Infection Prevention and Control in Child Care Centres

Cleaning and disinfection checklist

Commonly touched surfaces and items should be cleaned and disinfected frequently (e.g. at least once a day) to limit the potential spread of germs. When the facility is experiencing an outbreak, cleaning and disinfection of these surfaces and items is required more often. Develop a checklist specific to your facility, using this checklist as a guide. Remember to always work from clean areas to dirty areas.

General areas:

  • Door knobs/frames/handles/other frequently touched areas on the door
  • Locker doors/cubby holes/storage bins for children
  • Desks/tables/chairs/counter tops
  • Hand railings
  • Light switches
  • Water fountains
  • Elevator buttons
  • Shared equipment (such as toys, sports equipment and musical instruments after each use, computer keyboards and mice, etc.)
  • Telephones/faxes/photocopiers/intercoms
  • Play areas and toy storage areas
  • Floors (especially where children play on them)

Kitchen/staff room:

  • Food preparation areas and equipment
  • Counter tops
  • Fridge handles
  • Microwaves
  • Coffee pots/kettles
  • Tables/chairs

Child and staff washrooms:

  • Stall door edges and locks
  • Coat hooks
  • Sanitary napkin dispensers
  • Paper towel dispensers
  • Soap dispensers
  • Taps/faucets
  • Flush handles
  • Toilet seats
  • Toilet bowls and urinals

Important points to remember:

  • Use single use cloths or disposable paper towels to clean sinks and toilets/urinals
  • Ensure an adequate supply of paper towels and soap
  • Do not top up partially empty dispensers; once empty, containers should be cleaned, disinfected, dried, and then refilled
  • Soap/detergent must be rinsed off prior to disinfection

For more information, call Ottawa Public Health at 613-580-6744

Cleaning and Disinfection of Toys

Infants and young children share toys and often place them in their mouths. This increases the risk of spreading infections. To reduce this risk, play areas and storage spaces should be cleaned and disinfected on a regular basis. Ensure that the disinfectant is safe and suitable for use on toys. Consult the manufacturer's recommendations for dilution and contact times for these disinfectants.

Cleaning and disinfecting hard plastic toys

  • Remove toys from the play area after use and place them in a collection box for cleaning and disinfection
  • Clean and disinfect the collection box at the same time that toys are being cleaned and disinfected
  • Clean toys in hot soapy water prior to using a disinfectant
  • Use a brush to clean crevices or hard to reach areas
  • Rinse toys well under running water as soap may neutralize the disinfectant
  • Soak toys in an appropriate disinfectant for required amount of time (contact time)
  • Use a solution of 10 ml (2 tsp) sodium hypochlorite (household bleach) per 1 liter (4 cups) of water as a disinfectant. This solution requires a contact time of 10 minutes. Only mix bleach with water and never with other disinfectants or cleaners
  • Rinse toys with clean water to remove any disinfectant solution, if indicated on the label; bleach does not require rinsing
  • Clean and disinfect dishwasher-safe, hard plastic toys in a commercial dishwasher with a sanitizer or a hot rinse cycle
  • Completely air dry toys before they are returned to use
  • Keep a record of when toys were cleaned and disinfected

Cleaning and disinfecting soft, porous toys or dress up clothes

  • Launder fabrics or plush toys in a washing machine with hot water, and dry in a clothes dryer on a hot cycle
  • Avoid using disinfectant products on porous surfaces

Cleaning other items

  • Clean and disinfect other items (e.g., scissors, puzzles, storage bins, etc.) when they are visibly dirty
  • Items such as books and some craft equipment may be difficult to clean, so consider discarding them once they are soiled
  • Avoid sensory play during an outbreak, such as activities using play dough, sand or water
  • Clean and disinfect computer keyboards, mice and other electronics between uses

For more information, call Ottawa Public Health at 613-580-6744.

Chain of infection

 

Download PDF [429 kb]

Diagram showing the chain of infection for germs

Germs (agent)

  • Bacteria
  • Viruses
  • Parasites

Where germs live (reservoir)

  • People
  • Animals/Pets (dogs, cats, reptiles)
  • Wild animals
  • Food
  • Soil
  • Water

How germs get out (portal of exit)

  • Mouth (vomit, saliva)
  • Cuts in the skin (blood)
  • During diapering and toileting stool

Germs get around (mode of transmission)

  • Contact (hands, toys, sand)
  • Droplets (when you speak, sneeze or cough)

How germs get in (portal of entry)

  • Mouth
  • Cuts in the skin
  • Eyes

Next sick person (susceptible host)

  • Babies
  • Children
  • Elderly
  • People with a weakened immune system
  • Unimmunized people
  • Anyone

Cycle repeats

 

Diaper changing

Diapering areas in child care centres are important to consider to prevent the spread of germs.

