Children’s Environmental Health Network

Proper hygiene in a child care facility should be considered an essential part of daily operations. Any type of facility that serves a volume of children daily – preschools, primary schools, daycare facilities, even home-based daycare – should ensure that hygiene is a priority. With so many children sharing space, the risk of infection spreading quickly is very high. Sound hygiene procedures can limit the spread of bacteria, viruses, and disease, and improve the well-being of the children.

There are two facets to child care facility hygiene: staff and faculty education and compliance with industry standards; and student/child education. Every child care facility should be able to implement and demonstrate following healthy hygiene practices to minimize the spread of infection. The success of a facility’s hygiene program can have a direct effect on the financial success of the facility itself; many parents will choose a provider based on their ability to keep their child safe from all sorts of dangers, including infection and disease.

Of course, it goes without saying that the cleanliness of the facility should be maintained with daily cleaning and disinfecting of any equipment or surfaces that people contact, such as restrooms, kitchens, classrooms, desktops, and doorknobs. Implementing proper hygiene procedures (read below) will minimize the impact of any shortcoming of your cleaning standards, but an ounce of prevention is worth a pound of cure.

The Importance of Hygiene in Child Care Facilities

It’s no wonder that germs and infections can spread so rapidly in a child care facility, considering all the activities that take place: children running around touching everything in sight (including bathroom surfaces), sharing crayons, playing with toys, touching furniture, sharing books, touching food and eating utensils. Given the high degree of physical contact in this environment, it’s probably the ideal breeding ground for infectious disease. It’s essential that everyone works towards keeping the child care environment as sterile as possible through the proper use of hygiene.

How Infections Spread

There are numerous ways for infections to spread in a child care center, from airborne germs originating from sneezes and coughs, to direct contact with objects, surfaces, and others (children or adults) in the environment. Our goal with proper hygiene procedures is to minimize the risk to everyone in the facility, particularly the children.

The Best Strategy: Hand Hygiene

Teaching, and reinforcing, children to wash their hands at appropriate times is the single best method to minimize the spread of germs and infections. More importantly, teaching them specific handwashing techniques using soap and water, length of time washing, and when to wash.

A recent study by researchers at Michigan State University observed 3,749 people leaving the bathroom. Only 66.9 percent used soap; 10.3 percent didn’t wash their hands at all; 23 percent just wet their hands (they called it “attempted washing”); only 5.3 percent of the people spent 15 seconds or longer washing, rubbing, and rinsing their hands. The AVERAGE time was only 6 seconds.

Our conclusion: if children are taught solid hand-washing strategies, they are likely to continue using those skills into adulthood.

When to Wash Hands

The Centers for Disease Control (CDC) offers these tips for when to wash hands:

• Before, during, and after preparing food
• Before eating food
• Before and after caring for someone who is sick
• Before and after treating a cut or wound
• After using the toilet
• After changing diapers or cleaning up a child who has used the toilet
• After blowing your nose, coughing, or sneezing
• After touching an animal, animal feed, or animal waste
• After handling pet food or pet treats
• After touching garbage

Children learn by observing, so ensuring your facility’s staff follow these procedures personally is of utmost importance. Having a handwashing sink right in the classroom is a tremendous tool to teach this skill.

How to Wash Hands

The CDC’s recommendations for HOW to wash hands for maximum effect:

• Wet your hands with clean, running water (warm or cold), turn off the tap and apply soap.
• Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.
• Scrub your hands for at least 20 seconds. Hum the “Happy Birthday” song from beginning to end twice.
• Rinse your hands well under clean, running water.
• Dry your hands using a clean towel or air dry them.

Additional tips recommend using a paper towel or single-use towel, and avoiding directly touching the faucet handles after washing by using a paper towel. Many sources recommend never using a cloth roll towel, as they can easily store and transfer bacteria and viruses.

Implementing Hygiene Procedures in Child Care Facilities

There are numerous strategies that should be established to minimize the risk of infection in a child care facility, some for children and others for adults or parents. They include:

• Teaching and reinforcing basic rules of hygiene with the children, including hand washing, covering mouths while coughing, never sharing drinks or food, using a tissue when they have a cold or other symptoms
• Requiring all adults (both workers in the facility and parents/visitors) to wash their hands regularly, especially after using the toilet, changing diapers, handling children, or touching any surfaces
• Establishing and maintaining strict hygiene practices, particularly in areas like bathrooms, kitchens, rest areas, and play areas
• Following hygienic standards for changing diapers, toileting, and wiping children’s noses

Follow Through at Home

Teaching and reinforcing good hygiene at the child care facility is simply not enough – parents need to reinforce the same practices at home to minimize the chance of the little ones bringing infectious diseases and germs into the facility. Encourage families (through education) to follow the same procedures in place at the facility – most importantly, washing hands regularly and covering mouths when coughing and sneezing.

