Infection Control in Child Care Settings Script Introduction Welcome to “Infection Control in Child Care Settings.” This 2-hour course is part of a series of online trainings designed to help you, as child care providers and directors, implement current, research-based best practices in your child care environments. During today’s training, we will discuss how to fight germs that invade your child care setting, reduce the incidence of infection among children and staff, and learn practical application of basic infection control. Learning Objectives When you have completed this course, you should be able to:     

Define infection control, Understand how infectious disease is spread, Explain why handwashing is a crucial part of infection control, Recognize the difference between cleaning and disinfecting, and Identify the steps of safe food preparation and handling.

Importance of Health and Safety Practices in Child Care Settings Children of all ages will get sick during many points of their lives. As children are exposed to and become infected by germs, their immune systems typically become stronger and allow children to recover more quickly from future exposures. Obviously, when children are in a group setting, like a child care home or center, the likelihood of becoming exposed to the germs that cause illnesses, like the common cold and strep throat, increases. Childhood illnesses may not affect a family until a child starts child care or school. After that, it may seem to the family that the child is sick all of the time. This is a normal and important part of childhood health. However, if caregivers are not vigilant about preventing and reducing the spread of germs in their child care environments, both children and staff will become needlessly sick, spreading and sharing infections in a never-ending cycle (Texas A&M AgriLife Extension, 2007). Illness can be controlled by limiting the way germs, which include microorganisms like bacteria, viruses, fungi, or parasites, can be passed from person to person, or “transmitted.” The benefits of infection control include reducing:  

Child care illness, Number of doctor visits,

1

    

Antibiotic use, Absences from school, Expenses incurred by parents of sick children, Cost to parents as employees, and Cost of lost productivity at workplaces.

(Texas A&M AgriLife Extension, 2009) Infectious and Contagious Diseases The process of keeping the transmission of germs to an absolute minimum is known as infection control. All child care providers should learn and use health precautions to prevent or reduce illness. Since some illnesses are contagious even before symptoms appear, child care providers must be aware of how diseases are communicated among children and between children and providers. When discussing infection control, you will often hear the terms “infectious disease” and “communicable disease.” These terms are often used interchangeably and are sometimes misunderstood. Let’s quickly define each term. An infectious disease is a disease caused by germs that enter the body such as fungi, bacteria, or viruses. These germs grow and multiply in the body and make a person ill. Even though the person is ill, the disease may not be contagious (Merriam-Webster’s Medical Dictionary, 2015). A contagious disease is an infectious disease that is spread through contact from one person to another. The disease is spread through contact with body fluids directly from a sick person or from contaminated items that the sick person has touched or soiled. The most common modes of contamination are touching, sneezing, coughing, and bleeding (Nemours Foundation, 2015). Therefore, infection control is the ability to prevent the spread of contagious diseases within a set environment, such as a child care setting. This can be done with best practices that are well established. Examples of these best practices are:    

Establishing set policies and guidelines, Practicing good hygiene, Cleaning and disinfecting items and surfaces, and Utilizing cough and sneeze etiquette.

Purpose of Infection Control The purpose of infection control is to reduce the amount of contagious germs in a specific environment, such as in a child care setting. Limiting the contact of germs with vulnerable populations, like young children with underdeveloped immune systems, reduces the risk of disease. Infection control decreases the likelihood of contracting common preventable diseases among children and staff in child care settings. There is evidence to prove that using basic infection control measures can significantly reduce the spread and likelihood of contagious illnesses.

2

Almost one-quarter - 23.4 percent - of children under the age of five are in some form of organized child care arrangement, which includes child care centers, nurseries, and preschools (U.S. Bureau of the Census, 2011). Unhygienic habits, like sharing mouthed toys and objects, and wearing soiled diapers, in a confined space with other children contribute to the increased likelihood of illness among the children and staff and their families (American Academy of Pediatrics, 2015). Infants in group care are diagnosed with approximately eight respiratory infections per year, which is three to four times more than kindergarteners (American Academy of Pediatrics, 2015). The good news, however, is that children who are in child care settings during their infant, toddler, and preschool years experience significantly fewer upper respiratory infections in the first five years of school than their peers who were primarily cared for at home or in a small care setting (American Academy of Pediatrics, 2015). As we discussed earlier, the infections that occur early in a child’s life help set the stage later for a stronger immune system, but child care providers must remember that illness transmission can cause frequent staff and child absences, hospitalizations, and resistance to antibiotics. By becoming knowledgeable about types of infections and vigilantly preventing them, caregivers will keep disease transmission to a healthy minimum. Most Common Infections in Child Care Settings Common infections found in child care settings are: 

