Preventing and Managing Illness in Child Care Centres

The information on this page is for child care professionals. If you are looking for information for community members visit Child Care and Early Learning.

On this page:

• Preventing Illness
  • Infection prevention policies and procedures
  • Hand hygiene 
  • Diapering area requirements
  • Personal items
  • Cleaning and disinfecting
  • Preventing blood-borne infections
• Managing Illness and Outbreaks
  • Reporting outbreaks to Public Health
  • Responsibility of parents/guardians
  • Exclusion guidelines during non-outbreak periods
  • Gastrointestinal outbreak management
• Additional resources 

Preventing illness

Children are more likely to get sick than adults. Child care centre owners and staff can help protect children from infection and illness.

One of the best ways to reduce illness in child care centers is through regular hand washing.

Infection prevention policies and procedures 

Child care centres must have policies and procedures in place for infection prevention and control.

Public Health requires your child care centre to have policies and procedures for:

1. Excluding, re-admitting and cohorting sick children, child care staff and volunteers. Cohorting means caring for groups with the same illness together. Staff and children that are cohorted should not interact with well children and staff. Toys, equipment and other materials cannot be shared.
2. Reporting infectious diseases and potential outbreaks to Public Health.
3. Communicating about illnesses and outbreaks to parents/guardians.
4. Handling blood and body fluids and recording events that involve cleaning or exposure to blood or body fluids.
5. Diapering.
6. Cleaning and disinfecting toys, pet cages, furniture, frequently touched surfaces, sensory and water play tables.
7. Dealing with emergency situations like fires, power outages, sewage back-up, no heat, no water or water interruption.

Hand hygiene   

Hands pick up germs from anything they touch, and can spread germs to objects, surfaces, food and other people. Hand washing with soap and water is still the best way to reduce the spread of illness.

See the Preventing Infections page for handwashing steps and printable resources.

Children should wash their hands

• When they arrive at the centre and before they go home
• Before eating, drinking, using water play tables
• After a diaper change, using the toilet
• After playing outside, handling pets, cages or other pet objects
• After sneezing or coughing into hands
• Whenever hands are visibly dirty

Child care staff and volunteers should wash their hands

• When they arrive at the centre and before they go home
• Before handling food, preparing bottles, feeding children
• Between handling raw and cooked food – cross contamination is a risk
• Before giving or applying medication or ointment to a child or self
• After changing diapers, assisting a child to use the toilet, using the toilet
• After contact with body fluids (e.g., runny noses, spit, vomit, blood)
• After handling pets, pet cages or other pet objects
• After cleaning, and removing gloves
• After handling garbage
• Whenever hands are visibly dirty

Disposable gloves

• Disposable gloves do not replace hand washing.
• Child care staff must wash their hands before putting on gloves and immediately after removing gloves.
• Child care staff should wear disposable gloves to clean up blood, vomit, urine and stool.
• Child care staff should wear disposable gloves when they have cuts on their hands and when the diaper change involves a messy bowel movement.

Alcohol-based hand rubs 

Do not use alcohol-based hand rubs when hands are visibly soiled. Hand rubs are useful when you can't access a sink or running water. Always use an alcohol-based product. Products that are not alcohol-based will not kill germs.

Since hand rubs contain 60 to 90 per cent alcohol, they are a fire hazard and can be harmful if children swallow them. To reduce the risk, child care staff should always help children use alcohol-based hand rubs.

See the How to use Alcohol Based Hand Rub poster (printable resource)

Diapering area requirements

Diapering location and surface 

• Separate diapering area from feeding and food preparation areas.
• Use a diapering surface that is non-absorbent and easy to clean.
• Do not rinse or wash soiled diapers and clothing.
• Use a foot activated garbage receptacle with a disposable liner.
• Post and follow appropriate diapering procedures.

Creams, ointments and wipes 

• Prevent contamination of creams and ointments. Use a single-use applicator or a new pair of disposable gloves for each application.
• Label creams, ointments and wipes for each child. Do not use the same container of product on different children.

Hand sink

• Have a designated hand sink adjacent to diapering table.
• Provide liquid soap and paper towels in dispensers.

Cleaners and disinfectants 

• Provide appropriate cleaner and disinfectant at or near the diapering table.
• Label the disinfectant spray bottle with the disinfectant name.

Personal items

Every toy and surface of the child care centre must be kept clean and sanitary.

Bed linens

• Cots and mattresses must be non-absorbent and easy to clean.
• Clean and disinfect cots and mattresses at least once a week and when they are soiled.
• Designate bed linens for every child.
• Label bed linens, cots and mattresses with an identifying label for each child.
• Store cots and linens in clean dry areas to prevent mould and mildew growth.
• Cots and linens must be stored separately and away from everyday activities.
• Launder bed linens at least once a week and when soiled. Use the hottest setting on the clothes dryer.
• Launder bed linens if a child inadvertently uses another child’s cot.

