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    • List ways infectious diseases spread.
    • Describe hygiene practices that prevent the spread of infectious diseases.
    • Distinguish between cleaning, sanitizing, and disinfecting.
    • Implement hygiene practices to cut down the spread of infectious diseases.




    The Importance of Healthy Environments

    Have you ever gone to a restaurant and sat down at a sticky table or found dried food on your fork? Have you ever hesitated about picking up a pen at the bank or grocery store because the person in front of you had a cold? Have you ever put a public toilet seat down with your foot to avoid touching it? Have you ever stayed in a hotel room that made you want to avoid touching the comforter or the remote control?

    Most people have experienced some of these uncomfortable health-related situations. As adults, we can respond to such situations by avoiding certain restaurants or hotels or by washing our hands as soon as we leave the bank or restroom stall. We want to stay healthy, and we want to believe that our environments are reasonably clean. Children and their families have these same desires. Family child care homes must provide clean environments that help prevent the spread of communicable diseases. It is your responsibility to make sure children have a safe and healthy environment for play and learning.


    Germs are the cause of infectious diseases. Unfortunately, germs cannot be seen by the naked eye, and they generally are transmitted without us even knowing it. Germs are transmitted as a result of:

    • Direct contact: Touching fluid from another person’s infection (e.g., saliva, nasal mucus) transmitted through environmental objects, such as toys or cabinet handles, or person to person. It only takes a small drop of fluid for transmission to occur.
    • Respiratory: Spread via the mouth and nose through the air when someone sneezes or coughs.
    • Blood infections: Spread when blood, or sometimes other bodily fluids that may contain blood, enters the blood stream of another person.
    • Fecal-oral transmission: Spread to a person’s mouth via hands soiled with feces, possibly via food, surfaces or objects. Hands and surfaces may appear clean, but feces germs can still be present.

    There is no way to completely eliminate the transmission of germs, especially with all the play and material sharing that happens in the care and education of children. But there are ways to decrease the transmission of germs among children, providers and families. In addition to following health-related policies you establish for your program (e.g., exclusion and readmission policies), it is essential that you adhere to thorough cleaning and sanitation requirements and follow proper handwashing procedures (see Lesson Two for more on handwashing). 

    Cleaning, Sanitizing, and Disinfecting: What’s the Difference?

    Although we often use the words cleaning, sanitizing, and disinfecting interchangeably, they each have their own meanings. To provide a safe and healthy environment for children, you need to understand the difference between each term (American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education, 2011). This will help you know which products are designed for each purpose.

    1. Cleaning means to remove dirt or debris from a surface and sometimes involves scrubbing or friction in order to remove the debris. For example, you spray a table with a mix of water and detergent to remove food particles and debris after a meal.

    2. Sanitizing means to reduce germs on a surface. When you sanitize a surface, it meets most health regulations. Sanitizing products usually are not effective unless the surface has been cleaned first. After cleaning the table with detergent and water, you spray an approved mix of water and bleach to sanitize the table and kill germs. 

    3. Disinfecting means to destroy most germs on a surface. Disinfecting a surface is often necessary when it has made contact with body fluids. Disinfecting usually requires a stronger bleach-water mixture. You disinfect on non-porous surfaces, such as diaper-change tables, countertops, door and cabinet handles, and toilets and other bathroom surfaces.

    Keep in mind that children should not be near surfaces, materials, and toys (including tables and restroom areas) while surfaces or items are being sanitized or disinfected. Inhalation of chemicals as they are being applied can be dangerous. Also remember that all chemicals should be locked and out of children’s reach. However, children can help with the cleaning process as appropriate (e.g., helping to clean a table with soap and water after meal time).

    Any products sold to sanitize or disinfect are required by law to be registered with the Environmental Protection Agency (EPA) to ensure they are safe for you to use. In the reference section at the end of this lesson you can find information from the Caring for Our Children: National Health and Safety Performance Standards regarding selecting and using sanitizers and disinfectants. When you clean, sanitize, or disinfect, you should follow manufacturer’s recommendations for mixing the solution and the manufacturer’s procedures for sanitizing and disinfecting. Typically, this means washing the materials or surface by hand with soap or detergent and water, sanitizing or disinfecting, and allowing the object to air dry. You can also use a dishwasher to sanitize toys or materials if it has a sanitize setting or a high-temperature option.

    The U.S. Department of Health and Human Services (DHHS) and the Centers for Disease Control and Prevention (CDC) recommend that if an EPA-approved disinfectant is not available, then you should use a fresh chlorine bleach solution. The DHHS and CDC provide the following guidelines on preparing and using this disinfectant solution:

    • Add 1 tablespoon of bleach to 1 quart (4 cups) of water. For a larger supply of disinfectant, add ¼ cup of bleach to 1 gallon (16 cups) of water.
    • Apply the solution to the surface with a cloth.
    • Let it stand for 3 to 5 minutes.
    • Rinse the surface with clean water.