Colds – More than 100 different rhinoviruses are known to cause the symptoms of the common cold. The first signs of a cold include a scratchy throat, a runny or stuffy nose, and sneezing. Discharge from the nose may appear as thick yellow or green. Children can get as many as eight colds a year, and this viral infection is the number one reason children visit the doctor and stay home from school (Nemours, 2015),



Gastroenteritis – Commonly called “stomach flu,” gastroenteritis is characterized by vomiting and diarrhea. Gastroenteritis can be caused by viral, bacterial, or parasitic infections. Gastroenteritis usually is not serious and generally lasts just a few days, but it is highly contagious. The greatest risk from gastroenteritis is dehydration, with young children being most at risk (Nemours, 2015),



Ear Infections – An ear infection, medically known as acute otitis media, is most often a bacterial or viral infection that affects the middle ear. Children are more affected by ear infections than adults. Signs of ear infections include “ear pain, especially when lying down, tugging or pulling at an ear, difficulty sleeping, crying more than usual, acting more irritable than usual, difficulty hearing or responding to sounds, loss of balance, fever of 100 degrees Fahrenheit or higher, drainage of fluid from the ear, headache, and/or loss of appetite” (Mayo Clinic, 2013). It is important to recognize these symptoms, because while ear infections are usually easily treated, long-term problems like hearing loss can occur if no medical treatment is sought,



Pink Eye – Pink eye, medically termed conjunctivitis, can be a viral or bacterial infection

3

that results in inflammation of the clear membrane that covers the white part of the eye and lines the inner surface of the eyelids. Symptoms of pink eye include redness, itchiness, a gritty feeling, or a discharge that forms a crust during the night that may prevent one or both eyes from opening in the morning, and tearing or watering of the eye (Mayo Clinic, 2015), and

 Sore throat – Most sore throats are caused by viruses, but about 15 percent of children’s sore throats are caused by streptococci, the bacteria that causes strep throat. Other bacterial infections can cause tonsillitis. If a child in your care has a sore throat accompanied by breathing difficulty, difficulty swallowing, or he cannot tolerate liquids, seek immediate emergency care. Contact a child’s parent and request medical attention if she has a sore throat for longer than a week, or has a fever, swollen tonsils, white patches or pus on the back of her throat, swollen lymph nodes, or signs of dehydration (Mayo Clinic, 2015). Other Common Childhood Illnesses Other common illnesses in children are:    

Chicken pox – A condition characterized by itchy, fluid-filled blisters caused by a virus, Ringworm – A skin infection caused by a fungus, not by a worm, Head lice – Tiny insects that infest the hair of the scalp and sometimes eyebrows and eyelashes, resulting in intense itching and occasional red bumps that become crusty and ooze, and Impetigo – A skin disorder caused by bacterial infection and characterized by crusty skin lesions. Typically, the infection begins as a cluster of tiny blisters, followed by oozing and the formation of a thick, yellow- or brown-colored crust that is firmly stuck to the skin (Nemours, 2015).

Serious Infectious Diseases Finally, less common but more serious infectious diseases include:   

Meningitis – Viral or bacterial infection that causes inflammation of the membranes covering the brain and spinal cord. Symptoms may include fever and chills, nausea and vomiting, stiff neck, sensitivity to light, and mental status changes, Hepatitis A – A liver disease caused by a virus. It spreads through the ingestion of fecal matter from close contact with others or by contaminated food or drinks. Hepatitis A is a vaccine-preventable disease, and Hepatitis B – A liver disease caused by a virus. It spreads through contact with blood and body fluids from an infected individual. Infants can be born with Hepatitis B. Hepatitis B is also a vaccine-preventable disease.

Other serious diseases to be mindful of in the child care setting are HIV/AIDS and MRSA (methicillin-resistant Staphylococcus aureus).

