Public Health Requirements for Child Care Centres

Daycare centres, child care centres, preschools and before and after school programs are important places in our community where care, food and education are provided to babies and children. 

Public health requirements

Public health requirements for child care centres are in place to protect children and staff from infections and illness.  Public health provides requirements on:

Infections are a concern in child care centres because:

  • Young children tend not to wash their hands without supervision. They often place their fingers, toys and other objects in their mouths, all of which may have germs on them.
  • Children’s immune systems are developing to protect against illnesses.  A child care centre is where children may be exposed to illnesses.
  • Infections spread easily because germs can be in feces (poop), saliva or nasal secretions; on skin; or in the eyes of a sick person. A child care worker or child can be exposed to these infections during their day-to-day activities in a child care centre.

Spread of infections

Contagious or communicable infections spread from person to person. Bacteria, viruses, parasites or fungi cause these infections.

For illnesses to spread from person to person, all of the following conditions must be present:

  1. Germs including bacteria, viruses, parasites and fungi
    Viruses and bacteria are the most common cause of infections in child care centres. Both can survive outside of the body from several hours to several weeks.

    A person with an infection can spread an infection even if they do not seem sick. The time when a person is able to spread infection is called the contagious period. People can be infectious before they develop symptoms, during their illness or after they get better depending on the infection.
     
  2. Methods of transmission including food, toys, water, other surfaces and body fluids
    Germs that cause gastrointestinal illness can be spread through feces (poop). If hands are not washed after using the toilet or changing a diaper, they can be contaminated and can spread germs to food, water, sink taps, furniture or toys.
    Germs that cause respiratory infections such as colds, flu or strep throat are in saliva and nasal secretions. Sneezing and coughing spreads these germs through the air to other people. These germs may also be hands or things such as Kleenex because they can survive in the environment for hours to days.

    Blood-borne infections  such as hepatitis B, hepatitis C and HIV have not been spread in Canadian child care centres.
     
  3. A person to become infected
    A new person becomes infected if the virus or bacteria enters their body and they are not already immune to it. Viruses and bacteria enter the body through the mouth, nose, eyes or broken skin.

Hand washing is the most effective way to reduce the spread of infections in a child care centre. It is vital that staff wash their hands properly immediately after changing diapers or helping a child use the toilet.

All outbreaks are reportable to Public Health Services, no matter what the cause. In addition, operators must report specific diseases to Public Health Services.

Operator responsibilities for reporting diseases

If you have been told that staff or a child has a reportable disease that can be transmitted in child care centres you must report it by calling Public Health Services at 905-546-2063.

It is not necessary to confirm or get a diagnosis from a doctor before reporting an infectious disease; you can use information from the child’s parent or observations from the staff at the child care centre for reporting. We handle all personal information confidentially.

Public Health Services will investigate and provide information and guidance for infection control including letters for parents and recommendations for cleaning.

The Day Nurseries Act requires operators to track illnesses among children at child care centres. For each child the following must be done every day:

  • Observe the child for illness upon arrival
  • Note symptoms of illness in the child’s records
  • Keep attendance records regarding arrival, departure and absences

An Illness Surveillance Form or Line List is a record of the history of illnesses among the children and staff, allowing comparisons to be made from day to day and season to season. It provides a baseline of the number or type of illnesses to take action to control or reduce the spread of illnesses later on. Baseline incidence of illnesses allows the operator to notice when there is an increase or change of illness in the child care centre.

How to track and record illness

1.Ask parents or caregivers, “How is _____ feeling today?” when they drop children off.  Ask more questions if they mention an illness and exclude children from attending the child care centre that day, as appropriate.

2.Record symptoms or reports of illness, or absences due to illness on the Staff and Student Line Listing  (DOC, 57 KB).

  • The symptoms should be new symptoms or a change from the child’s usual behaviour or disposition.
  • Record the child’s name once for each occurrence of illness.
  • Complete dates, symptoms, action and notes for each illness.

3.At the end of each month determine:

  • the number of all the children who were ill
  • the number of each symptom reported by adding up each column

4.Compare numbers to:

  • the previous month
  • the same month the year before

5.Ask:

  • Is there a concerning or significant increase in the number of children ill?
  • Is there a concerning or significant increase or change in the symptoms?

6.Call Public Health Services at 905-546-2063 if there is a significant increase in the number of children ill or change in symptoms.

