Outbreaks in Child Care Centers

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Reporting and requests

Outbreak reporting

To report an outbreak during regular business hours, please complete the Initial Outbreak Notification Form below or call 613-580-2424 ext. 26325. Evenings, weekends or holidays, call 3-1-1 and ask to speak with the Public Health Inspector on-call.

NEW design, same reporting form:

Notification of Increase in Illness Intake Form

For outbreak definitions, please refer to the Outbreak Definitions section.

Specimen pick-up or drop-off requests

To request an Ottawa Public Health specimen pick-up, please complete the Facility Specimen Collection Request Form below. If encountering any issues, please call 613-580-2424 extension 26325.

To learn more about ordering specimen kits, the kit, requisition form, and specimen collection, please refer to the How to collect stool specimens section. 

Facility Specimen Collection Request Form
Outbreak related specimen collection only.

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Forms and templates

Outbreak Line List

Please use the templates below in either print format or PDF fillable format for reporting of cases to the Infection Prevention and Control team at Ottawa Public Health.

Fillable version - Outbreak line listing (PDF - 794 KB)

Print version - Outbreak line listing (PDF - 766 KB)

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Resources and guidance

What are outbreaks?

Respiratory outbreaks

A respiratory outbreak is an increase in respiratory illness among a group of people at the same time and place. Respiratory illnesses can be caused by bacteria or viruses that affect the respiratory system (e.g., nose, throat, and lungs).

Symptoms of a respiratory illness include fever, cough, runny nose, congestion, sneezing, sore throat, and difficulty swallowing. Other symptoms may include headache, sore muscles, fatigue, poor appetite, and irritability. COVID-19, influenza and respiratory syncytial virus (RSV) are examples of viruses that cause respiratory illnesses. Respiratory illnesses can spread:

  • From person to person through contact with droplets of someone who has a respiratory illness. This can be spread from coughing, sneezing, and talking.
  • Indirectly through contact with contaminated objects/surfaces.

Gastrointestinal outbreaks

Enteric outbreaks (or gastroenteritis outbreaks) is a sudden onset of gastrointestinal illness and may occur in schools throughout the year. Gastrointestinal illness (GI) is caused by bacteria, viruses, or parasites leading to symptoms such as nausea, vomiting and diarrhea.

GI illnesses can spread:

  • From person-person through contact with bodily fluids
  • Through consumption of contaminated food/water
  • Indirectly through contact with contaminated object/surfaces
Chain of infection

Download PDF [429 kb]

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

Outbreak Definition

A Child Care Setting should report an outbreak of illness to Ottawa Public Health (OPH):

  • When there are three (3) or more cases (children or staff) of gastrointestinal illness (e.g. nausea, vomiting, diarrhea) within a program, group, or the entire setting in a three (3)-day period, even if cases occurred at home
    OR
  • When your child care setting absenteeism rate increases above what the setting would typically experience and the absences are not perceived to be linked to other factors such as holidays, the operator/owner should notify OPH.
    OR
  • If there are one or more case(s) of a reportable enteric disease in the setting as per the Guidelines for Communicable Disease and Other Childhood Health Issues for Schools and Child Care Centres.

When an outbreak is suspected, follow the guidance in the Infection prevention and control measures during outbreaks section below.

Other Infectious Diseases

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. 

Outbreak Control Measures
Screening
  • Initial screening should occur at home to avoid any sick children or staff entering the facility.
  • As an added precaution, it is recommended that the facility also conducts screening on all those entering the facility and sending those with symptoms back home.
  • Refer to the Ministry of Health’s COVID-19 school and childcare screening tool.

Management of symptomatic individuals
  • Individuals who have respiratory symptoms or a positive COVID-19 test must self-isolate immediately until symptoms have been improving for 24 hours and no fever is present. Longer self-isolation is recommended in certain populations, such as those with severe illness, those who are immunocompromised, and those who live or work in a highest risk setting.
  • Individuals who have enteric/gastrointestinal symptoms including vomiting and/or diarrhea, should be excluded until symptoms have been resolved for at least 48 hours.
  • Follow exclusion criteria for other illness as described in the Guidelines for Communicable Diseases and Other Childhood Health Issues for Schools and Child Care Centres.