4

How Are Infections Transmitted? Infection is spread from one person to another by both direct and indirect means. Direct contact is from one person to another either by touching, sneezing, coughing, kissing, or other personal contact. Infection spreads indirectly when a person gets ill from touching a surface that has been contaminated by another person’s germs. This usually happens by sneezing, coughing, and touching surfaces with unwashed hands, especially after changing a diaper, or using the toilet. Also, food and water may become contaminated by a sick person drinking from your cup or handling your food. Foodborne illness occurs when food is not properly cooked or stored at the correct temperature. We will talk about sanitizing best practices in a few minutes, but it is important to note that the flu virus can live on a surface for up to 48 hours if not destroyed by disinfection. According to the Centers for Disease Control and Prevention (2011), during flu season:   

As many as 20,000 children younger than five years old are hospitalized from flu complications, People with the flu can infect others from one day before getting sick to five to seven days after, and The flu can be particularly dangerous for young children and any child with certain longterm health conditions like asthma.

Routes of Transmission Understanding how germs are transmitted can help us in identifying the best ways to prevent or reduce the spread of illness. There are four primary ways common illnesses that children acquire are spread:    

Airborne and respiratory, Fecal and oral, Blood and body fluids, and Direct contact.

(Boston University School of Public Health, 2014). Airborne and Respiratory Airborne or respiratory transmission of infection occurs when germs, including viruses, bacteria, and parasites, pass from the lungs, throat, or nose of one person to another person through the air. Respiratory infections, such as colds and flu, are responsible for most illnesses. Most colds are identified by fever, runny nose, coughing, and sneezing. Illness is spread by coughs or sneezes into the air or by secretions from the nose or mouth. Other illnesses that are spread by airborne droplets include chicken pox, hand-foot-and-mouth disease, measles, mumps, whooping cough (also called pertussis), and rubella.

5

Fecal and Oral Fecal or oral transmission occurs when feces or objects contaminated with feces are touched and then the mouth is touched. These types of infections are usually intestinal infections that cause diarrhea. In these cases, viruses, bacteria, or parasites spread infection from person to person directly from the bowel movement to the mouth, usually by way of the hands, by diapering, or indirectly by food or other objects that get into the mouth. Some examples of illnesses spread through fecal or oral transmission include viral enteritis, E. coli, Giardia, Salmonella, and Hepatitis A. Blood and Body Fluids Blood or body fluid transmission occurs only when there is direct contact between the blood or body fluids of an infected person and an uninfected person. HIV, Hepatitis B, and Hepatitis C are some examples of diseases transmitted through direct contact with the blood or body fluids of an infected person. Direct Contact Direct contact transmission occurs when an uninfected person touches the skin or body fluid of an infected person or touches a contaminated surface – in other words, they come into “direct contact” with the virus, bacteria, or parasite. Skin infections and infestations such as impetigo, lice, scabies, ringworm, and herpes simplex are generally transmitted through direct contact. Contact with nasal and oral secretions can spread illnesses such as chicken pox, influenza, measles, meningococcal meningitis, mumps, whooping cough, rubella, and pink eye. Regardless of how disease is transmitted or how minor or severe the illness, the precautions necessary to prevent their spread are the same. Now that we have identified common childhood infections and how they are spread, let’s discuss what you can do to minimize the spread of communicable disease and promote a healthy environment for the children in your care. Hand Hygiene Handwashing is the number one way to prevent the spread of communicable disease. This message cannot be emphasized strongly enough. Running hands under water for a few seconds does not remove any of the soil or any germs. Because we use our hands to touch all kinds of objects and then frequently touch our eyes, noses, mouths, and skin, hands can transport all sorts of germs into our bodies. You should always wash your hands as soon as you arrive at work, and wash a child’s hands upon his arrival to the child care center. Be sure to wash your hands before and after using the toilet, eating, handling food, feeding children, and giving medication either orally or topically.

6

Additionally, wash your hands after:      

Changing a child’s diaper or assisting with toileting, Cleaning up any type of body fluids, such as blood, urine, feces, vomit, or mucous, Handling uncooked food, especially poultry and pork, Playing on the playground or in the sandbox, Handling garbage, and Handling animals.

Obviously, you should wash your hands whenever they are visibly dirty. Importance of Soap Soap is an invaluable tool in preventing illness. It cleans and rids your skin of germs. Regular liquid soap is best to use in a child care setting, as it delivers the proper amount of soap for one handwashing per pump. Antibacterial soap is not recommended because it can promote resistant strains of germs. Proper handwashing with soap and water removes all dirt and contaminants off the surface of your hands. Additionally, soap and water will greatly reduce germs with combined effort of friction, heat, and time. Alcohol-based hand sanitizer can be used in places where there is a lack of running water and soap, like on field trips, at the grocery store, and in the car, but is generally not appropriate for most situations in child care. Alcohol-based hand sanitizer does not substitute for proper handwashing since it doesn’t remove the surface dirt. Dirt will prevent the product from reaching and destroying the germs. Remember, if it does not produce a lather, it is not soap. Also, be aware that alcohol-based hand sanitizers can be flammable and can be toxic to young children if ingested. How to Wash Studies have shown that unwashed hands are the main carriers of disease and illness. Diarrhearelated illness has been shown to decrease by 31 percent through proper handwashing (CDC, 2014). These are the handwashing procedures recommended by the Centers for Disease Control and Prevention:   