7.Keep the monthly records in a labelled file folder or binder.

8.If you suspect a child has a reportable disease report the case as soon as possible to Public Health Services at 905-546-2063. Do not wait until the end of the month if you have any concerns.

Ill children

Consider these signs or symptoms to determine if a child is ill:

  • Unusual behaviour
  • Cough
  • Fever
  • Poor appetite
  • Red eyes
  • Diarrhea
  • Sleepiness
  • Rash
  • Vomiting

A child that is non-responsive, having trouble breathing, is having a convulsion or whose condition is deteriorating rapidly must receive immediate medical attention; call 911.

What to do with children not well enough to be at the child care centre

Contact the child’s parent or guardian to pick up the ill child if they are not well enough to be at the child care centre. Until the parent or guardian arrives, ensure that:

  • The ill child is separate from well children, preferably in a room with a cot or crib
  • Only one staff member cares for the sick child or children
  • You record the illness on the Illness Line Listing form
  • The child plays with different toys than other children and toys are disinfected after use
  • The child does not participate in water or sensory play
  • The ill child’s hands are washed frequently
  • Staff wash their hands after caring for a sick child

Call Public Health Services  at 905-546-2063 if you are concerned or a significant number of children are ill at the child care centre.

Symptoms and illnesses that exclude children from child care centres

Do not allow a child with any of the following symptoms to stay at the child care centre:

  • Fever and other symptoms such as nausea or vomiting
  • Fever and a body rash
  • Diarrhea – two or more liquid bowel movements (poop) or a change from the child’s normal bowel movement (e.g., runny, watery or bloody poop) with no other explanation such as laxative use.
  • Vomiting  two or more times in the last 24 hours with no other explanation such as medication
  • Yellow or white eye discharge that is not treated
  • Severe cough
  • Yellowish skin or eyes or jaundice
  • Irritability, continuous crying more than usual

The table below outlines diseases or illnesses and how long the disease requires a child to stay away from a child care centre.

Disease

How long children should stay away from the child care centre

Chickenpox 

Until the fever goes away and spots have crusted over with scabs
 
Diarrhea with no known cause 24 hours after the last diarrhea 
Diarrhea caused by E. coli or Shigella Until two consecutive negative stool specimens, or poop samples, are taken, 24 hours apart
 
Diarrhea from Giardia  Until diarrhea stops
Diarrhea from Norovirus  Until 48 hours after the last diarrhea 
Diarrhea from Salmonella or Campylobacter  Until 24 hours after the last diarrhea 
Flu Until fever goes away and the child is feeling better 
Head lice Until 24 hours after the first treatment was applied  
Hepatitis A Until one week after the start of jaundice
Impetigo Until 24 hours after starting antibiotics
Measles   Until four days after the rash started
Meningitis - bacterial or viral  Until the child is better; decision to be made by a doctor
Mumps Until nine days after swelling started 
Pertussis, also known as whooping cough Until five days after starting antibiotics or until three weeks if not treated with antibiotics 
Pinkeye with yellow or white discharge  Until one full day of antibiotic treatment 
Pinworms  Until 24 hours after starting treatment 
Pneumonia  Until feeling better and no fever and if treated, 48 hours after antibiotic therapy has started 
Ringworm  Until treatment starts; keep child from swimming or wading pools and water play until treatment is complete 
Scabies 24 hours after starting treatment
Scarlet fever  24 hours after starting treatment
Strep throat Until 24 hours after antibiotics are started 
Tuberculosis Call Public Health Services at 905- 546-2063 
Vomiting  Until the vomiting stops or it is determined that the vomiting is caused by a non-infectious condition

For children well enough to be at the child care centre

If a child has an illness but is well enough to be in child care and does not have symptoms or a disease that require exclusion ensure that:

  • The child washes their hands more frequently
  • Staff wash hands more frequently
  • The child does not participate in water play
  • Staff clean and disinfect play areas and toys more often

Symptoms or illnesses that do not exclude children from child care centres

The following symptoms or illnesses do not require that a child be excluded from child care centres:

  • Cold sores, unless they are severe
  • Cytomegalovirus infections or CMV
  • Ear infections also known as otitis media, unless they are severe
  • Fever only unless a baby six months or less has it
  • Fifth disease, also called Parvovirus B19, Erythema Infectiosum and slapped face syndrome
  • Hand, foot and mouth disease 
  • Asymptomatic giardia
  • Hepatitis B 
  • HIV
  • Irritated eye without discharge
  • Roseola
  • Thrush and Candida diaper rash
  • Shingles

Ill staff

Ill staff should not be at work. Ill staff cannot work in the kitchen. When staff begin working at the child care centre they should get the centre’s policy for ill staff, which should include information about when staff are expected to stay home.  Record absences and exclusions in staff records.