Management of household and non-household close contacts
  • For a total of 10 days after the last exposure to the COVID-19 positive case or individual with COVID-19 symptoms, the individual should:
    • Self-monitor for symptoms. They should self-isolate immediately if they develop any symptoms of COVID-19 and seek testing if eligible.
    • Wear a well fitted mask in public settings including child care and school, unless under 2-year-old. 
      • Reasonable exceptions would include removal for essential activities like eating, while maintaining as much physical distance as possible.
      • Participation in activities where masking can be maintained throughout may be resumed, but individuals should avoid activities where mask removal would be necessary (e.g., dining out; playing a wind instrument; high contact sports where masks cannot be safely worn); and
      • Individuals who are unable to mask (e.g., children under two years of age, etc.) may return to public settings without masking.
    • Avoid non-essential visits to anyone who is immunocompromised or at higher risk of illness (e.g., seniors); and
    • Avoid non-essential visits to highest risk settings such as hospitals and long-term care homes. Where essential visit cannot be avoided, close contacts should wear a medical mask, maintain physical distancing, and notify the highest risk setting (e.g., hospital) of their recent exposure.

Management of ill individuals onsite
  • Limit movement of staff and children, as well as equipment used between cohorts where possible during outbreaks.
  • Symptomatic staff/child procedure in place including isolation of ill individual; contacting family for pickup of ill child(ren); and sending ill individual home.
  • 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.
  • Appropriate PPE worn by all staff supervising ill children (medical mask, optional non-fit-tested N-95 mask, eye protection and gloves) and all ill children (medical mask if child is older than two and mask tolerated).

Personal protective equipment

Refer to Public Health Ontario – Refresher for Schools and Childcare for more details

  • Follow PPE guidance as per provincial guidance for all close contacts
  • Sufficient stock of PPE (medical masks, non-medical masks) is always available for staff and children. PPE logs are recommended.
  • PPE training for staff and children (donning and doffing).
  • Gloves worn by staff if there is possibility of contact with bodily fluids (e.g., during diaper changes).

 

Cleaning and disinfection

Refer to OPH Webpage – Cleaning and Disinfection in Childcare and School Settings for more details.

  • Disinfectant contains a Drug Identification Number and is not expired.
  • Follow manufactures instructions for product’s use.
  • Remove sensory play during outbreaks (e.g., water or sand tables).
  • Fabric furniture should be removed or covered with a nonabsorbent easy cleanable cover during outbreak.
  • Enhanced cleaning and disinfection of high touch surfaces, washrooms, toys/other shared objects minimum 2x/day; immediate cleaning & disinfection of items used by ill child or as needed (e.g., toys, blankets).
  • Clean and disinfect high-touch surfaces at least twice daily and as needed using an enhanced cleaner/disinfectant (e.g., doorknobs, water fountain knobs, light switches, toilet, and faucet handles).
  • Clean and disinfect linens, cots, and cribs at least once a week and immediately after use by a symptomatic child.
  • Clean and disinfect diaper changing stations immediately after each use.
  • Personal items (e.g., sippy cups, soothers, utensils) are not shared.

Hand hygiene
  • Train and encourage appropriate hand hygiene and respiratory etiquette for all staff, children, and visitors including the use of soap and water when hands are visibly soiled and alcohol-based hand rub (ABHR). Provide supervision/ assistance to children as needed. Ensure adequate supplies are available.
  • Alcohol based hand rub (ABHR) with a minimum 70 per cent alcohol concentration must be available throughout the facility (including ideally at the entry point to each classroom) and/or plain liquid soap in dispensers, with sinks and paper towels in dispensers.
Specimen Kits and Collection

Specimen identification is a critical part of outbreak investigations. Once the causative agent is known through specimen testing, the public health unit and the home can determine the appropriate next steps to mitigate transmission by implementing targeted interventions.

Specimen collection kits (stool or NP) can be ordered through Ottawa Public Health using the Facility Specimen Collection Request Form when an outbreak has been declared.