    If you choose to use bleach as your form of disinfectant, a fresh batch of chlorine bleach should be made every day. All bleach solutions begin to degrade after 24 hours.


    What do clean and healthy family child care environments look like? In these environments, cleanliness is a habit. Soiled or mouthed toys go into a labeled “soiled toy” bin for cleaning. Spray bottles are available for cleaning and sanitizing; soap mixtures and bleach mixtures are changed daily. While all behaviors demonstrated in the following videos are consistent with appropriate best practices, you may occasionally observe a practice that is not currently supported or encouraged in your area. Please discuss these situations with your coach, trainer, or family child care administrator and collectively decide about the relevance and impact of the practice. Watch the video below to see ways family child care providers maintain a clean and healthy environment.

    Maintaining A Healthy Environment

    Clean environments prevent the spread of communicable disease.

    Standard and Universal Precautions

    Another way to reduce the risk of transmission of microorganisms (germs) that can cause infection is to practice standard or universal precautions. Standard precautions cover all situations where you may come into contact with body fluids. Universal precautions apply specifically to contact with blood and do not apply to contact with feces, nasal secretions, sputum, sweat, tears, urine, saliva, or vomit unless these body fluids also contain blood. In child care settings, standard precautions involve using barriers to prevent contact with body fluids from another person and cleaning and disinfecting contaminated surfaces. You can read more about standard precautions in the Standard and Universal Precautions as they Apply to Child Care Settings fact sheet attached.

    Barriers you might use to help prevent bodily fluid contact might include:

    • Disposable diaper table paper
    • Disposable towels
    • Gloves
    • Plastic bags, securely sealed

    You should always use disposable nonporous gloves when blood or body fluids containing blood may be involved. It is best to use a non latex brand of gloves, as some children in your care may be allergic to latex. Gloves are optional for diapering and contact with other bodily fluids described above, but check with your coach, trainer, family child care administrator, service guidelines or licensing agent for recommended times for using gloves. Gloves are not necessary for feeding human breast milk.

    Whenever gloves are worn, you should practice good hand hygiene. See Lesson Two for more on handwashing and Lesson Three for more on glove procedures.


    Your role is critical in ensuring your program is a clean and healthy environment where children learn and thrive. This section describes what you can do to keep your family child care home healthy, and the Apply section provides a more detailed schedule to help support healthy practices.

    Keeping Your Care Space Healthy

    Toys and Materials

    One toy can be used by many children every day. Toys can become homes for germs, especially if children put them in their mouths, cough or sneeze on them, or touch them after toileting. It is very important to regularly clean and sanitize the toys in your home. Here is how:

    • Keep a box or bin labeled “soiled toys.” When a child mouths a toy or coughs or sneezes on it, place the toy in the bin. According to the American Academy of Pediatrics, you can keep soapy water in the bin, or the bin can be a dry spot for storing toys until you can clean them. Make sure you have cleaned and sanitized the toy before returning it to the learning environment.
    • Clean activity spaces, dress-up clothes, and machine-washable cloth toys at least weekly.
    • Clean hats daily.
    • Clean mouthed toys after each use and sanitize them before returning them to the play area.
    • You can put plastic toys in the dishwasher to clean and sanitize them.

    Kitchens and Other Program Surfaces

    Many surfaces in your family child care home probably serve multiple purposes. Maybe you serve snacks on a table that is later used for puzzles, or children use the same sink to wash their hands after using the restroom or after art. Cleaning, sanitizing, and disinfecting surfaces on a schedule can help you keep a healthy environment. Here are guidelines for surfaces in your environment:

    • Clean and sanitize computer keyboards after each use.
    • Clean and disinfect doorknobs and handles daily.
    • Clean and sanitize food-preparation surfaces before and after each use.
    • Clean and sanitize dishes after each use.
    • Clean and sanitize food tables and trays before and after each use.
    • Clean countertops after each use and sanitize daily.
    • Clean the refrigerator monthly.
    • Clean the floors daily.
    • Clean phone receivers daily.
    • Vacuum carpets daily.

    Because bugs and rodents can thrive on even tiny crumbs that you may neglect to clean up and dispose of properly, it is important to have a daily routine that prevents any possibility of infestation. Remember to: 

    • Clean up spilled food right away. 
    • Store non-perishable food in thick plastic or metal containers with tight lids. 
    • After use, store pet food in rodent-proof containers and never leave pet food out overnight.  
    • Dispose of indoor trash and garbage daily. 
    • Wash indoor trash containers frequently with soap and water. 