Symptoms and illnesses that exclude staff from child care centres

Do not allow staff with any of the following symptoms to stay at the child care centre:

  • Fever and other symptoms such as nausea or vomiting
  • Fever and a body rash
  • Diarrhea – two or more liquid bowel movements (poop) or a change from normal bowel movements (e.g., runny, watery or bloody poop) with no other explanation such as laxative use
  • Vomiting  two or more times in the last 24 hours with no other explanation such as medication
  • Yellow or white eye discharge that is not treated
  • Severe cough
  • Yellowish skin or eyes or jaundice 

An outbreak is when the number of ill children or staff becomes a concern or when they significantly exceed the usual number, and people who are ill have similar symptoms. When 10% of the children at the child care centre have a similar illness, this is a warning there may be an outbreak.

Some diseases such as measles should be treated like an outbreak even if there is only one case. If you are unsure whether the illness is an outbreak, call Public Health Services at 905-546-2063.

Outbreak and illness signs and checklists

Print these signs for your child care centre:

Print these checklists if you have an outbreak at your child care centre:

 

Outbreaks can include:

1. Gastroenteritis outbreaks

Gastroenteritis is upset of the stomach and intestines with one or more of the following symptoms:

  • Diarrhea
  • Vomiting
  • Nausea
  • Stomach cramps
  • Headache
  • Weakness

Germs that cause gastroenteritis are:

  • Salmonella
  • Campylobacter
  • Norovirus
  • E. coli 0157
  • others

What to do in a gastroenteritis outbreak

Here are the steps to take in a gastroenteritis outbreak.  Print a gastroenteritis outbreak checklist (DOC, 75 KB) to help you remember the steps. 

  1. Call Public Health Services at 905-546-2063 to talk to a public health inspector.  They will help determine if there is an outbreak.
  2. Fax the Line Listing Form (DOC, 57 KB) to Public Health Services at 905-546-4078.
  3. Remind staff and children to wash their hands often.
  4. Save food served at the child care centre in the fridge, not in the freezer.  Public health staff can check if the food is a source of illness.
  5. Separate ill children and/or staff from well children.  Ensure that only designated staff have contact with the ill children, and other staff only have contact with well children.
  6. Send ill children home. Remind staff and parents of the exclusion policy in the child care centre.
  7. Clean and disinfect toys and environmental surfaces thoroughly and more often; notify cleaning staff. Baby and toddler areas need special attention. High level disinfectant must be used during a gastroenteritis outbreak.

If Public Health Services declares an outbreak:

8.Do not allow children to play in the water during the outbreak.

9. Post a notice at the front entrance of the child care centre (see above) to tell parents about the outbreak. Have information about the illness for parents.

10.Public Health Services provides stool specimen collection kits with instructions.  Distribute these kits to parents of recently ill children or get parent’s consent to collect stool specimens (poop) from ill children.  

11.Double bag the stool specimens (poop) in a covered container with ice packs or place in the fridge to keep them cold.

12.Call Public Health Services at 905-546-2063 for pick-up of stool specimens. They must get to the lab within 48 hours of collection.

13.Call Public Health Services at 905-546-2063 every day about new cases, changes in symptoms, lab results, pick-up or drop-off of specimen kits until the outbreak is over.

An outbreak cannot be declared over without consultation and agreement from Public Health Services. Talk with your public health inspector or call 905-546-2063. 

2. Respiratory Illness outbreaks

Symptoms of respiratory illness include:

  • Fever
  • Cough
  • Sore throat
  • Runny nose
  • Sore muscles
  • Tiredness
  • Headache
  • Dizziness
  • Vomiting, diarrhea and stomach upset in children

Germs that can cause respiratory illness include rhinovirus, or the common cold, influenza, RSV and others.

What to do in a respiratory illness outbreak

Here are the steps to take in a respiratory illness outbreak.  Print a respiratory outbreak checklist (DOC, 75 KB) to help you remember the steps.