Combs/brushes

• Store children’s personal items separately in a clean and sanitary manner.

Cloths used for face and hands

• Use cloths for face and hands only once and then place in laundry.
• Launder soiled cloths at least daily. Use the hottest setting on the clothes dryer.
• Laundry baskets must be non-absorbent and easy to clean.
• Replace worn cloths.

Cleaning and disinfecting

Cleaning and disinfecting reduces the spread of germs. Some germs can live for hours, days or weeks on toys, counters, diapering tables, doorknobs, computer keyboards and other surfaces. Cleaning is as important as disinfecting.

See the Surface Disinfection with Chlorine (Bleach) chart (printable resource)

Disinfectant tips

• Use a disinfectant that is appropriate for the surface you are cleaning. Disinfecting kills or inactivates germs on surfaces in areas other than food preparation.
  • All disinfectants, except for bleach, must have an eight digit Drug Identification Number (DIN) from Health Canada.
  • Products with a DIN must be used according to manufacturer’s instructions with particular attention to contact time.
• Not all products are made the same.
• Read the label (if using a pre-mixed commercially available disinfectant) to determine how long it needs to remain on the surface. Some disinfectants require up to 10 minutes of contact time.
• It is recommended that any disinfectants in the workplace have a Material Safety Data Sheet (MSDS) that is available to all staff.

Cleaning and disinfecting schedule 

These recommendations are for normal operating conditions. During a disease outbreak, extra cleaning and disinfecting are needed. Not all toys can be immersed or sprayed with disinfectant. A clean cloth moistened with a disinfecting agent may be used to wipe surfaces, where appropriate.

Safe use of toys and sensory materials

Arts and crafts materials, toys, personal and sensory items including water and sand can easily collect germs. To help prevent the spread of infection, child care providers must follow these guidelines for play at the centre. 

Sharing of personal items among children is not recommended.

Prevention of blood-borne infections

Blood-borne infections are very rare in children and the risk for transmission in child care settings remains extremely low. However, it is important to assume that all blood may be cause infections.

Follow these key steps when in contact with blood: 

1. Wash your hands before and after exposure to blood or any other body fluids and before and after removing gloves. Washing with plain soap and water is effective. Alcohol-based hand rub can also be used, but only if hands are not visibly dirty. 
2. Wear disposable gloves during first aid or cleaning up blood or body fluid spills from surfaces. Wash hands well after removing gloves. 
3. Clean contaminated surfaces: Wearing gloves, immediately wipe up spills of blood with paper towels and dispose of them into a plastic lined garbage receptacle. Wash the area with hot water and a household cleaner and then rinse. For specific information on how much bleach to mix with water and how long the mix should be in contact with the contaminated surface, please see the Surface Disinfection with Chlorine (Bleach) chart.

4. Dispose of contaminated items like tissues, paper towels, and any blood-soiled articles into a plastic bag and then tie it at the top. Dispose of bag in the garbage.

5. Launder items while wearing gloves. Rinse blood-stained laundry in cold water but do not remove body fluids by spraying with water. Launder using a regular laundry detergent with household bleach (according to product instructions and where suitable for fabrics) and a normal machine wash and dry. If unable to launder on site, place the contaminated laundry in a plastic bag and then tie it shut to take home.

Managing illness and outbreaks 

Watch for early signs and symptoms of illness in children and staff. Preventing an illness is easier than dealing with it after it has spread. 

Child care providers should record all symptoms and signs of illness. You should keep an illness tracking form for each room to record all symptoms accurately. Use this form to see if there is an increase in children with the same symptoms or if anyone has any unusual symptoms.

The form should include:

• The date
• Child’s name
• The date symptoms first appeared
• The symptom(s) the child experienced
• The outcome of the situation (child absent, child sent home, etc.)
• Staff initials

If you think that a child has an infectious disease or if you are suspicious of an enteric or gastrointestinal outbreak (diarrhea and/or vomiting), report it immediately to Public Health. 

Reporting outbreaks to Public Health

All reportable diseases and potential outbreaks should be reported by calling Region of Waterloo Public Health. To know what diseases are reportable see diseases of Public Health significance for Region of Waterloo. Public Health staff can also provide information and guidance on reporting.

• To report diseases of Public Health significance
  
  • Call 519-575-4400 and ask to speak to infectious diseases.
• To report a higher than normal number of sick children or gastrointestinal outbreaks (diarrhea or vomiting), complete the Childcare Centre Outbreak Reporting Form.

For emergency after hours, weekend and holiday support call 519-575-4400.

Legal Requirements

Under the Health Protection and Promotion Act, child care providers are legally required to report to Public Health if someone has or may have a reportable disease.

You do not need a confirmation or diagnosis from a health care provider to report a disease. 

Confidentiality

Everyone's health information is private. Personal information can only be collected and used in a restricted way. The identity of children or staff will not be shared with the community or to other individuals at the child care centre.

