diapers. As a result, staff are at an increased risk of becoming ill or spreading infectious germs if they do not take special precautions when changing a diaper.

Diaper Procedures

Designate a diaper change area within the child care.

Wash hands and organize needed supplies.

Disposable gloves must be available in the diaper change area for use during enteric outbreaks or diarrheal incidents. Put gloves on prior to changing the diaper.

When a child’s clothes are soiled, ensure child does not come into contact with your clothes as you place him/her on change table.

Fold the diaper inward and set it aside.

Clean child with a pre-moistened disposable wipe or single use towel. Discard soiled diaper and wipes/towels in a plastic-lined receptacle with lid.

Place soiled clothing into a plastic bag, without washing or rinsing, to send home with parents/guardians for cleaning.

Skin care products should be labelled with each child’s name and dispensed using a disposable applicator.

If you are wearing disposable gloves, remove and dispose of them in the plastic-lined receptacle.

Wash your hands with soap and warm water.

Diaper and dress the child.

Wash the child’s hands with soap, running water and use paper towels to dry.

Clean area first with soap and water then disinfect the diapering area with a low-level disinfectant such as 200 ppm bleach (5ml bleach: 1 L water) for the appropriate contact time.

Surfaces soiled with feces/body fluids should be cleaned with soap and water then disinfected with 5000 ppm bleach (1:10 bleach solution) for 10 minutes or an appropriate disinfectant that is effective against non-enveloped viruses (e.g., Norovirus, Rotavirus). Refer to Manufacturer recommendations on the product label for mixing instructions and appropriate contact times.

Wash your hands thoroughly with soap and water.

Single page PDF version of Diaper Procedures

Cloth Diaper Procedures

Designate a diaper change area within the child care.

Wash hands and organize needed supplies.

Disposable gloves must be available in the diaper change area for use during enteric outbreaks or diarrheal incidents. If using gloves, put them on prior to changing the diaper.

When a child’s clothes are soiled, ensure child does not come into contact with your clothes as you place him/her on change table.

Fold the soiled surface of the cloth diaper inward and set it aside. If pins are used, remove, and close them.

Place soiled diaper and any soiled clothing into a plastic bag, without washing or rinsing, to send home with parents/guardians for cleaning. Ensure that the plastic bags or washable “wet bags” are stored in plastic containers designated for each child using cloth diapers.

Clean child with a pre-moistened disposable wipe or single use towel. Discard soiled wipes/towels in a plastic-lined receptacle with lid.

Skin care products should be labelled with each child’s name and dispensed using a disposable applicator.

If you are wearing disposable gloves, remove and dispose of them in the plastic-lined receptacle.

Wash your hands with soap and warm water.

Diaper and dress the child.

Wash the child’s hands with soap, running water and use paper towels to dry.

Clean area first with soap and water then disinfect the diapering area with a low-level disinfectant such as 200 ppm bleach (5ml bleach: 1 L water) for the appropriate contact time.

Surfaces soiled with feces/body fluids should be cleaned with soap and water then disinfected with 5000 ppm bleach (1:10 bleach solution) for 10 minute or an appropriate disinfectant that is effective against non-enveloped viruses (e.g., Norovirus, Rotavirus). Refer to Manufacturer recommendations on the product label for mixing instructions and appropriate contact times.

Wash your hands thoroughly with soap and water.

Single page PDF version of Cloth Diaper Procedures available here.

Guidelines for Common Surfaces

Cribs, Cots, and Mats

Sleep areas have the potential for spreading infectious diseases if cots, cribs, and mats are placed too close together or shared. Children coughing and sneezing during naps can spread respiratory infections. The following care should be taken when using cribs, cots, or mats in your child care:

All bedding, including cots, beds, cribs, and mats, should be maintained in a clean and sanitary manner.

Cots and mats constructed of washable and waterproof materials are to be provided for toddlers.

Sleeping surfaces or mats (including linen) that are placed directly on the floor should be stored separately. A method for distinguishing top from bottom should be devised to ensure that the same side is always placed to the floor.

Cribs, cots, and mats should be separated by at least 1 m (three feet) unless divided by screens in order to reduce the transmission of disease and respiratory illness.

A crib, cot, or mat must be thoroughly cleaned and disinfected prior to another child using it.

Linens should be laundered at least once a week and more often as needed (for example, after a fecal or urine accident).

Linen used for more than one child must be laundered between uses.

Cribs, cots, or mats that are contaminated with feces, urine, or other body fluids, must be cleaned and disinfected and linen must be properly laundered.

Linen and cots should be stored in a separate area to prevent contamination.

Bed linens used on the cribs, cots, or mats should be tight-fitting and washable.

Ensure that infants sleeping outdoors in a carriage are protected by netting.

Infection Control in Sensory Play

Sensory play equipment can easily become contaminated with germs, and when it’s contaminated it can easily spread infections.

Steps for safe use:

Ensure that staff, wash their hands prior to setting up the sensory table.

Staff and children must wash their hands before and after use of sensory table.