  1. Call Public Health Services at 905-546-2063 to talk to a public health inspector who will help to determine if there is an outbreak.
  2. Fax the Line Listing Form (DOC, 57 KB) to Public Health Services at 905-546-4078.
  3. Remind staff and children to wash their hands often.
  4. Send ill children and staff home. Remind staff and parents of the exclusion policy in the child care centre. Until they are picked-up, separate ill children and staff from well children.  Have some staff only with ill children, and some staff only with well children.
  5. Clean and disinfect toys and environmental surfaces thoroughly and more often; notify cleaning staff. Baby and toddler areas need special attention.  We recommend frequent cleaning of high use surfaces such as doorknobs, faucets, tables and toys, followed by routine disinfection for the control of respiratory illness outbreaks. If you have questions about cleaning and disinfection, call Public Health Services at 905-546-2063.

If Public Health Services declares an outbreak:

6. Post a notice at the front entrance of the child care centre (see above) to tell parents about the outbreak.  Have information about the illness available for parents.

7.Tell parents and guardians that any ill children who see a doctor for their illness should tell the doctor about the outbreak.

  • The doctor should write the outbreak number on any specimens or samples collected.
  • Public Health Services can give a letter to parents with instructions.
  • You can call Public Health Services at 905-546-2063 to pick up specimens or samples, or to facilitate their testing. Samples must reach the lab within 48 hours.

8.If there is an outbreak of an illness where a vaccine is available to prevent the illness such as measles, mumps or rubella, do not allow unimmunized children to come to the child care centre until the outbreak is declared over and until the longest known incubation period for the illness has passed since they last attended daycare. Public health staff can help you with this calculation.

9.Call Public Health Services at 905-546-2063 every day about new cases, new admissions, changes in symptoms or lab results until the outbreak is over.

An outbreak cannot be declared over without consultation and agreement from Public Health Services. Talk to your public health inspector or call 905-546-2063.

The two best ways to clean hands are:

  1. Frequent hand washing with soap and water
  2. Frequent use of alcohol-based hand rub

Children should only use hand rub when they are supervised.  Children or staff should not use hand rub when their hands are visibly dirty or soiled or when hands are wet.

  • Print a poster (PDF, 26 KB) to hang by the sink to remind staff and children how to wash hands properly. 

When to wash hands

Staff and children should wash their hands:

  • When they first get to the child care centre.
  • Before and after handling, preparing and eating food; bottle feeding; using water tables; putting on gloves; giving or applying medication or cream to a child or themselves; changing diapers; any contact with body fluids such as runny noses, spit, vomit or blood; or helping children in the bathroom.
  • After using the toilet; playing outside; handling pets, pet cages, or other pet objects; cleaning up anything; or removing gloves.
  • Before going home.
  • Whenever hands are visibly dirty.

Children cannot use a large common basin to rinse their hands. Children should wipe their hands with a paper towel, then go to a sink and wash their hands with soap and warm water.

When to use disposable gloves

Staff should wear disposable gloves to clean up blood, vomit, urine (pee) or feces (poop).

  • We recommend using vinyl gloves due to latex allergies.
  • Gloves do not replace hand washing. Staff must wash their hands before putting gloves on and immediately after removing gloves.

Cleaning and disinfecting reduce the spread of viruses and bacteria. Some viruses and bacteria can live for weeks on toys and other surfaces like change tables. Cleaning with soap and water reduces the number of bacteria and viruses that may be on surfaces. Disinfecting after cleaning will kill most of the viruses and bacteria that were left after cleaning. A cleaning schedule is necessary to make sure cleaning is done.  A good practice is to use a checklist with everything that needs to be cleaned.

Disinfectants

Disinfectants work best on pre-washed objects and surfaces.

  • All disinfectants require a certain amount of time, usually up to 10 minutes, they need to stay wet on a surface in order to disinfect properly.  This is called contact time. Read the label on the disinfectant for directions on the product you use.
  • Apply disinfectants with a spray bottle. Label the bottle and keep it out of reach of children.
  • You can buy commercially prepared disinfectants. Check with the supplier or sales person about how to use them.

