Reducing Contagious Illness in the Child Care Setting–Part 2 – Volume 16, Issue 2, 2007

Reducing Contagious Illness in the Child Care Setting–Part 2 – Volume 16, Issue 2, 2007
Child Care
Editors: Stephen Green, Ph.D., & Susan Lee
Volume 16 • Issue 2 • 2007
Reducing Contagious Illness in the Child Care Setting: Part 2*
Part 1 of this 3-part series (Volume 16,
Issue 1, 2007) focused on common types
of communicable diseases, how germs
are transmitted, and the importance of
handwashing as an effective strategy
for reducing the spread of such diseases.
In this issue, we will focus on tips for
cleaning, sanitizing, and disinfecting
surfaces that pose a risk to children and
staff, and best practices for handling food.
Cleaning, Sanitizing &
In addition to handwashing, cleaning
and sanitizing/disinfecting surfaces
that could pose a risk to children or
staff is one of the most important
steps to reducing the spread of
communicable diseases in the child
care setting (American Academy
of Pediatrics et al., 2002). Before we
go any further, let’s
take a moment to
distinguish the terms
cleaning, sanitizing,
and disinfecting.
• Cleaning –
Removing dirt
and soil with soap
and water.
In addition to handwashing,
cleaning and sanitizing/
disinfecting surfaces that could
pose a risk to children or staff
is one of the most important
steps to reducing the spread of
communicable diseases in the
child care setting.
• Sanitizing –
Removing dirt
and soil AND
certain bacteria so
that the number
of germs is reduced to such a
level that the spread of disease is
• Disinfecting – Removing dirt and
soil AND bacteria AND virtually
all germs (National Resource
Center for Health and Safety
in Child Care, 2006). Sanitizing
and disinfecting are often used
to describe the same type of
“cleaning” – to remove germs to
a level that the spread of disease
from one person to another is
unlikely. For this reason, we
will use the word sanitizing
throughout the remainder of this
issue to describe such “cleaning.”
Routine cleaning with detergent and
water is the most useful method for
removing germs from surfaces in
the child-care setting. Some items
and surfaces, however, require the
additional step of sanitizing after
cleaning to reduce the number of
germs on a surface to a level that
is unlikely to transmit disease
(American Academy of Pediatrics et
al., 2002). Sanitizing applies to many
routine housekeeping procedures
including bedding, bathrooms,
kitchen countertops, floors, and walls
(National Resource Center for Health
and Safety in Child Care, 2006).
Sanitizer solutions can be applied in
several ways to surfaces that have
been cleaned with detergent and
• Spray bottle – used for diaperchanging surfaces, toilets, potty
chairs, door knobs, cabinet
handles, phone receivers,
countertops, and tables.
• Clothes rinsed in sanitizing
solution – used for foodpreparation areas, large toys,
books, and activity centers.
• Dipping the object in a container
filled with sanitizing solution –
used for smaller toys.
To view previous issues of Child Care Connections:
It is important to note that the
duration of contact and concentration
of the sanitizing solution vary
with the type of application. More
chemical is required when a cloth
or object is dipped into sanitizing
solution because each time the cloth
or object is dipped, some germs are
released into the solution, potentially
contaminating the solution if it is
not at a high enough concentration.
When applying sanitizing solution,
always read the label and follow
instructions for dilution and
minimum contact time (American
Academy of Pediatrics et al., 2002;
National Resource Center for Health
and Safety in Child Care, 2006).
In general, it is best not to rinse off
sanitizer or wipe the object dry right
away. A sanitizer must be in contact
with the germs long enough to kill
• for spray bleach solution, usually
allow a minimum of 2 minutes to
air dry;
• for cleaned and rinsed dishes
submerged in a properly prepared
bleach solution, usually allow 1
minute of contact time (See more
details in the box below, Recipes for
Cleaning & Sanitizing).
Since chlorine evaporates into the air
leaving no residue, surfaces sanitized
with bleach may be left to air dry.
Some industrial sanitizers, however,
require rinsing in fresh water
before the object can be used again
(American Academy of Pediatrics et
al., 2002).
• Any leftover
should be
discarded at
the end of
the day.
Cleaning & Sanitizing
• Spray
bottles and
be clearly
labeled and
stored out of reach of children
(American Academy of Pediatrics
et al., 2002).
For regular cleaning, detergent and
water is most useful. For sanitizing,
household bleach with water
is recommended. It is effective,
economical, convenient, easy to mix,
non-toxic, safe if handled properly,
and readily available. Be sure to
purchase “household” bleach and not
bleach used for industrial application,
which can be hazardous. Household
bleach comes in two strengths: 5.25%
hypochlorite (regular strength) or
6% (ultra strength). Note: Use bleach
with caution on metal or metallic
surfaces. If bleach is found to be
corrosive, use a different sanitizer on
these materials (American Academy
of Pediatrics et al., 2002).