Check to be sure a clean, disposable paper towel is available, Turn on warm water, no less than 60 degrees Fahrenheit and no more than 120 degrees Fahrenheit, Moisten hands with warm water, and apply liquid soap to hands,

7

    

Rub hands together vigorously for at least 10 seconds. Rub the areas between your fingers, around your nail beds, under your fingernails and jewelry, and along the back of your hands. Rinse hands under warm water, until they are free of soap and dirt. Leave the water running while drying hands, Dry hands with a clean, disposable, paper towel, Turn off the water, using the paper towel to turn the tap, and Throw away the paper towel in a lined trash container. Use hand lotion to prevent chapping, if desired.

Provide assistance for children who can stand but are not yet able to wash their hands independently. You may need to cradle a child in your arm when you are safely able to do so. A child-sized sink or a safety step can help children more easily wash their own hands. For children who are unable to stand and are too heavy to hold safely, and for infants who are too young to be raised to the faucet and reach for the water, use the following method:   

Wipe the child’s hands with a damp paper towel moistened with a drop of liquid soap and discard the towel, Wipe the child’s hands with a clean, wet paper towel until his hands are free of soap, again discarding the towel, and Dry the child’s hands with a clean paper towel.

Hair and Body Hygiene Now that we have covered proper handwashing techniques, let’s talk about other parts of the body. Proper body and hair hygiene is an important part of infection control because it helps prevent the spread of head lice and other skin infections that can easily be transmitted between staff and children. Make sure that your child care setting has, and always follows, a policy that requires checking all children’s heads regularly for any signs of head lice. Do not share any personal items such as combs, brushes, hats, scarves, hair ribbons, bedding, or towels, and be sure to wash bedding, stuffed animals, and other textiles regularly. Make sure that all staff and parents know that by bathing and washing hair regularly, we can help keep skin and hair free of any possible skin infections. Good Habits Overall, basic health practices help strengthen your immune system and prevent you from getting a contagious illness. Here are some good habits to incorporate into your routine:    

Eat a well-balanced diet from all six food groups: grains, vegetables, fruits, dairy, meat and beans, and oils, Exercise daily for at least 30 minutes at a moderate to vigorous intensity level, Get at least 7 to 8 hours of sleep per night, Drink at least eight, 8-ounce glasses of water daily,

8

    

Wash hands often with soap and water to remove germs. Apply hand lotion when necessary, Maintain overall good hygiene, Keep hands away from your eyes, nose, and mouth, Ensure that your vaccinations are up to date. Check your records and consult your doctor, and, Do not smoke.

Once these practices become daily habits, you will notice an immediate and long-lasting positive effect on your life. ACTIVITY: LIFESTYLE CHECK Look at the list of good habits that we just discussed. On a piece of paper, make two columns. In the left column, list those habits that are currently a part of your daily routine. In the right column, write down any habits that you need to add. Which column is longer? Don’t feel overwhelmed if you have several lifestyle changes to make. Just start by making small, manageable positive changes each and every day, and soon you will be on the road to a healthier and more satisfying life! Cover Your Cough Coughing and sneezing contaminate the air and surrounding surfaces. If you cover your cough or sneeze with your hand, and then touch surfaces such as phones, doorknobs, or pens, germs can easily be spread to others. When you need to sneeze, sneeze into a tissue and dispose of it in a trash container. Wash your hands after sneezing into a tissue to remove the germs that are now on your hands and fingertips. When a tissue is not available, an alternative is to cough or sneeze into the sleeve of your upper arm. This contains the germs in the fabric of your shirt and most likely will not transfer to a surface or another person. This might be a bit unpleasant, but it is better than coughing or sneezing on others and on surfaces. You can always change clothes and machine wash and dry any affected fabrics. Gloves Gloves are used as a barrier to reduce the number of germs that get on your hands. Use disposable, nonporous gloves during exposure to blood, vomit, or other bodily fluids that may contain blood (Minimum Standards, 2014). You should also wear gloves when changing diapers of children who have diarrhea, and always use a new pair of gloves for each child. Some programs require or allow gloves to be worn during every diaper change. Again, make sure you wear a fresh pair of gloves when changing each individual child. Make sure you do not contaminate yourself with body fluids when putting on and removing gloves, and never touch the soiled side of a glove with your bare hands.