Acetic acid, also known as vinegar is not a disinfectant. It does not kill bacteria. Disinfectants include:

Chlorine bleach

Chlorine bleach is also called sodium hypochlorite or chlorine.  Here are some tips for using chlorine bleach:

  • Do not use bleach as a disinfectant unless it has been mixed with water.
  • Chlorine bleach kills most germs.
  • Household bleach has a concentration of 3 - 5.25% chlorine. Read the label to make sure the chlorine concentration is not higher than 5.25%.
  • Chlorine bleach solutions lose strength over time. You must mix solutions every day.  Check the concentration using chlorine test strips to ensure the appropriate strength has been made.
  • Never mix chlorine bleach with any other chemicals.

There are two different mixtures of bleach and water you can use as disinfectants:

1. Low level disinfectant (1:100)

Low level disinfectants are for all general purpose disinfecting, not for clean-up of body fluids such as vomit, feces (poop) or blood.

Make the low level disinfectant by using one of the following methods:

  • Slowly add 50 mL (¼ cup) of bleach to 5 litres (25 cups) of water  
  • Slowly add 5 mL (1 teaspoon) of bleach to 500 mL (2 cups) of water

2. High level disinfectant (1:10)

A high level disinfectant is for surfaces contaminated with feces (poop), vomit, urine (pee) or blood.

Make the high level disinfectant by using one of the following methods:

  • Slowly add 250 mL (1 cup) of bleach to 2250 mL (9 cups) of water  
  • Slowly add 125 mL (½ cup) of bleach to 1125 mL (4 ½ cups) of water

Other disinfectants or commercial products

Some commercial products are chemicals that are already mixed at a store or supplier.

  • Make sure to follow the manufacturer’s instructions for using these chemicals. If possible, use test strips to check the diluted solution strength.
  • Some products require you to rinse after use, especially if you apply it to a surface that comes into contact with food.
  • Check the manufacturers label for the appropriate uses of the product (e.g., environmental cleaning, body fluids).

Dishwashers

You can use dishwashers to clean and disinfect toys. If you use a dishwasher intended for home use, you can only use it two times each day.  The dish detergent you use must contain a chlorine compound.

Minimum recommendations for cleaning

See the table below for minimum recommendations for cleaning and disinfecting under normal conditions. During an outbreak of a communicable disease, extra cleaning and disinfecting is necessary.

Toys When How
Small toys that go into mouth Daily

Clean, disinfect and air dry.

Hard plastic toys can go into the dishwasher and soft toys can go in the washing machine.

Large toys Weekly Clean, disinfect and air dry.
Dress-up clothes Weekly Wash in the washing machine. Dry on the hottest setting in the dryer.
Hats After each play session Wipe or wash in the washing machine.
Sleep area When How
Crib rail Daily if crib is shared with other children. Clean, disinfect, wait several minutes, then wipe.
 
Crib sheets or blankets Weekly for toilet trained children.  Daily if shared with other children. Wash in the washing machine on the hottest setting and dry in the dryer on the hottest setting.
Crib mattress Weekly Clean, disinfect and air dry.
Play area When How
Dining table tops Before and after meals Clean, disinfect and air dry.
Vinyl or tile floors Daily in baby and toddler areas and eating areas.  Weekly in other areas. Clean with soap and water.
Carpet Twice weekly
Twice per year
Vacuum
Steam clean
Small rugs Twice weekly Vacuum or wash in washing machine.
Toilet or potty area When How
Toilet bowl Weekly Clean with toilet bowl cleaner.
Toilet seat and rim Daily Clean, disinfect and air dry.
Toilet flushing handle, door knobs, counters, water taps Daily Clean, disinfect and air dry.
Potty chair After each use Clean, disinfect and air dry.
Diaper change surface After each use Clean, disinfect and wipe dry.

Cleaning vomit, feces, urine or blood

Immediately remove children from the area and begin clean up for vomit, feces (poop), urine (pee) or blood.

  • Wear non-porous gloves such as vinyl or heavy-duty rubber gloves.
  • Be careful to prevent any body fluids from splashing into your eyes, mouth, nose or open sores.
  • Take care that body fluids do not get on your clothes.
  • Use disposable paper towels, a mop and pail, or an absorbent powder to clean up vomit, feces (poop), urine (pee) or blood.
  • Thoroughly clean the area with a detergent and rinse with water.
  • Throw out paper towels in a leak proof plastic bag.  Tie the bag and place in a childproof garbage receptacle with a tight fitting lid.
  • After the area is cleaned, soak with high level disinfectant, having a 1:10 bleach and water mixture or other disinfectant.  Wipe up extra disinfectant and let the area air dry.
  • Clean the mop and pail, rinse with high level, wring out and hang to air dry.
  • Remove gloves and place them in a leak-proof bag.  Place the bag in the garbage.
  • Wash hands with soap and water.
  • Vomit or blood that gets on a sensory play table requires immediate emptying, washing, rinsing and high level disinfecting.
  • All waster toys require similar cleaning and disinfecting.
  • Discontinue sensory play activities when illness is circulating in the centre for a minimum of one week or until the children’s health improves.