The following measures are important infection prevention and control practices for such areas:  

  • Keep the diapering stations separate from food preparation, eating and activity areas
  • Ensure the surface for diapering is made of a smooth, non-porous and cleanable material
  • Dedicate a hand wash sink close to the diapering station with warm water, soap and disposable towels
  • When diapering a child, it is important to ensure that staff wash their hands prior to putting on gloves and handling the soiled diaper
  • Gloves should be removed after handling the soiled diaper, followed by hand washing
  • Gloves are single use and should not be used for another task or for diapering another child
  • Place soiled diapers immediately in a nearby garbage can with a secure lid and disposable liner; a foot operated garbage can is preferred
  • Ensure personal diapering items are clearly labelled for each child (creams, wipes and diapers); do not use a child's dedicated items on another child
  • If a child's clothing becomes soiled, place it in a plastic bag and send home for laundering
  • Use an appropriate cleaner and disinfectant to clean the diapering surface between each use (e.g., after each diaper change)
  • Assist children with hand washing after diapering

For more information, call Ottawa Public Health at 613-580-6744

Hand hygiene for infants and young children

Keeping children's hands clean is the best way to keep them from spreading germs. Young children need to be taught when and how to clean their hands.

It is important for children to clean their hands frequently, including, but not limited to:

  • After going to the washroom
  • Before eating
  • After coughing, sneezing or blowing their nose
  • After playing with shared toys
  • After touching animals
  • After outdoor activities

Hand hygiene techniques

Cleaning children's hands can be done by washing them with warm running water and soap or by using alcohol based hand sanitizers. Children may need assistance and supervision while washing their hands to ensure that they are washed correctly. 

Washing your hands

  1. Wet hands under running water
  2. Apply liquid soap
  3. Lather and rub hands for at least 15 seconds
  4. Rinse hands
  5. Towel or air dry hands
  6. Turn taps off with a towel or your sleeve

Cleaning Your Hands with a Hand Sanitizer

  1. Place a quarter-size drop of alcohol- based hand sanitizer in your palm
  2. Rub hands together, palm to palm
  3. Rub back of each hand with palm and fingers of the other hand
  4. Rub around each thumb
  5. Rub fingertips of each hand back and forth in the other hand
  6. Rub until your hands are dry (at least 15 seconds)

Washing a young child's hands

  1. Wet a paper towel with water and a small amount of liquid soap
  2. Rub child's hands for 15 seconds
  3. Rinse under running water
  4. Dry hands with a paper towel

Cleaning a Young Child's Hands with Hand Sanitizer

  1. Clean your hands first using the method above
  2. Place a dime size drop of hand sanitizer on your own hands
  3. Rub child's hands until dry (at least 15 seconds)

For more information, call Ottawa Public Health at 613-580-6744

Environmental cleaning and disinfection in child care centres and schools

Shared items and high touch surfaces can be sources for spread of infection, especially in child care centres and schools. Such surfaces may include door knobs, taps, handrails, phones, computer keyboards, elevator buttons, countertops, as well as shared sports equipment or toys. These surfaces and items can easily become contaminated by viruses or bacteria which can spread from one person to another. Developing policies and procedures for cleaning and disinfection is important to prevent the spread of infections in your centre or school.

Cleaning

Cleaning is the physical action of removing debris from a surface. Cleaning with soap or detergent, and water, will remove organic material such as food, body fluids, fecal matter, or soil from surfaces. Residue from the soap or detergent must be rinsed off prior to disinfection to prevent neutralization of some disinfectants.

Disinfection

Disinfection must occur after cleaning. Disinfection inactivates or kills microorganisms (germs) that may be present on surfaces and that cleaning does not remove. A number of disinfectant products can be used in a child care facility on a regular basis. A different disinfectant may be required in outbreak situations. This may be discussed with your product supplier or with Ottawa Public Health as needed.

All-in-one cleaning/disinfecting products must contain a drug identification number (DIN) from Health Canada. The disinfectant contact time, which is the time that a surface must remain wet for a disinfectant to be effective, varies between products. Follow manufacturers' instructions for disinfectant contact times, dilution and handling of products, including for pre-saturated disinfectant wipes. If gloves are indicated for handling a product, ensure they are single use and discarded between tasks.

Flip-top bottles are preferred to apply cleaning solution. If using a spray bottle, saturate the cloth first then wipe the surface. Avoid the use of aerosol cans as this can propel the germs and cleaning solution into the air.

Household bleach diluted in water is an inexpensive and effective disinfectant and can be used for most surfaces. It should be prepared daily. Ensure that surfaces are cleaned with a detergent or cleaning agent before the household bleach mixture is used as a disinfectant.

The following table can be used as a reference for preparing household bleach solutions:

Concentration

Uses

Mixture

Contact time

100 parts per million (ppm)

To sanitize items such as combs, brushes and floors

To sanitize kitchen utensils in a commercial dishwasher

2 mL of bleach with 1 litre of water

OR ½ teaspoon (tsp) of bleach with 4 cups of water

1 minute

200 ppm

To sanitize dishes and utensils in place when they are too large to be washed in a dishwasher or submerged in a sink

To sanitize kitchen surfaces such as counter tops and cutting boards

4 mL of bleach with 1 litre of water

OR

¾ tsp of bleach with 4 cups of water

1 minute

500 ppm

To sanitize child care surfaces, diapering stations, toys, play areas, pet cages and high touch surfaces

10 mL of bleach with 1 litre of water

OR

2 tsp of bleach with 4 cups of water

1 minute

5000 ppm

To disinfect surfaces or items that have been in contact with blood or body fluids, including blood spills, vomit or fecal (stool) contamination

To sanitize surfaces or items during outbreaks of illnesses in child care or school settings

100 mL of bleach with 1 litre of water

OR

½ cup of bleach with 4 cups of water

≥10 minutes

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