Single use items which are porous, absorb contamination, and do not allow for effective cleaning or disinfection (i.e., water, feathers, and cotton balls) must be discarded after use.

Clean and disinfect or discard sensory items and table after each week when in use.

Store disinfected sensory items in labeled sealed containers.

Examples of appropriate sensory materials:

Water with food colouring/soap

Snow

Sand (bake in oven to 82°C/180°F)

Feathers (store purchased)

Pasta/rice

Cotton balls

Wood chips/shavings

Small pieces of wood

New aquarium gravel

Sensory Items from Outside

Bringing items inside from the natural environment can be a great learning tool for children, but these items may have insects, moulds, and bacteria on them. Here are some examples of items and how to make outdoor items safer for the child care:

Item	Method
Bark, twigs, pieces of wood, pine cones	Place in a sealed bag and place in the freezer for 24 hours before bringing into the classroom
Rocks	Wash to remove the dirt
Leaves/flowers	Inspect for insects before bringing in the classroom
Bird nests	If purchased from a store it is acceptable If brought in from outside, the bird’s nest must be placed in an enclosed bag where children can see it but not touch it Wash hands after contact with the bird’s nest
Bird feathers	If purchased from a store, it is acceptable Clean with soap and water, let air dry/dry with a hair dryer Look at them through an enclosed bag

Single page PDF version of Infection Control in Sensory Play available here.

Water Play

Water Play All staff and children must wash their hands before and after water play.

The water play table must be cleaned and disinfected properly before filling it.

The water play container should be drained, cleaned, and disinfected after each use, and whenever you suspect contamination.

Toys used in water play should be cleaned and disinfected after each use.

Children with open sores or wounds must not be allowed to play at the water table.

Carefully supervise children to make sure that they do not drink the water.

Remove any water toys that come into contact with a child’s mouth during shared water play.

Discontinue the use of water play tables during an outbreak of communicable disease as this might be a potential source of spread.

Remember: Children must be constantly supervised when there is any water present. This includes wading pools, tubs, or sinks.

Guidelines for Personal Items

What qualifies as a personal item?

Personal items can include:

Face cloths

Combs and hair brushes

Toothbrushes

Toothpaste

Clothing (coats, hats, mittens)

Handling Personal Items

Personal items can spread infectious germs from one child to another. It is very important to avoid the sharing of personal items.

The following points highlight how to handle personal items:

Ensure that each child has their own individual face cloth, comb, brush, toothbrush, and toothpaste. Label these items with the child’s name.

Store face cloths, combs, brushes, and toothbrushes separately so that they do not touch one another and make sure that they are not shared.

Ensure that children’s personal items such as hats and coats are stored separately and that the hook or cubby used for the storage of these items is labeled with the child’s name.

An effort should be made to provide each child with their own personal cubby or locker for the storage of their personal items.

Pets and Animals

Risks of Pets in a Child Care Setting

Animals in child care settings, whether as resident animals housed in the facility or as short-term visiting animals, can be a valuable learning tool and can stimulate children’s interest, curiosity and appreciation of nature. Providing opportunities to explore, care for, and interact with the natural world helps to strengthen these connections.

While animals can pose a risk of infectious disease transmission and injury, particularly for infants and children under the age of five years, measures can be taken to minimize these risks while offering children these important opportunities.

The Ministry of Health and Long-Term Care (MOHLTC) has developed a best practice guidance document for the management of animals in child care centres to assist the operator in choosing appropriate pets and in implementing measures to be taken to minimize the risk of injury or infection to the children and staff.

Visits to Farms or Petting Zoos

Animals at farms and petting zoos present the same risks as pets in child care centres. There are added hazards because the animals are unknown to you. Before visiting a farm or petting zoo, review the MOHLTC (Ministry of Health and Long-Term Care) guidance document titled Recommendations to Prevent Disease and Injury Associated with Petting Zoos in Ontario.

Taking Proper Precautions with Animals

If you do allow animals (such as hamsters, gerbils, rabbits, or guinea pigs) into your child care centre on a permanent or visiting basis, take the following precautions:

Ensure that animals are always kept in pens or cages. Pens and cages should be kept at a safe distance from the children because debris can be knocked out of the cage and become accessible to children.

Make staff responsible for cleaning cages and feeding animals, not the children.

Turtles, newts, salamanders, and birds are not recommended because they often carry diseases that can be spread to people.

Although keeping dogs and cats is permitted, it is not encouraged. Ensure that these animals are vaccinated for rabies and that the vaccination is kept up to date.

Ensure that visiting animals have documented proof of current rabies vaccination, if applicable.

Ensure that children and staff wash their hands thoroughly after handling animals.

Separate pet cages from children’s sleeping areas.

Pets are not allowed in outdoor children’s play areas.

Remember: Any incident involving an animal bite or scratch must be reported immediately to the Health Unit's Environmental Health (EH) program so that appropriate steps can be taken to make sure the pet is free of rabies. They can be reached at 1-800-563-2808 ext.5400.