Exposure to blood carries a risk of infection from blood-borne viruses such hepatitis B, hepatitis C or HIV. The risk of getting these viruses in child care centres is low.

Exposure to blood-borne viruses can result from:

  • A splash of blood onto broken skin such as an open cut, wound or rash
  • A splash of blood onto mucous membranes such as eyes, nose or mouth
  • A cut or skin puncture from a sharp object that has blood on it

Here are some tips for blood exposure:

  • Assume that all blood, body fluids and secretions, except sweat, are potentially infectious
  • Wear disposable gloves to prevent transmission of blood borne infections
  • Wash your hands often

What to do if you are exposed to blood

If you are exposed to blood:

  1. Immediately wash exposed skin thoroughly with water and soap. If blood splashed onto the mucous membrane of eyes, nose or mouth, flush the area thoroughly with water.
  2. Remove clothes with blood on them.
  3. Encourage bleeding by pressing on the wound if blood got on broken skin such as a wound or scratch.  Apply a skin antiseptic and cover with a sterile dressing or Band-Aid.  Check your first-aid kit for these items.
  4. Go to the closest hospital emergency department immediately to see if you need treatment.
  5. Report the blood exposure to the child care centre supervisor and record details such as:
  • Name of person exposed
  • Date of injury
  • Circumstances surrounding the injury
  • Action taken

Human bites

There is a concern about spread of infection from human bites only if the skin is broken.  

Transmission of HIV is very unlikely through a bite.

What to do for human bites

If you, a staff member or child is bitten by another person:

  1. Wash the bite mark with soap and water.
  2. Apply a mild antiseptic. Check your first aid kit for this item.
  3. If the bite cases skin to break, encourage bleeding by putting pressure on the wound.
  4. Check tetanus vaccination records for the person who was bitten.
  5. Document the bite in your files.
  6. Tell parents about the bite – both the child who bit and the child who was bitten, if applicable. 
  • Recommend the child see a doctor if parents are concerned about hepatitis B. Call Public Health Services at 905-546-2063 if either child involved has hepatitis B. 
  • Tell parents about signs and symptoms of infection. A doctor should check infected bites. Parents can call Public Health Services at 905-546-2063 for information

7.Talk to parents about their child's biting if it happens again.

Below you will find recommendations for how to set up diaper changing areas at a child care centre and how to change diapers.

Diaper changing area

Here is how to set up the diaper changing area at a child care centre:

  • Have a designated hand sink beside the table where you change diapers
  • Have liquid soap and paper towels in dispensers at the sink
  • Keep appropriate cleaner and disinfectant near the table where you change diapers
  • Separate the diaper changing area from the eating area
  • The diaper change pad must be easily cleaned and disinfected, such as vinyl
  • Post and practice appropriate diaper change procedures
  • Use an applicator or new pair of gloves to get cream, ointment or wipes to avoid contamination
  • Label creams, ointment and wipes with each child’s name
  • Do not rinse or wash dirty diapers and/or clothing
  • The garbage receptacle should be foot activated with a disposable liner

How to change diapers

Here are the steps to take to change a diaper:

  1. Place everything you need to change a diaper where you can reach it.
  2. Wash your hands.
  3. Put on a new pair of gloves.
  4. Lay the child down on the table.
  5. Take off the dirty diaper and throw it in a lined garbage can or diaper disposal system.
  6. Clean the child’s bum, put on a new diaper and dress the child.
  7. Clean the diaper changing surface with detergent and water using a spray bottle.
  8. Disinfect the diaper changing surface with Quaternary ammonium product, bleach and water, accelerated hydrogen peroxide or other acceptable disinfectant.  All spray bottle used as a  disinfectant must be labelled.
  9. Take gloves off and throw out in a lined garbage can.
  10. Wash your hands.
  11. Wash the child’s hands.

