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    Objectives
    • Articulate the importance of proper hygiene in keeping everyone healthy.
    • Identify management practices that promote proper hygiene.
    • Provide ongoing training to staff members on handwashing and universal health precautions.
    • Observe and provide feedback on general hygiene practices.

    Learn

    Learn

    Know

    Child and youth programs are natural environments for the transmission of infectious diseases; you could go so far as to say they are germ incubators. With all the runny noses, toileting, touching, picking, and mouthing that occurs within child care and learning programs, it's surprising that anyone is healthy. Your best defense against the spread of infectious diseases is a strong offense. Your actions support wellness when you maintain a clean environment (see Lesson One) and assure staff and children in your program practice good hygiene.

    When it comes to reducing the spread of disease, nothing is as effective as washing our hands. Classrooms stay healthier when everyone engages in this germ-fighting activity. Staff must constantly model and discuss handwashing with the children in your program. When handwashing occurs as it should, children and youth will be healthier and staff will miss fewer days of work.

    Handwashing is one practice that everyone at your program can do to prevent the spread of illness. However, many staff members will not have been trained in proper handwashing procedures. You will need to make sure that staff members know the best ways and times to wash their hands. This information is detailed below.

    For handwashing to be effective, proper procedures must be followed. Every step of the handwashing procedure is important to the whole process, and a missed step can cause re-contamination and the spread of germs. Wash your hands with liquid soap for at least 20 seconds, and always turn off the faucet with a paper towel. Discuss with your staff when and under what conditions staff members or children may use alcohol-based hand sanitizers (i.e., on field trips when water is not available). A poster showing proper handwashing procedures should be posted by every adult and child sink for reference (see Apply attachments). In addition, handwashing supplies should always be well stocked and accessible.

    Staff members can model healthy habits for each other and children. Make sure you wash your hands at the appropriate times (e.g., each time you enter a classroom or program) and that you always follow proper handwashing procedures. See the full list below of times providers should wash their hands. Your adherence to washing your hands at the appropriate times sets a strong example for the rest of your staff. Proper handwashing is an activity that should happen regularly in the classes of children of all ages; it should be habit. The skills your staff teach children can also help bring these practices home. A recent study revealed that after using a public restroom, only 31% of men and 65% of women washed their hands. (Judah et al., 2009).

    In addition to washing hands when they are visibly soiled, there are specific times when handwashing is especially important. The American Academy of Pediatrics recommends the following:

    Children

    • Upon arrival
    • When moving from one child-care group to another
    • Before and after eating, handling food, bottle feeding
    • After using the toilet, diapering
    • After handling body fluids (urine, blood, feces, vomit, mucus, saliva)
    • After coughing or contact with runny noses
    • After touching contaminated objects, such as trash cans
    • Before and after playing in water that is used by more than one person
    • After sand play, messy play
    • After playing outdoors
    • After handling animals or animal waste

    Providers

    • Upon arrival to work
    • After breaks
    • When moving from one child-care group to another
    • Before and after preparing food or beverages, including bottles
    • Before and after eating, handling food or feeding children, including bottle feeding
    • After using toilet
    • After helping children toilet
    • Before and after diapering
    • After handling bodily fluids (urine, blood, feces, vomit, mucus, saliva)
    • After coughing, sneezing, contact with runny noses
    • Before and after giving medication
    • Before and after applying medical ointment or cream in which a break in the skin may be encountered.
    • After removing gloves used for any reason
    • After cleaning or handling garbage
    • After handling animals or animal waste
    • Before and after playing in water that is used by more than one person
    • After playing outdoors
    • After sand play, messy play

    Young children will need much guidance in learning how to wash their hands appropriately and infants and young toddlers will need physical assistance to complete the task. Check out the Apply section for handwashing materials you can share with staff. Work with your trainers and coaches to ensure all staff members know how to properly support handwashing with the children in their care. For toddlers, preschoolers and school-age children, encourage staff members to construct their own handwashing posters with the children's help, so that all members of the classroom or program community know what to do. Children are sometimes more inclined to appropriately follow an important routine like handwashing if they see themselves or their friends in the pictures, or if they help create the words.

    hand washing steps diagram

    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, but universal precautions applies specifically to contact with blood, and does 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 involves using barriers to prevent contact with body fluids from another person, as well as cleaning and sanitizing 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 or staff members might use to help prevent bodily fluid contact might include:

    • Moisture-resistant disposable diaper table paper
    • Disposable towels
    • Gloves
    • Plastic bags, securely sealed

    Staff should always use disposable non-porous gloves when blood or body fluids containing blood may be involved. Gloves are optional for diapering and contact with other bodily fluids described above, but adhere to your Service or program guidelines regarding the use of gloves. Gloves are not necessary for feeding human breast milk.

    Whenever gloves are worn, make sure staff practice good hand hygiene; wearing gloves does not remove the need to properly wash hands after the task is complete. The appropriate procedure for removing gloves to reduce contamination is also attached.

    Coughing and Sneezing

    Respiratory infections and germs are spread through coughing and sneezing. In addition to handwashing after coughing or sneezing, here are a couple simple ways to cut down on the spread of those airborne germs:

    • Cough into your elbow instead of your hand. Older toddlers can be shown this technique, but know they might not remember to do it all the time. Model this practice to help them start healthy practices.
    • Cover sneezes with a disposable tissue if one is available. Dispose of tissues in a hands-free trash can.

    Keep tissues well-supplied in all program areas. Encourage staff to take tissues outside to reinforce that healthy habits happen regardless of location. Used tissues should be disposed of immediately, and children should wash their hands after coughing and sneezing. Staff should model these behaviors to help children learn. Proper handwashing after sneezing, coughing into your hand, blowing your nose, or after helping a child who has sneezed is important to maintain a healthy environment and to avoid the spread of disease.