Important notes about bleach:
• Bleach solution and water loses
its strength and is weakened by
heat and sunlight. Therefore, it
should be mixed with cool, fresh
water every day for maximum
Recipes for Cleaning & Sanitizing
Recipe for spray application on surfaces that have been cleaned and
rinsed (minimum contact time = 2 minutes)
¼ cup household bleach + 1 gallon of cool water OR 1 tablespoon household
bleach + 1 quart of cool water.
This recipe is appropriate for bathrooms, diapering areas, countertops,
tables, toys, door knobs, cabinet handles, phone receivers, sinks, floors, and
surfaces contaminated with body fluid. Note: Always clean the surface first.
If there is a spill, wipe up as much as possible with a paper towel; then clean
and sanitize. Where surfaces contaminated with body fluids are involved,
wear gloves (see Gloving Procedure in this issue).
Recipe for submerging of eating utensils that have been cleaned and
rinsed (minimum contact time = 1 minute)
1 tablespoon bleach + 1 gallon of cool water.
Child Care Connections – Vol. 16, Issue 2
Industrial Products
In addition to bleach-sanitizing
solution, industrial products are
also available. Choose products that
meet the Environmental Protection
Agency’s (EPA’s) standards for
“hospital grade” germicides
(solutions that kill germs). Be
cautious of industrial products
labeled as “disinfectants,” having
“germicidal action,” or that simply
say “kills germs” – they may not
have the same effectiveness as bleach
and water or EPA-approved hospital
grade germicides. Always read the
label for instructions (American
Academy of Pediatrics et al., 2002).
For a sample cleaning/sanitizing
schedule, see http://www.healthykids.
Gloving Procedure:
How & Why?
Why use gloves?
“Gloves provide a protective barrier
against germs that cause infections.
Use gloves made of disposable latex.
If you’re allergic to latex, use vinyl
• Wearing gloves does not replace
the need to wash your hands.
Latex and vinyl gloves are a
good barrier, but they may not be
completely non-porous.
Texas A&M AgriLife Extension Service
• Wearing gloves reduces
contamination, but does not
eliminate it.
• If the gloves become contaminated
while you are wearing them,
be sure to remove them before
touching clean surfaces.
Disposable gloves should be worn:
• when contact with blood or
blood-containing fluids is likely,
particularly if the caregiver’s
hands have open cuts or sores
– for instance, when providing
first aid or changing a diaper with
bloody diarrhea; and
• when cleaning surfaces
contaminated with blood or body
fluids, such as large amounts of
vomit or feces.
• Ball up the dirty glove in the palm
of the other gloved hand.
• With the clean hand, strip the
glove off from underneath the
wrist, turning the glove inside out.
Touch dirty surfaces only to dirty
• Discard the gloves immediately in
a plastic bag-lined step can.
• Wash your hands (American
Academy of Pediatrics et al., 2002).
Best Practices for Reducing
the Spread of Infection
– Handling Food
For added
wear gloves
changing the
diaper of a
child with diarrhea or a diagnosed
gastrointestinal disease. Wearing
gloves for routine diaper changing is
Of particular concern when
handling food is taking precautions
against foodborne illness (i.e., food
poisoning) and any other illness
that can occur through fecal/oral
transmission. E. coli is one type of
bacteria, typically contaminating
ground meat, which can cause
severe illness and be particularly
threatening to children younger than
5 years. E. coli can potentially cause
kidney failure and even death in
these children (Global Healthy Child
Care, 2005).
If your skin does come into contact
with blood or other body fluids,
immediately and thoroughly wash
the contaminated skin” (Global
Healthy Child Care, 2005).
Thus, the rule of thumb for food
handling to reduce the risk and
spread of any communicable disease
is “cool it, clean it, cook it” (Global
Healthy Child Care, 2005).
How to use gloves?
Using the appropriate gloving
procedure can keep you and the
children you care for safer from
infection. Use the following steps, in
order, when using disposable gloves:
Cool It
Raw meat and poultry (especially
ground meats) are more perishable
than most foods. Bacteria can
multiply in ground meat and poultry
in a temperature range between 39140 degrees F. Keep these products
• Wash your hands and dry them.
• Put on a clean pair of gloves.
• Provide the appropriate care
– disposing of any contaminated
materials in a leak-proof, plastic
bag that can be tied or sealed.
• Remove each glove carefully. Grab
the first glove at the palm and
strip the glove off. Touch dirty
surfaces only to dirty surfaces.
Texas A&M AgriLife Extension Service
Keep meats on ice if you are more
than an hour from the store to the
child-care facility. Defrost meats by
placing them in a container that will
hold juices, and let them thaw in
the refrigerator – NEVER at room
temperature. Cook or freeze meat
within one to two days (Global
Healthy Child Care, 2005).