A great strategy to minimize the transfer of germs and infection is to encourage everyone to get in the habit of washing their hands when they arrive and before they leave the facility.

Additional Tips for Family Hygiene Involvement

It’s helpful for everyone involved to encourage family members to reinforce good hygiene habits at home. You may want to suggest the following strategies to the childrens’ parents:

• Reminding children to wash their hands, frequently. For example, after using the restroom, before meals, after playing outside, or playing with the family pet.
• Include a change of clothes or underwear in case of accidents, especially for younger children who are still potty training.
• Keep a child home when they are ill! Only allow the child to return to child care after they are no longer contagious.

Standard 3.2.2.2: Handwashing Procedure

Excerpt from the National Health and Safety Performance Standards

Children and staff members should wash their hands using the following method:

1. Check to be sure a clean, disposable paper (or single-use cloth) towel is available;
2. Turn on warm water, between 60°F and 120°F, to a comfortable temperature;
3. Moisten hands with water and apply soap (not antibacterial) to hands;
4. Rub hands together vigorously until a soapy lather appears, hands are out of the water stream, and continue for at least twenty seconds (sing Happy Birthday silently twice) (2). Rub areas between fingers, around nail beds, under fingernails, jewelry, and back of hands. Nails should be kept short; acrylic nails should not wear (3);
5. Rinse hands under running water, between 60°F and 120°F, until they are free of soap and dirt. Leave the water running while drying hands;
6. Dry hands with the clean, disposable paper or single-use cloth towel;
7. If taps do not shut off automatically, turn taps off with a disposable paper or single-use cloth towel;
8. Throw the disposable paper towel into a lined trash container, place single-use cloth towels in the laundry hamper; or hang individually labeled cloth towels to dry. Use hand lotion to prevent chapping of hands, if desired.

The use of alcohol-based hand sanitizers is an alternative to traditional handwashing with soap and water by children over twenty-four months of age and adults on hands that are not visibly soiled. A single pump of an alcohol-based sanitizer should be dispensed. Hands should be rubbed together, distributing sanitizer to all hand and finger surfaces and hands should be permitted to air dry.

Situations/times that children and staff should wash their hands should be posted in all handwashing areas.

The use of antimicrobial soap is not recommended in child care settings. There are no data to support the use of antibacterial soaps over other liquid soaps.

Children and staff who need to open a door to leave a bathroom or diaper-changing area should open the door with a disposable towel to avoid possibly re-contaminating clean hands. If a child can not open the door or turn off the faucet, they should be assisted by an adult.

RATIONALE:

Running water over the hands removes visible soil. Wetting the hands before applying soap helps to create a lather that can loosen the soil. The soap lather loosens the soil and brings it into solution on the surface of the skin. Rinsing the lather off into a sink removes the soil from the hands that the soap brought into the solution. Warm water, between 60°F and 120°F, is more comfortable than cold water; using warm water also promotes adequate rinsing during handwashing (1).

Acceptable forms of soap include liquid and powder.

COMMENTS:

Pre-moistened cleansing towelettes do not effectively clean hands and should not be used as a substitute for washing hands with soap and running water. When running water is unavailable or impractical, the use of alcohol-based hand sanitizer (Standard 3.2.2.5) is a suitable alternative.

Outbreaks of disease have been linked to shared wash water and washbasins (4). Water basins should not be used as an alternative to running water. Camp sinks and portable commercial sinks with foot or hand pumps dispense water as for a plumbed sink and are satisfactory if filled with fresh water daily. The staff should clean and disinfect the water reservoir container and water catch basin daily.

Single-use towels should be used unless an automatic electric hand-dryer is available.

The use of cloth roller towels is not recommended for the following reasons:

1. Children often use cloth roll dispensers improperly, resulting in more than one child using the same section of towel; and
2. Incidents of unintentional strangulation have been reported (U.S. Consumer Product Safety Commission Data Office, pers. comm.)

TYPE OF FACILITY:

Small Family Child Care Home, Center, Large Family Child Care Home