Outbreaks in Child Care Centers

A Child Care Centre should report an Outbreak of Illness to Ottawa Public Health (OPH)

When there are three (3) or more cases of gastrointestinal (GI) illness (child and/or staff) within a program, group, or the entire centre in a three (3) day period, even if cases occurred at home
OR
If there are one or more case(s) of a reportable enteric disease in the centre (see below)
OR
If there is >10% absenteeism due to illness within a program or entire centre on one day.

When an outbreak is suspected, implement outbreak control measures:

• Clean and disinfect commonly touched surfaces and common areas
• Post signs to alert staff and parents or guardians of increased absenteeism or outbreak
• Clean and disinfect toys and play areas twice daily and when visibly soiled
• Exclude ill children and staff
• If possible, keep ill children in a separate supervised area until a parent or guardian takes them home
• Be diligent to perform hand hygiene

Report to OPH

If an outbreak is suspected or you are uncertain if you have an outbreak, call OPH Outbreak Reporting Line at 613-580-6744 ext 26325, Monday to Friday from 8:30 am to 4:30 pm or 3-1-1 after hours.

If an outbreak is confirmed by OPH, fax the line listing to OPH at 613-580-9649 on a daily basis until the outbreak is declared over by OPH.

Do you have children absent with other illnesses?

Refer to the Guidelines for Communicable Disease and Other Childhood Health Issues for Schools and Child Care Centres. 

Exclusion of ill children and/or staff

Children and/or staff should stay at home when they have: 

• Symptoms of an enteric illness, including vomiting and/or diarrhea, and until their symptoms have been resolved for at least 48 hours
• Symptoms of a respiratory illness, including fever, cough, sore throat, congestion, runny nose, or sneezing until they are fever-free for 24 hours and feeling better without the use of medication
• Other symptoms as described in the Guidelines for Communicable Diseases and Other Childhood Health Issues for Schools and Child Care Centres (2017, or as current).

During an outbreak, staff should be vigilant about monitoring children for symptoms of illness. Children returning to the child care centre or school after illness should be able to resume all regular activities.

Cohorting of ill children

If possible, ill children should be kept in a separate, supervised area that can be easily cleaned and disinfected, until a parent or guardian takes them home. 

Cleaning and disinfection

Routine cleaning and disinfection is essential to prevent the spread of germs. During outbreaks, you may need to take additional measures, including, but not limited to, the following: 

• Ensure that the disinfectant used during an outbreak is effective to kill Norovirus, a virus which often results in enteric outbreaks
• Clean and disinfect high touch surfaces at least twice a day
• Avoid sensory play during outbreaks (e.g. water or sand activities, use of play-dough)
• Remove shared items such as toys that cannot be easily cleaned and disinfected for the duration of the outbreak

Hand Hygiene

Hand hygiene is essential for all staff and children to prevent the spread of germs. Infants and young children should be supervised when performing hand hygiene to ensure it is done properly. Hand hygiene includes both hand washing and hand sanitizing and should be done more frequently during outbreaks.

You must ensure that:

• Hands are washed with liquid soap and running water for at least 15 seconds if visibly soiled
• Hands should be rubbed with 70-90% alcohol-based hand sanitizers for at least 15 seconds if not visibly soiled

Signage

Appropriate notices and posters should be posted at all entrances to advise parents, guardians, and visitors of an outbreak at the child care centre or school.

For more information, call the Ottawa Public Health Outbreak Reporting Line at 613-580-6744 ext 26325

Learn more about preventing the spread of germs in the below resources prepared by OPH.

The information below is available in other formats. Contact Ottawa Public Health at 613-580-6744 to request the document in an accessible format.

• Ottawa's Health is in Your Hands
  Downloadable PDF: Poster 1.2 MB
• Hand washing poster (PDF) [930 kb]
  Poster and factsheet: English [PDF 606 KB] ; French [PDF 666 KB] ; Arabic [PDF 1.7 KB]
• Hand sanitizing
  Poster only: English [PDF 5.4 MB]
  Poster and factsheet: Arabic [PDF 1.6 KB]

Outbreak line listing for child care centers and schools [PDF 160 kb]

Fax daily to: 613-580-9649

Collection

• Check the expiration date on the sterile containers. DO NOT use expired kits
• If blood or mucus is present in the stool, take the sample from this part of the stool
• Stool specimens that have been in contact with water in the toilet are unacceptable 

Collection Procedure:

• Complete laboratory submission form and label the containers prior to collecting the specimens
• Adults and toilet trained children should defecate into a clean container (i.e. a disposable plate or nun's cap). In the event of incontinence or for children who are not toilet trained, collect stool sample (feces) from the soiled diaper/incontinence brief or directly from the child's training "potty"
• Using the individual "scoop" attached to each of the caps, transfer stool into the corresponding sterile container  fill the white cap vial first
• Tighten the caps. Do not use excessive force to tighten the caps as the containers may crack and leak in transit
• Place the containers in the inner pocket of the plastic biohazard bag
• Place the General Test Requisition form in the small outer pocket of the plastic biohazard bag. DO NOT place the form in the inner pocket      
• Place the biohazard bag into the brown paper bag, provided and refrigerate the sample(s)
• Perform hand hygiene. If hands are visibly soiled, use soap and water.
• Call Ottawa Public Health at 613-580-6744, ext. 26325 for stool sample pick-up and delivery to the Public Health Laboratory located in Ottawa.
• DO NOT submit the specimen to the lab without contacting Ottawa Public Health

Labelling

Label each container with the client's name, Date of Birth and date the stool sample was collected

Samples that are incorrectly filled out, or packaged improperly will be discarded by Public Health Lab