Here are some requirements for hygiene practices at child care centres:

Toothbrushes and holders

  • Clearly label all toothbrushes with the child’s name.
  • Do not allow children to share or borrow toothbrushes.
  • Store toothbrushes so they do not touch any other toothbrush.
  • Never disinfect toothbrushes. If a child uses another child’s toothbrush or if two toothbrushes come in contact, throw them away and give the children new toothbrushes.
  • Toothbrush holders should be made of easily cleaned material that is non-absorbent, such as rigid plastic. Holders must not be made out of cloth or cardboard.
  • Arrange holders so that toothbrushes are not above or below others to prevent contamination by dripping.
  • Staff should put toothpaste out for children to avoid contamination. One way to do this is to place a separate drop of toothpaste on a paper towel for each child, then use the toothbrush to scoop the toothpaste up.

Cubby storage areas

  • Store children’s personal items in a clean and sanitary cubby and post their names in each cubby space.

Make-up

  • Do not share make-up that contacts touches mucous membranes such as eyes or mouth.
  • Apply make-up with single-use applicators.

Face painting

  • Apply face paint with single use applicators such as cotton swabs.
  • Use a new swab for each application of face paint or make-up even on the same child.

Combs

Label combs for each child or clean, rinse and disinfect combs in between each use.

Sheets, blankets and mattresses

  • Use sheets and blankets for one child only. Do not share bedding.
  • Label all sheets and blankets with each child’s name.
  • Use cots and mattresses made of water repellent material.
  • Store sheets and blankets in an area where there is no mould or mildew and out of the way of everyday activities.
  • Wash all blankets and sheets in the washing machine at least once a week, or when dirty. Use the hottest setting to dry blankets and sheets in the dryer.
  • Wash blankets and sheets if a child inadvertently uses another child’s bed or cot.

Face cloths and hand wipes

  • Use reusable face cloths and hand wipes one time and place in a container out of reach of children. The container must be non-absorbent and cleanable.
  • Replace cloths when they become torn or worn.

Food handlers must follow the requirements of the Ontario Food Premises Regulation.  Read the Food Premises Regulation to learn about:

  • food storage temperatures
  • food service equipment
  • standards for milk, meat products and eggs

The following requirements must be met in child care centres:

  • All high risk and medium risk child care centres in Hamilton must have a certified food handler working in a supervisory capacity during all hours of operation under Hamilton’s Food Handler Certification By-law No. 07-245 (PDF, 385 kB).
  • During routine inspections by public health, inspectors will ask the person acting in a supervisory capacity to show their food handler certification card obtained upon completion of a recognized food handler certification course.  Register for the Food Handler Certification Course.
  • Ill kitchen staff cannot work until they are well. For some illnesses this means staying off work until lab tests come back clearing them to work. Check with Public Health Services at 905-546-2063 for specific requirements.
  • Staff who change children’s diapers cannot work in the kitchen or prepare any food during the same shift.
  • Kitchen staff who clean the child care centre, excluding the kitchen, cannot clean until after they are done handling food (e.g., do food preparation in the morning and cleaning in the afternoon).
  • You must record the temperatures of hazardous foods upon arrival at the child care centre , as well as before serving if the food if it is not served immediately. Keep this information on file. Hot hazardous food must be at 60 C or above upon delivery and before eating, and cold hazardous food at 4 C or lower upon delivery and before eating.
  • Food prepared at home cannot be given to the children. If there is a special event or holiday, and a parent wants to bring in a special food item, they must prepare it at the day care centre or purchase it from a licensed food premise, such as  bringing in a birthday cake from a licensed bakery.
  • You can use domestic dishwashers meant for home use in the child care centre kitchen; however the dishwasher can only be operated a maximum of two times per day. You must use a detergent that has a chlorine compound in the dishwasher. 

Public health requirements are listed below for play areas such as wading pools and sensory play.

Wading pools

You must follow the Operating Procedures for Non-Regulated Recreational Water Facilities for minimum standards for recreational water use at the child care centre.

We recommend using a sprinkler instead of a wading pool. This reduces the risk of exposure to potential harmful bacteria, viruses or parasites. The requirements for wading pools include:

  • Children who wear diapers can only go in the wading pool if they are wearing swim diapers intended for water play.
  • Ill children cannot go in the wading pool.
  • You cannot use wading pools when there is an outbreak of illness.