9

ACTIVITY: GLOVE REMOVAL SAFETY VIDEO To best illustrate best practices of glove removal, let’s watch this video developed by the UCLA Office of Environment, Health and Safety (2013). The video highlights two glove removal practices: “Fold and Tuck” and “Double Fold.” If you have a pair of gloves handy, practice both methods as you watch the video. If you do not have gloves available, just pretend and go through the motions. https://www.youtube.com/watch?v=dyLEd9cng5U

Sick Children and Employees Children in a child care setting are typically indoors most of the day, especially during cold weather months, and are in close proximity to each other. You can see how this environment allows for easy spreading of germs and infection. It is therefore important to quickly identify a sick child and know when he needs to be removed from child care. It is also crucial for effective infection control that sick child care staff stay home when they are ill. Have a policy that allows staff to take sick leave until they are well before returning to work. This reduces the likelihood of a sick person spreading her illness to other staff and children in her care. The illness she has may be mild, but when spread to others with limited immunity, the symptoms and complications of this illness may become more severe. Therefore, play it safe and stay home when you are sick, and encourage others to do so as well. Symptoms Requiring Removal of Children from Child Care Setting Sometimes it is easy to identify a sick child who needs to go home. Generally, when children are sick, they are not as active, withdraw from activities, and become cranky easily. They may have eye discharge, diarrhea, fever, or stomach pain. Sick children typically require a lot of attention, and the health and safety of the other children can be jeopardized. Once you notice that a child is not acting like he usually does, immediately check for signs of illness. A child needs to be removed from the child care setting if they have an oral temperature above 101 degrees Fahrenheit, or an armpit temperature above 100 degrees, and behavior changes or any of the following:      

Sore throat, Diarrhea, Vomiting, Ear ache, Body rash, or Eye infection.

10

Additionally, a child should be removed from care if she is unable to participate comfortably in activities including outdoor play, or if the illness demands a greater level of care than what can be reasonably provided. If a child shows signs of possible severe illness such as lethargy, abnormal breathing, uncontrollable diarrhea, two or more episodes of vomiting in 24 hours, a rash with fever, mouth sores with drooling, and/or marked behavior changes, call the child’s parents or emergency contact and have the child removed from care and medically evaluated as needed. If the child is diagnosed with a communicable disease, you should require medical documentation indicating that the child is no longer contagious before admitting her back into care (Minimum Standards, 2014). Certain illnesses are so serious or so contagious that child care providers are required to report any cases that occur in their programs. For a list of communicable disease exclusions and mandatory reporting guidelines as defined by the Texas Department of State Health Services, please visit http://www.dshs.state.tx.us/schoolhealth/chap8.pdf. Immunizations The Texas Department of State Health Services requires that children be current on their vaccines upon entry into a child care program. Their records should be reviewed and updated on an ongoing basis. Compare the child’s records to the immunization schedule and the state’s requirements regularly, and send notices home to parents when children are approaching a scheduled vaccine. All child care employees are required to be up-to-date on their vaccinations as well, since they are in regular contact with children who may have contagious illnesses. According to the CDC (2014), this is especially important for female staff of childbearing age. Women in this age group have an increased likelihood of acquiring an infection that could affect their unborn child if vaccinations are not current. Vaccination exemptions for children and adults must meet certain requirements and documentation guidelines. For more information about these exemptions, please contact the Texas Department of State Health Services or your state’s health department. Otherwise, review your vaccination records, compare it to the adult immunization schedule, consult your doctor, and get vaccinated! If you have any questions about child or adult vaccination schedules, please contact your medical professional or your local health department. Cleaning and Sanitation What is the difference between cleaning and disinfecting? Is there a real difference? The answer is “Yes!” There is a major difference between cleaning the dirt and grime off of a surface and killing and removing virtually all germs. Here is a breakdown of the differences:

11

  

Cleaning – means removing dirt and soil with detergent and water, Sanitizing – means using a product to kill and remove some germs from non-porous surfaces, and Disinfecting – means using a product to kill and remove virtually all germs from a non-porous surface.

