Learning Objectives

By the end of this module, you should be able to:

• Identify standard precautions to prevent illness.

Universal Precautions to Prevent the Spread of Illness

There are some standard practices that prevent, or reduce the risk of, the spread of illness in early learning and childcare programs. These are modelled after practices in health care, where everyone is treated as being potentially infected with something that is contagious. Many illnesses are contagious before the infected person is symptomatic, so waiting until you see signs of illness is an ineffective way of preventing its spread. Educators can practice these four things to help control the spread of illness.

1. Hand washing
2. Use of disposable nonporous gloves when working with bodily fluids
3. Disinfecting potentially contaminated surfaces
4. Proper disposal of potentially contaminated waste

Handwashing

Regular handwashing is a crucial step to minimizing the spread of germs. Hands pick up germs from all the things they touch and then spread them from one place to another. Germs that are on hands can also enter the body when a person eats or when they touch their eyes, nose, mouth, or any area on the body where the skin is broken (because of a cut, rash, etc.).

All that is needed for handwashing is soap and clean, running water. Handwashing with soap and water removes visible dirt and hidden germs. Studies have demonstrated that handwashing reduced the number of diarrheal illnesses by 31 percent and respiratory illnesses by 21 percent.

Hands should be washed:

• Before eating, feeding, or preparing food. This prevents germs from getting into the mouth from hands. (Hygiene practices related specifically to food safety will be addressed in Module 5.4)
• After touching saliva (after feeding or eating), mucus (wiping a nose, using a tissue), bodily fluids (toileting, diapering), food, or animals
• When visibly dirty, after touching garbage, or after cleaning

The Center for Disease Control recommends the following hand washing steps:

1. Wet your hands with clean, running water (warm or cold) and apply soap.
2. Rub your hands together to make a lather and scrub your hands well; be sure to scrub the backs of your hands, between your fingers, and under your nails.
3. Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
4. Rinse your hands well under running water.
5. Dry your hands using a clean towel or air dry them.

Infants and young children will need help with handwashing.

Wearing Disposable Gloves

Educators should wear gloves when they anticipate coming into contact with any of the following (on a child’s body or a contaminated surface)

• Blood or bodily substances (i.e., fluids or solids)
• Mucous membranes (e.g., nasal, oral, genital area)
• Non-intact skin (e.g., rashes or cuts and scrapes)

Once the gloves are soiled, it’s important to remove them carefully.

1. Using a gloved hand, grasp the palm area of the other gloved hand and peel off the first glove.
2. Hold the removed glove in the gloved hand.
3. Slide fingers of the ungloved hand under the remaining glove at the wrist and peel off the second glove over the first glove.
4. Discard the gloves in a waste container.

You should wash your hands after removing your gloves. Never re-use gloves.

Cleaning, Sanitizing and Disinfecting

Germs spread onto surfaces from hands and objects (tissues or mouthed toys) or from a sneeze or cough. It is important to clean all surfaces well, including toys and any surface that a young child puts in his mouth, because germs cannot be seen, and it is easy to overlook surfaces that do not look soiled or dirty.

Toileting and diapering involve germs from bodily fluids and fecal material. These germs spread easily in a bathroom onto hands, flushers, and faucets. Routinely washing bathroom surfaces removes most germs and prevents them from spreading.

The terms “cleaning,” “sanitizing,” and “disinfecting” deserve close attention.

• Cleaning removes visible soil, dirt, and germs. Soap and water will clean most surfaces.
• Sanitizing reduces, but does not totally get rid of, germs to a level that is unlikely to cause disease. Sanitizers may be appropriate to use on surfaces where you eat (such as a table or highchair tray) and with toys that children place in their mouths. It is important to follow the instructions on the label, which may also include rinsing surfaces after using the sanitizing product.
• Disinfecting destroys or inactivates infectious germs on surfaces. Disinfectants may be used on diaper-changing tables, toilets, and counter tops.

Early learning and childcare programs can create a bleach and water solution of one tablespoon household bleach to one quart water for surfaces that need to be sanitized or disinfected. To use effectively, the surface must be wetted with the solution and allowed to air dry. A fresh bleach solution should be made each day to maintain effectiveness and stored in a clearly labeled spray bottle out of children’s reach. Research shows that other chemicals (e.g., ammonia, vinegar, baking soda, Borax) are not effective against some bacteria.

Items that can be washed in a dishwasher or hot cycle of a washing machine do not have to be disinfected because these machines use water that is hot enough for a long enough period of time to kill most germs.

Cleaning and disinfecting are essential. Studies have shown that some germs, including influenza virus, can survive on surfaces for two to eight hours; rotavirus can survive up to 10 days.

Table 8.2 – Schedule for Cleaning and Disinfecting

Disposal of Waste

Proper disposal and storage of garbage waste prevent the spread of disease, odors, and problems with pests. Disposable items (diapers, gloves, paper towels, and facial tissues) should be thrown away immediately in an appropriate container. Make sure the container is water and rodent-proof, operated with a foot pedal, is lined with a plastic bag, within reach of diaper changing area, handwashing sink, and food preparation areas, out-of-reach of and unable to be knocked over by infants and toddlers. The containers should be emptied, cleaned, and sanitized daily.

Diaper Changing

Diaper changing areas should be smooth and nonporous (such as a plastic-covered pad), have a raised edge to prevent children from falling, be near a sink, be out of reach from children, and away from food preparation areas.

The following diaper changing procedure should be posted in the changing area and followed to protect the health and safety of children and staff: 

Step 1: Before bringing the child to the diaper changing area, perform hand hygiene (including putting on gloves, if using) and bring supplies to the diaper changing area, and place a disposable liner on the changing area.

Step 2: Carry/bring the child to the changing table/surface, keeping soiled clothing away from you and any surfaces you cannot easily clean and sanitize after the change. Always keep a hand on the child.

Step 3: Remove the soiled diaper and clothing without contaminating any surface not already in contact with stool or urine. Put soiled diaper in covered waste container. Put any soiled clothing in a plastic bag that is securely closed to give to family.

Step 4: Clean the child’s diaper area with disposable wipes and place soiled wipes into a covered waste container.

Step 5: Removed the disposable liner and gloves and place in waste container.

Step 6: Use facial tissue to apply any creams or ointments. Slide clean diaper under the child and fasten it and dress the child.

Step 6: Wash the child’s hands and return the child to a supervised area.

Step 7: Clean and disinfect the diaper-changing surface and any equipment or supplies that were touched (and any other area child soiled before changed).

Step 8: Perform hand hygiene and record the diaper change, diaper contents, and/or any problems.

Educators should never leave a child unattended on a table or countertop. A safety strap or harness should not be used on the diaper changing table/surface.

Potty Chairs

Due to being hard to clean and disinfect, potty chairs are not ideal in a childcare environment. If they are used, they should be used in the bathroom only. After each use:

• Empty contents immediately into the toilet
• Rinse with water and dump water into the toilet
• Wash with soap and water (with a paper towel) and empty soapy water into the toilet
• Rinse again and empty into the toilet
• Spray with bleach solution
• Air dry
• Wash and disinfect sink
• Wash hands (child and adult)

References

1. Centers for Disease Control and Prevention, (2023). Safe removal of gloves. https://www.cdc.gov/oralhealth/infectioncontrol/faqs/personal-protective-equipment.html