Sensory play

Here are the public health requirements for sensory play:

Water play tables

  • Children must wash their hands before and after using a water play table.
  • Children cannot participate in water play if they have an infection of any kind or open sores or wounds.
  • Do not use a water play table during an outbreak of illness.
  • Drain water after every use or every couple of hours, whichever is shorter.
  • You must wash, rinse and disinfect the water table and toys after each play session.
  • Use only non-absorbent toys for water play.
  • Ensure water play tables are protected or covered if rooms are shared with other groups.
  • Drain, clean and disinfect water tables at the end of the day.

Indoor sandboxes

  • Use sand that is pre-packaged, sealed and sold as play sand.
  • Keep all pets and food away from the sandbox.
  • Air dry wet sand overnight.
  • Buy easy to clean, rustproof and non-breakable sandbox toys.
  • Clean and disinfect sandbox toys after each use.
  • Replace sand monthly or as often as required.

Outdoor sandboxes

  • Cover the sandbox when it is not in use to prevent animals from getting in.
  • Rake the sand every day.
  • Replace sand every season such as the start of summer, or as often as required.

Other sensory play 

Throw out rice, pasta, confetti and other sensory items after four or five uses.
Do not use cereal for sensory play.

Clean and disinfect the basin when the sensory material is changed.

The following guidelines and requirements are in place for pets and animals visiting or living at child care centres:

  • All dogs and cats that live at or visit a child care centre require proof of getting a rabies vaccination each year under the Ontario Ministry of Community and Social Services Day Nursery Manual and the Ontario Ministry of Health and Long-Term Care Rabies Immunization Regulation 567 under the Health Protection and Promotion Act.
  • The Ontario Food Premises Regulation does not allow live birds or animals in kitchen areas.
  • Reptiles and turtles are not acceptable pets for child care centres, as they are known to carry Salmonella bacteria.
  • Hamsters, guinea pigs, degus and fish are good pets for child care centres.
  • All animals that come to the centre must be healthy.
  • We do not recommend birds in cages, outside or inside child care centres because they can attract mice and require extra housekeeping duties. Bird feces contains Salmonella.
  • Chick incubators are permitted in child care centres if the incubators have a cover to prevent children from unsupervised handling of the chicks and contact with dropping and shavings. Staff and children must wash their hands after handling the chicks and/or cleaning the incubator.

Rules for handling or interacting with pets and animals

  • Staff and children must thoroughly wash their hands after handling a pet, its food or its belongings.
  • Do not allow children to kiss animals or put their face too close to a pet.
  • Never allow a child near a dog or cat while it is eating, drinking or sleeping.
  • Supervise children when they are handling pets.
  • Keep cages and aquariums clean and sanitary.
  • Never allow children to feed or touch an animal such as a dog, cat or other animal that is not their own pet as any animal may bite.
  • Keep children away from stray dogs or cats or wild animals such as raccoons, skunks, foxes and especially bats.  These animals could be infected with rabies but not show any sign they are sick.
  • Report any unusual animal activity to Animal Services at 905-574-3433.
  • Scratches or bites from a bat, dog, cat, fox, raccoon, skunk or any other mammal, requires immediate medical attention.

Animal bites

Here are the steps to take if a child is bitten by an animal while in the care of the child care centre:

1.Wash the bite immediately with soap and warm water.  Rinse with clean water and apply an antiseptic. Check your first aid kit for this item.

2.Record the bite or scratch.

3.Phone parents or guardian to tell them to pick up their child and see a doctor.  Tell the parent or guardian that you are reporting the bite to Public Health.

4.Report the animal bite or scratch to Public Health Services at 905-546-2489 so they can assess the risk of rabies infection.  You are legally required to report animal bites and scratches to Public Health Services.  You need to provide the following details to Public Health:

  • The pet owner’s name, home and work address and phone number
  • A description of the animal including breed, colour and markings, size, pet name
  • A description of events before the bite or scratch such as “the pet was held too tightly” or “a wild animal came up and bit the child”
  • Name of the child who was bitten, child’s address, parent or guardian’s phone number

 

Public Health Services provides the following services for child care centres:

  • Consultation on development and maintenance of infection prevention and control practices and written policies related to immunization, reporting of infectious diseases and outbreak management
  • Inspections and assessments of infection prevention and control policies and practices as well as food safety practices
  • Infection prevention and control education for staff 

Contact us

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