Clean and Disinfect In addition to handwashing, cleaning, sanitizing, and disinfecting surfaces that could pose a risk to children or staff are important steps to reducing the spread of communicable diseases in a child care setting (American Academy of Pediatrics, 2015). Clean and disinfect dishes, including eating utensils, plates, bottles, table trays, and pacifiers, changing tables, counter tops, door knobs, floors, bathroom fixtures, and all other non-porous surfaces. Don’t forget to clean and disinfect children’s toys, especially if they have been put into a child’s mouth. Bedding should be washed in a washing machine and dried in an automatic dryer. Refer to the Minimum Standards for Child Care for detailed information about how frequently to clean and sanitize specific items and surfaces. Cleaning and Sanitizing Process The Minimum Standards for Child Care specify that sanitizing in child care requires a four-step process. First, clean the object or surface with a mild soap to remove all surface dirt and grime. Second, rinse with clear water. Third, soak or spray the item with a disinfecting solution for at least two minutes. Fourth, allow solution on the item or surface to air dry, unless it is likely to be mouthed by a child, in which case you should rinse it with cool water and then allow it to air dry. There are two types of disinfecting solutions that are approved by the Texas Department of Family and Protective Services – Child Care Licensing for use in child care facilities. The first option is a self-made solution using diluted household bleach. A diluted bleach solution is an excellent choice for a disinfectant. It is economical, convenient, and readily available. Here are a few notes to remember about bleach: 

Bleach loses its strength over time and is weakened by heat and sunlight. Therefore, make a fresh batch of bleach solution daily,  Spray bottles and containers should be clearly labeled and always stored out of reach of children,  Do not mix bleach with ammonia or other household chemicals as it produces noxious and very dangerous fumes, and  Always use any bleach solution or disinfectant in a well-ventilated room. The commonly accepted recipe for mixing a bleach solution is: 1/4 cup household bleach in 1 gallon of cool water, or 1 tablespoon of bleach in 1 quart of cool water. This strong solution can be used to disinfect surfaces and items that are not likely to end up in children’s mouths. When disinfecting items like toys and dishes, you should use a solution of one tablespoon of bleach for each gallon of water. These solutions can be placed in spray bottles for convenient application. A

12

dishwashing machine can substitute in cleaning and disinfecting dishes because it uses both heat and time sterilization. The other option for a disinfecting solution is an EPA-registered disinfectant. To be sure a disinfectant meets this requirement, look for an EPA registration number on the product label. The product label should include instructions for using the product in a hospital as a disinfectant, and should not leave toxic residue on surfaces that could be mouthed by children, such as crib rails and toys. If the product has warnings against using it on food contact surfaces or in areas used by children, then it is not appropriate for use in a child care setting. Diapering Diaper changes can easily lead to the spread of infectious disease, because adults and children are more likely to come into contact with bodily fluids during diapering than almost any other time. Following appropriate diaper changing procedures is a big step toward successful infection control. When diapering a child, the first thing to do is get organized. Have all the items needed to change the diaper in one area, including a clean diaper, any parent-approved ointments, wipes, and a trash can. Make sure the diaper-changing surface is clean and dry before putting the child on the changing table. Then follow these steps:        

Remove the dirty diaper, making sure not to soil the surrounding area, Clean the diaper area of the child thoroughly and use ointment if approved, Put a clean diaper on the child, Wash the child’s hands, Dispose of the soiled diaper properly in a lined trash container, Clean and disinfect the changing table, Wash your hands, remembering to scrub under fingernails and jewelry, and Repeat each step for the next child.

For added protection, remember that it’s important to wear gloves when changing the diaper of a child with diarrhea or a diagnosed gastrointestinal disease. Follow the gloving guidelines that we discussed earlier in this course, and any policies specified by your program director. Food Preparation and Handling Now let’s talk about the role that food preparation and handling plays in effective infection control. Of particular concern when handling food is taking precautions against foodborne illness, also known as food poisoning, and other illness that can occur through fecal and oral transmission. E. coli is one type of bacteria that can cause severe illness and be particularly threatening to children younger than five years, and it is typically found in contaminated ground meat.