Kit contains two sterile containers:

Container NumberColour of CapTransport MediaTest Required
#1 White cap Empty vial Virology
#2 Green cap Red transport medium Bacteriology

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 unable to be accepted due to contamination

Collection Procedure:

*These first two steps are very important – if the label and/or form are missing information, illegible, or filled out incorrectly, the lab will not test the sample.

  1. Label the sample containers with the child’s name, health card number (ID number on the label), and the date/time the stool sample is collected.     
  2. Complete all of the required sections of the “General Test Requisition” form
    • Patient information section
    • Public health unit outbreak number
    • Date stool sample collected
    • Date of symptom onset (date symptoms started)
  3. Collect the stool sample  
    • Adults and toilet trained children: Defecate into a clean container (i.e. a disposable plate). Stool that has been in contact with water is cannot be accepted. TIP: Urinate first if needed.
    • Children who are not toilet trained: Collect the stool sample from the soiled diaper or directly from the child's training "potty."   
    • Using the individual "scoop" attached to each of the caps, transfer stool into the corresponding sterile containers. Fill the white cap container first.  
    • Fill to the line indicated on the container. Do not overfill.   
    • Tighten the caps. Do not use excessive force to tighten the caps as the containers may crack and leak.  
    • Place the containers in the inner pocket of the plastic biohazard bag and seal the zip-lock 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 and refrigerate the sample(s) immediately after collection. Stool samples should be placed on the bottom shelf of a fridge and food should not be stored in the same fridge as the stool samples. A cooler with ice or an ice pack can be used if a separate fridge is not available. Do not freeze the sample.
    • Perform hand hygiene. If hands are visibly soiled, use soap and water.
    • Call Ottawa Public Health at 613-580-2424, ext. 26325 for stool sample pick-up and delivery to the Public Health Laboratory located in Ottawa. Deadline for same day pick up is 3:00 pm. Inform your child care and early years operator that a stool sample was collected.  

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.

Enteric Outbreak Resources
Supporting child care and early years during COVID-19

Keeping COVID-19 transmission low in the community is important to help prevent the introduction of the virus into child care and early years services. OPH will continue to support Providers via the OPH information line (613-580-6744) as well as the Outbreak Reporting Line (613-580-2424 ext. 26325) if questions arise regarding case management and/or outbreaks.

As we learn to live with COVID-19, we must recognize that all of us have a role to play when it comes to reducing the risks from the virus.

Staff and families should continue daily screening for COVID-19 symptoms for all family members and stay home when sick. Information for those who have symptoms, test positive for COVID-19 or high-risk contacts is available visit our web page.

Here are links and resources to support child care and early years in relation to COVID-19:

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)

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 settings 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 setting 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.
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.
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.
Mixing some cleaners and disinfectants (like chlorine bleach and ammonia) can be harmful, even deadly. Others can irritate your eyes, nose, or throat and cause breathing problems.

Guide for preparation of bleach solutions

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

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

2 minutes

1000 ppm

During outbreaks, to sanitize child care surfaces, diapering stations, toys, play areas, pet cages and high touch hard surfaces.

20 mL of bleach with 1 litre of water

OR

4 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

100 mL of bleach with 1 litre of water

OR

½ cup of bleach with 4 cups of water

≥10 minutes

*Note: The contact time, also known as the wet time, is the time that the disinfectant needs to stay wet on a surface to make sure it can kill all the germs. It is the length of time you leave the solution on the surface before wiping it down.

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 setting 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

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)
  • 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

Diaper changing

Diapering areas in child care settings are important to consider in preventing 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
  • Used cloth diapers (outer covering and liner) must be handled as little as possible to limit and prevent exposure to body fluids. Do not shake, scrape, or rinse the cloth diapers. However, formed stool may be released into a toilet if it can be done so with ease, then place soiled items into a plastic bag and return to parents. During an outbreak, children using cloth diapers should switch to disposable diapers for the duration of the outbreak
  • 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
Signage, Posters and Factsheets
Outbreak Signage
Hand Hygiene

For signage in additional languages, please refer to Ottawa Public Health’s Hand Hygiene webpage.
Personal Protective Equipment (PPE)

Physical Distancing

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