    Toileting Areas

    The restroom is the location where germs and bacteria are most likely to spread. It is very important to keep toileting areas clean. These guidelines will help you limit contamination:

    • Clean and disinfect any changing surfaces after each use.
    • Clean and disinfect sinks and faucets daily. If the sink is also used for non-toileting routines, disinfect it after toileting use.
    • Clean and disinfect countertops daily.
    • Clean and disinfect floors daily.

    Cribs, Cots and Bedding

    It is important to provide a healthy environment for sleep. Lice and skin infections can be spread through blankets or bedding that are stored and cleaned improperly. Follow these guidelines for healthy sleep environments:

    • Store each child’s bedding (sheets, blankets, pillows, sleeping bags) separately from the other children’s bedding.
    • Launder sheets and pillowcases weekly or before they are used by another child.
    • Clean cots and cribs weekly or before they are used by another child.
    • Launder blankets monthly. If the blankets touch a child’s skin, clean weekly.

    Coats, Hats and Personal Belongings

    Lice and skin infections can also be spread through coats, jackets, hats, and personal belongings that are stored and cleaned improperly. Follow these suggestions for maintaining healthy environments:

    • Store each child’s belongings (especially coats, hats, and jackets that may have contact with hair) separately from the other children’s belongings.
    • Clean out cubbies or locker spaces before they are used by another child.

    If your program uses a pool or offers water play or other experiences where children’s clothes can get wet or even damp with sweat, remember to encourage children to hang up play clothes to dry and take them home to be laundered daily. Mold and fungus can easily grow on damp, confined surfaces.

    To help you think about your role in maintaining a clean family child care home, watch the following video that summarizes information covered in this lesson about keeping your environment healthy.

    Cleaning, Sanitizing, and Disinfecting

    Watch this video to learn about proper cleaning, sanitizing, and disinfecting in your program.

    Completing this Course

    For more information on what to expect in this course, the Healthy Environments Competency Reflection, and a list of the accompanying Learn, Explore and Apply resources and activities offered throughout the lessons, visit the Family Child Care Healthy Environments Course Guide

    Please note the References & Resources section at the end of each lesson outlines reference sources and resources to find additional information on the topics covered. As you complete lessons, you are not expected to review all the online references available. However, you are welcome to explore the resources further if you have interest, or at the request of your trainer, coach, or administrator.



    It can be easy to miss important opportunities to clean, sanitize and disinfect toys and materials. Download and read the scenarios in Thinking about Healthy Environments and describe what steps you would take to keep your environment healthy. Then share your responses with a trainer, coach or family child care administrator. Finally, compare your answers to the suggested responses. Think about what you could do in your program to make maintaining healthy environments an everyday habit.



    It is important to know when and how to clean and sanitize materials in your program. Download and print the Guide for Cleaning, Sanitizing, and Disinfecting from Caring for our Children to help develop a cleaning schedule.


    CleanTo remove dirt or debris from a surface or object
    SanitizeTo reduce the germs on a surface or object so it meets health guidelines
    DisinfectTo destroy or remove most germs from a surface
    SputumMixture of saliva and mucus (phlegm) coughed up from the lower airways or respiratory tract, normally as a result of infection or other disease




    Which of the following is the best definition of “sanitizing”?


    True or false? The most effective way to clean toys is to spray with a water-bleach mixture and then air dry.


    A child had diarrhea in the restroom. When should you disinfect the surfaces?

    References & Resources

    American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2015). Caring for Our Children: National health and safety performance standards; Guidelines for early care and education programs, 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Also available at

    Aronson, S. S., Bradley, S., Louchheim, S., & Mancuso, D. (2002). Model Child Care Health Policies, 4th ed. Washington, DC: National Association for the Education of Young Children.

    Aronson, S. S., & Spahr, P. M. (Eds., 2002). Healthy Young Children: A Manual for Programs. Washington, DC: National Association for the Education of Young Children.

    Caring for Our Children: National Health and Safety Performance Standards (2015). Selecting an Appropriate Sanitizer or Disinfectant, Appendix J. Retrieved from

    Centers for Disease Control and Prevention (2020). How to Clean and Disinfect Schools to Help Slow the Spread of Flu.

    Centers for Disease Control and Prevention (2010). Clean up rodent food sources and nesting sites. Retrieved from

    National Association for the Education of Young Children (2007). Keeping Healthy: Families, Teachers, and Children. Washington, DC: NAEYC.

    North Carolina Child Care Health and Safety Resource Center (May 2009). Information available by calling 800-367-2229.

    Ritchie, S. & Willer B. (2008). Health: A Guide to the NAEYC Early Childhood Program Standard and Related Accreditation Criteria. Washington, DC: National Association for the Education of Young Children.