13

The rule of thumb for food handling to reduce the risk and spread of any communicable disease is “Cool It, Clean It, Cook It” (Global Healthy Child Care, 2015). Let’s take a look at each of these recommendations individually, and discuss how you can implement them in your program. Cool It The first step to food safety is to keep foods at the appropriate temperature. Raw meat and poultry, especially ground meats, are more perishable than most foods. Bacteria can multiply in ground meat and poultry in a temperature range between 39 to140 degrees Fahrenheit. Always keep these products refrigerated. Keep meats on ice if it takes you more than an hour to travel from the store to the child care facility. Defrost meats by placing them in a container that will hold juices, and let them thaw in the refrigerator – never at room temperature. Cook or freeze meat within one to two days (Global Healthy Child Care, 2015). Other foods, such as dairy products and some fruits and vegetables, may require refrigeration as well. Clean It The second step to food safety is to keep food preparation areas clean. Food preparation areas should be kept separate from areas used for eating, laundry, toileting, and diapering. Cleaning of food preparation areas and utensils requires a bit more diligence in a child care setting than at home. Use the following guidelines outlined by Global Healthy Child Care (2015) to help with cleaning food-handled items, as well as mouthed toys:    

  

Don’t use cloths or towels used to wipe countertops or other food-contact surfaces for anything else. These cloths must be sanitized after they are used, Don’t use a sponge – use a cloth that can be laundered. The structure of natural and artificial sponges provides an environment in which germs thrive, Wash food-contact surfaces with detergent and water, rinse, sanitize with bleach solution, and allow to air dry, Clean kitchenware, countertops, and other things that have come in contact with spoiled food or raw meat, chicken, or eggs. Sanitize by spraying them with the household bleach solution, allowing it to stand for at least two minutes, and then dry with a paper towel or air dry, Always wash your hands, utensils, countertops, cutting boards, clothes, towels, aprons, and sinks in hot soapy water after handling raw meat, Wash high-chair trays, bottles, and nipples in a dishwasher, if available. If the trays do not fit in the dishwasher, wash with detergent, rinse, spray with the bleach solution, and allow to air dry, and All eating and drinking utensils, tableware, and kitchenware should be cleaned and sanitized after each use; otherwise, use disposable items. Be sure to label any drinking cups brought in for a child with his name, and keep out of reach of other children.

The easiest way to clean and sanitize dishes is to use a dishwasher that incorporates chemicals or heat sanitizing. If hand-washing, you’ll need three different basins or compartments: one for

14

washing, one for rinsing, and one for sanitizing. Use the following procedure for hand-washing utensils:    

Scrape off any leftover food, Use the first compartment to wash the dishes thoroughly in hot water containing a soap solution, Rinse in the second compartment with clean water, and Use the third compartment to sanitize the dishes by one of these methods: o The safest and easiest method is to immerse the dishes for at least two minutes in a lukewarm bleach solution. Then air dry the sanitized items, or o The other option is to immerse the dishes for at least 30 seconds in water heated to 170 degrees Fahrenheit. The water temperature should be maintained at that temperature throughout the sanitizing process. A hot-water booster is usually required to heat water to a high enough temperature. To avoid burning the skin while immersing dishes and utensils in this hot-water bath, use special racks designed for this purpose. Then air dry the items. Because it requires very hot water, this method is less safe than the bleach-sanitizing method (Global Healthy Child Care, 2015).

Pick up and touch clean spoons, knives, and forks by their handles, not by any part that will be in contact with food. When children help set the table, be sure they have washed their hands thoroughly, and remind them not to touch the parts of the tableware that will have contact with food and go into the mouth. Handle clean cups, glasses, and bowls so that fingers and thumbs don’t touch the insides of the rims of these items (Global Healthy Child Care, 2015). Be mindful of good hygiene when around food by incorporating the following:      

Wear clean clothes, and maintain a high standard of personal cleanliness, Wash your hands using correct handwashing procedures before preparing and serving food and as necessary to keep your hands free of dirt, germs, and body fluids, Also keep your hands clean while handling food-contact surfaces, dishes, and utensils, Do not prepare or serve food while ill with a communicable disease or with uncovered hands or skin lesions. If you have skin lesions on your hands, you should wear gloves while involved with food, Keep your hair covered with a hair net or cap while preparing food, and Be sure children always wash their hands before and after eating.

Cook It The last step to food safety is to cook food properly. Be sure to cook foods to appropriate temperatures before serving. High heat kills harmful bacteria. When cooking raw ground meat, cook until you see no pink in the meat and the coolest part of the meat reaches 165.2 degrees Fahrenheit (Global Healthy Child Care, 2015). A regularly-calibrated meat thermometer should be used to test meat’s internal temperature.