Clean It
Food-preparation areas should be
kept separate from eating, laundry,
toileting, and diapering areas
(National Resource Center for Health
and Safety in Child Care, 2006).
Cleaning of food-preparation areas
and utensils requires a bit more
diligence in the child-care setting
than at home. Use the following
guidelines outlined by Global
Healthy Child Care (2005) to help
with cleaning food-handled items (as
well as mouthed toys):
• Don’t use cloths or towels used to
wipe countertops or other foodcontact surfaces for anything else.
These cloths must be sanitized
after they are used.
• Don’t use a sponge – use a cloth
that can be laundered. The
structure of natural and artificial
sponges provides an environment
in which germs thrive.
• Wash food-contact surfaces
with detergent and water; rinse;
sanitize with bleach solution; and
air dry.
• Clean kitchenware, countertops,
and other things that have come
in contact with spoiled food or
raw meat,
or eggs.
Sanitize by
with the
solution, allowing it to stand for at
least 2 minutes, and then dry with
a paper towel or allow to air dry.
• Always wash your hands, utensils,
countertops, cutting boards,
clothes, towels, aprons, and sinks
in hot soapy water after handling
raw meat.
• Wash high-chair trays, bottles,
and nipples in a dishwasher, if
available. If the trays do not fit
in the dishwasher, wash with
Child Care Connections – Vol. 16, Issue 2
detergent; rinse; spray with the
bleach solution; and air dry.
heated to 170 degrees F. The
water temperature should be
maintained at that temperature
throughout the sanitizing
process. A hot-water booster is
usually required to heat water
to a high enough temperature.
To avoid burning the skin
while immersing dishes and
utensils in this hot-water bath,
use special racks designed for
this purpose. Then air dry the
items. Because it requires very
hot water, this method is less
safe than the bleach-sanitizing
method (Global Healthy Child
Care, 2005).
• All eating and drinking utensils,
tableware, and kitchenware
should be cleaned and sanitized
after each use; or disposable items
can be used. Be sure to label any
drinking cups brought in for a
child with his/her name, and keep
out of reach of other children.
The easiest
way to clean
and sanitize
dishes is to use
a dishwasher,
chemicals or
heat sanitizing.
If handwashing,
you’ll need
three different
basins (compartments):
• one for washing,
• one for rinsing, and
• one for sanitizing.
Use the following procedure for
handwashing utensils (or toys):
• Scrape off any leftover food.
• Use the first compartment to wash
the dishes (or toys) thoroughly in
hot water containing a detergent
• Pick up and touch clean spoons,
knives, and forks by their
handles, not by any part that will
be in contact with food. When
children help set the table, be sure
they have washed their hands
thoroughly, and remind them not
to touch the parts of the tableware
that will have contact with food
and go into the mouth. Handle
clean cups, glasses, and bowls
so that fingers and thumbs don’t
touch the insides of the rims of
these items (Global Healthy Child
Care, 2005).
• Be mindful of good hygiene when
around food:
• Rinse in the second compartment.
• Use the third compartment to
sanitize the dishes (or toys) by one
of these methods:
The safest and easiest method
is to immerse the dishes (or
toys) for at least 2 minutes in
a lukewarm – not less than 75
degrees F – bleach solution.
Then air dry the sanitized
Immerse the dishes (and toys)
for at least 30 seconds in water
hands or skin lesions. If you
have skin lesions on your
hands, you should wear gloves
while involved with food.
Keep your hair covered with a
hair net or cap while preparing
Be sure children always wash
their hands before and after
Cook It
Be sure to cook foods to appropriate
temperatures before serving. High
heat kills harmful bacteria. When
cooking raw ground meat, cook until
you see no pink in the meat and the
coolest part of the meat reaches 165.2
degrees F (Global Healthy Child
Care, 2005). A
meat thermometer
(available at most
grocery stores)
can be used to test
meat’s internal
Source: Rice, C.A., and Pollard, J.M.
(2006). Reducing Contagious Illness in
the Child Care Setting: Taking Action
for Yourself and Your Kids. HealthHints,
Volume 10, Number 10.
Wear clean clothes, and
maintain a high standard of
personal cleanliness.
Wash your hands using correct
handwashing procedures
before preparing and serving
food and as necessary to keep
your hands free of dirt, germs,
and body fluids.
Also keep your hands clean
while handling food-contact
surfaces, dishes, and utensils.
Do not prepare or serve food
while ill with a communicable
disease or with uncovered
Child Care Connections
Editorial Staff
Texas A&M AgriLife Extension Service
Stephen Green, Ph.D.
Managing Editor
Susan Lee, B.A.
Technical/Design Editor
Educational programs of the Texas A&M AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin.
The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating
Child Care Connections – Vol. 16, Issue 2
Texas A&M AgriLife Extension Service
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