Outbreaks in Child Care Centers

Control Measures For Enteric and Respiratory Outbreaks

Ottawa Public Health aligns with provincial guidance for management of cases and contacts of COVID-19 in Ontario. 

Screening

Screening is encouraged for all staff, children, and visitors. 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 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. Refer to page 13 in the guidance. 
    • 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.
• More information on how to perform hand hygiene for children and infants can be found on parentinginottawa.ca.
• Printable hand hygiene resources.

• Parent Stool Sample Information (pdf - 81 KB) (This document is currently not in an accessible format. An accessible document will be posted shortly.)
• Child Care Enteric Outbreaks (pdf - 160 KB) (This document is currently not in an accessible format. An accessible document will be posted shortly.)