15

Conclusion During this course, we have discussed the importance of incorporating an effective infection control program into your child care center. While preventing the spread of germs and illness may seem a bit overwhelming at first, many of the best ways to keep your child care environment clean and infection-free are also some of the easiest. By instituting practices such as regular handwashing for even your youngest infants, you will set the stage for a lifetime of healthy habits for the children in your care. And don’t forget: these new positive habits that children pick up will also be taken home and incorporated by their parents as well! What a great way to keep both children and adults healthier. Here are the major messages we’d like you to take with you in your work with children:     

The purpose of infection control is to reduce the amount of contagious germs in an environment, Infection is spread from one person to another in a variety of ways, including through the air, orally, and through direct contact like hand-to-hand, Handwashing is the number one way to prevent the spread of communicable disease, Using a properly-made bleach solution is a quick and easy way to disinfect non-porous surfaces, and Following the “Cool It, Clean It, Cook It” method will greatly reduce the likelihood of exposing children to foodborne illness.

Thank you for your attention and your dedication to working with young children.

16

References American Academy of Pediatrics (2015). Preventing the Spread of Illness in Child Care or School. Retrieved from: https://www.healthychildren.org/English/healthissues/conditions/prevention/Pages/Prevention-In-Child-Care-or-School.aspx Boston University School of Public Health, (2014). Transmission of Infectious Disease. Retrieved from: http://sphweb.bumc.bu.edu/otlt/MPHModules/PH/PH709_Transmission/PH709_Transmission5.html Centers for Disease Control and Prevention, (2014). Handwashing: Clean Hands Save Lives. Retrieved from: http://www.cdc.gov/handwashing/why-handwashing.html Centers for Disease Control and Prevention, (2014). Preconception Health and Health Care. http://www.cdc.gov/preconception/careforwomen/immunization.html Centers for Disease Control and Prevention, (2011). The Flu: A Guide for Parents. Retrieved from: http://www.cdc.gov/flu/pdf/freeresources/updated/a_flu_guide_for_parents.pdf Global Healthy Child Care, (2015). Food Preparation. Retrieved from: http://www.globalhealthychildcare.dreamhosters.com Mayo Clinic, (2013). Diseases and Conditions: Ear Infections. Retrieved from: http://www.mayoclinic.org/diseases-conditions/ear-infections/basics/symptoms/con-20014260 Mayo Clinic, (2013). Diseases and Conditions: Pink Eye. Retrieved from: http://www.mayoclinic.org/diseases-conditions/pink-eye/basics/symptoms/con-20022732 Mayo Clinic, (2013). Diseases and Conditions: Sore Throat. Retrieved from: http://www.mayoclinic.org/symptom-checker/sore-throat-child/related-factors/itt-20009075 Merriam-Webster’s Medical Dictionary, (2015). Medical Dictionary. Retrieved from: http://www2.merriam-webster.com Nemours Foundation, (2015). Infections: Common Cold. Retrieved from: http://kidshealth.org/parent/infections/common/cold.html Nemours Foundation, (2015). KidsHealth A‐Z Dictionary. Retrieved from: http://kidshealth.org/parent/dictionary/g/az-gastroenteritis.html

17

Texas A&M AgriLife Extension Service, (2007). Child Care Connections. Reducing Contagious Illness in the Child Care Setting: Parts 1, 2, and 3. Texas A&M AgriLife Extension, (2015). Helping Control Illness Infection in Your Day Care. Retrieved from: http://extensiononline.tamu.edu/blog/helping-control-illness-infection-in-yourday-care.php Texas A&M AgriLife Extension Service, (2009). Infection Control in Child Care Settings. Texas Department of Family and Protective Services, (2014). Minimum Standards for Child Care. Retrieved from: http://www.dfps.state.tx.us/documents/Child_Care/Child_Care_Standards_and_Regulations/746 _Centers.pdf UCLA Office of Environment, Health and Safety, (2013). Glove Removal Safety. Retrieved from: https://www.youtube.com/watch?v=dyLEd9cng5U U.S. Bureau of the Census, (2011). Table 1b. Child Care Arrangements of Preschoolers Living with Mother, by Employment Status of Mother and Selected Characteristics: Spring 2010.

This course was developed and produced by the Texas A&M AgriLife Extension Service of the Texas A&M University System in cooperation with the Texas Department of Family and Protective Services, Child Care Licensing Division, and using funds provided by the Texas Workforce Commission.

18