All Public Health staff have a responsibility to protect the privacy and confidentiality of all personal health information that is collected, used, stored and shared.

Responsibility of parents/guardians

Parents/guardians need to:  

• Inform the centre when the child is sick.
• Describe the symptoms the child is experiencing.
• Keep the child away from the centre when they are sick.

If the child is not well enough to participate comfortably in all activities, the child should not be at the centre.

Exclusion guidelines during non-outbreak periods

Steps for exclusion when a child is sick:

1. Separate sick children from well children. Place sick children in the designated isolation area or sick room.
2. Keep sick children comfortable by providing separate cots and toys. Clean and disinfect cots and toys after use. Do not allow sick children to participate in group activities.
3. If possible, designate specific staff to care for sick children. Ideally, child care staff should not care for sick and well children at the same time.
4. Contact parents to pick up sick children and remind them of the exclusion policy.
5. Follow policies and procedures for exclusion periods.
6. Update your illness tracking form.

If necessary, post a notification at the front entrance of the childcare centre to let parents and visitors know of an illness and symptoms.

Exclusion guidelines for sick child care staff are the same as those for sick children. The child care centre should provide staff with a policy for sick employees, including when they must stay home.

What to do if a child is sick, but does not need to be excluded

Sometimes a child may be sick, but is well enough to stay in the child care centre or does not have symptoms or an illness that requires exclusion. Child care staff must make sure the:

• Child washes hands more frequently.
• Child care staff wash hands more frequently.
• Child does not participate in water play.
• Child care providers clean and disinfect play areas and toys more often.

Respiratory Illness

Region of Waterloo Public Health does not declare respiratory outbreaks in child care centres. Children or staff with new or worsening symptoms of respiratory illness not related to other causes or conditions should stay home. They can return when symptoms have improved for at least 24 hours and they have no fever. 

Symptoms of a gastrointestinal illness include diarrhea, vomiting, nausea, stomach cramps, headache or weakness. 

Gastrointestinal outbreak management

To report a higher than normal number of sick children or gastrointestinal outbreaks (diarrhea or vomiting), complete the Childcare Centre Outbreak Reporting Form.

Steps to manage a gastrointestinal outbreak

1. Isolate the ill children and arrange for prompt pick up.

2. To report a higher than normal number of sick children or gastrointestinal outbreaks (diarrhea or vomiting), complete the Childcare Centre Outbreak Reporting Form. Public Health staff will guide you with steps on how to bring the outbreak under control.

3. Begin a line listing. The Outbreak Activity Line List is a tracking tool for all of the children and staff who are sick. Each row represents a person who is sick. 

The list should include:

• The date
• The child’s name
• The date symptoms first appeared
• The symptoms the child experienced
• The outcome of the situation (child sent home, child absent, etc.)
• The child’s classroom

4. Establish control measures

• Review hand hygiene with staff and children. Supplement hand washing with the use of alcohol-based hand rubs (ABHRs), particularly for staff.
• Ensure that gloves and other personal protection are available for staff to use.
• There should be no new registrations during the outbreak period.
• Stop group activities including sensory play activities such as water tables, sand tables, etc.
• Discourage sharing of toys and personal items.
• Use disposable diapers and discard into a covered container.
• Cancel day programs and outings including field trips for the duration of the outbreak period.
• Exclude sick children and staff from child care until 48 hours after symptoms have stopped. This recommendation may change during an outbreak upon consultation with Public Health, depending on the cause of illness.
• Cohort infected or exposed children with staff who are caring for infected and exposed children. Staff should be dedicated to assigned rooms and not move between rooms.
• Request all staff not to work at other facilities during the outbreak.

 5. Increase disinfection in the child care centre.

• Staff should disinfect high touch surfaces such as door knobs, handles, crib rails and toys more often.
• Use a disinfectant such as accelerated hydrogen peroxide or chlorine bleach.
• Follow the manufacturer’s instructions for concentration and contact time for the disinfectant.
• If using household chlorine bleach, the required concentration and contact times are outlined in the Surface Disinfection with Chlorine (Bleach) chart (printable resource).

6. Collecting stool specimens. The collection of stool helps to determine the cause of the outbreak. Specimen collection should begin immediately upon identification of an outbreak. Public Health should be notified if the facility requires stool sample kits. Kits and instructions will be provided.

7. Inform parents and guardians of an outbreak status and place an outbreak notice on the door.

8. Update your Public Health inspector daily on the outbreak situation including new cases and hospitalizations. Your inspector can answer any questions you may have for pick-up and drop-off of specimen kits, cleaning and more. Your inspector will review the situation and, if applicable, confirm the outbreak can be declared over.

Additional resources

• List of other childhood illnesses and factsheets (Canadian Pediatric Society)
• Fifth disease and pregnancy (Canadian Pediatric Society)

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