    Cuts, Scrapes, and Sores

    As wounds heal, they might drip, ooze, or drain. These fluids can spread infection and the wound itself also is susceptible to infection. The American Academy of Pediatrics (2011) recommends covering and containing any wound that is leaking. If the wound is so severe or big that it cannot be contained, the child or adult should stay home until a scab has developed. Hand hygiene is critical before and after a staff member's contact with his/her, another staff-member's, or a child's sores, cuts, or scrapes.

    Blood and Other Body Fluids

    Blood can carry a variety of pathogens. Bloodborne pathogens include human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Transmission of these diseases in child care is rare. They are most frequently transmitted through needle sticks or when blood or other body fluid enters the body through eyes, nose, mouth, or broken skin. These diseases are not spread through saliva, sweat, or vomit. Casual contact like hugging, sharing a cup, using a public restroom, or coughing and sneezing do not spread bloodborne diseases.

    However, to promote hygiene practices and decrease the chance of contracting various infectious diseases, all staff members should wash their hands before and after helping a child or another staff member who has been injured, and after handling bodily fluids of any kind (i.e., mucus, blood, vomit, saliva, urine). Staff members should wash their hands immediately after contact with blood, body fluids, excretions, or wound dressings and bandages.

    Supervise & Support

    Management Practices That Promote Proper Hygiene

    The chart below summarizes your key responsibilities in terms of promoting hygiene.

    Management Practices

     

    Staff Practices

    I should always…

    To ensure

    Staff never…

    Ensure that staff are trained on proper handwashing technique and timing, for both themselves and the children.

     
    • Contribute to the transmission of infectious disease because they aren't appropriately washing their hands
    • Fail to teach children when and how to appropriately wash their hands.

    Ensure enough handwashing supplies or other hygienic supplies (e.g., tissues, gloves) are available in all relevant program areas.

     
    • Fail to follow appropriate handwashing technique or precautions due to lack of materials.

    Monitor handwashing procedures at regular intervals and address concerns immediately

     
    • Fail to follow policies for healthy hygiene and maintaining a healthy environment

    Offer visual reminders (e.g., with posters by program sinks) for proper handwashing technique and timing, and safe hygiene practices (e.g., covering your cough) at relevant places in your program.

     

     
    • Put children and youth at risk of becoming ill because they were not following hygienic practices
    • Feel uncomfortable advising children and families on proper handwashing or hygiene practices

    In Summary

    When you model healthy habits and set expectations that staff will model healthy habits too, you not only create a healthier today but a healthier tomorrow for everyone in your program.

    Healthy Habits

    Healthy habits start early and last a lifetime.

    Explore

    Explore

    Handwashing has been identified as the single most important thing people can do to reduce the transmission of infectious disease, yet this practice is still not done enough.

    Use the Handwashing Activity Chart to complete the chart for the times when handwashing is necessary for children and adults. Then compare the suggested responses with your answers.

    Apply

    Apply

    Attached are a host of resources to share with staff about handwashing, including steps and reminders about when to wash, as well as reminders about decreasing the spread of infectious diseases by covering coughs and sneezes. The posters below from the Minnesota Department of Health, the Centers for Disease Control and Prevention, and the North Carolina Child Care Health & Safety Resource Center can be excellent models for your own program. Consider the best location for these kinds of posters throughout your center. Talk with staff, trainers and coaches about the placement of these visual reminders. You can even encourage staff to create their own versions of these posters with the children and youth in their care.

    Glossary

    TermDescription
    ALCOHOL-BASED HAND SANITIZERAn alternative to soap and water when sinks are not available. The sanitizer can be a liquid, gel, or foam, but it should contain at least 60% alcohol. Check your program policies about the use of hand sanitizers
    BLOODBORNECarried or transmitted by the blood
    CONTAMINATETo infect or soil with germs in or on the body, on environmental surfaces, on articles of clothing, or in food or water
    FECALRelating to feces, stool; bodily solid waste
    RE-CONTAMINATIONTo again infect or soil with presence of infectious microorganisms (germs)
    STANDARD PRECAUTIONSThe CDC’s recommended steps you should take any time you come into contact with blood or body fluids to prevent the spread of disease

    Demonstrate

    Demonstrate
    Assessment

    Q1

    What practice can help reduce the spread of illness in your program?

    Q2

    True or False? Children’s hands should be washed after their diapers have been changed.

    Q3

    Finish this statement: Barriers that can be used to help prevent contact with bodily fluids are:

    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. Retrieved from http://nrckids.org

    Dell’Aringa, S. (1997). Handwashing. American Academy of Pediatrics. Retrieved from http://www.aappublications.org/content/13/5/2.2

    American Public Health Association. (2006). Hand hygiene in pre-K -12 school and child care settings.  Retrieved from https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/07/11/15/hand-hygiene-in-prek-to-12-schools-and-child-care-settings

    Aronson, S. S. & Spahr, P. M. (2002). Healthy young children: A manual for programs. Washington, DC: National Association for the Education of Young Children.

    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.

    Centers for Disease Control and Prevention. (2015). A New CDC Handwashing Study Shows Promising Results. Retrieved from https://www.cdc.gov/handwashing/child-development.html

    Harms, T., D. Cryer and R.M. Clifford. (2006). Infant/Toddler Environment Rating Scale, revised edition. New York Teachers College Press.

    Harms, T., D. Cryer and R.M. Clifford. (2005). Early Childhood Environment Rating Scale, revised edition. New York Teachers College Press.

    Harms, T., D. Jacobs and Romano. (1995). School Age Environment Rating Scale. New York Teachers College Press.

    Health and Safety in Family Child Care Homes. (2010). Ohio Department of Job and Family Services.

    Judah, G., Aunger, R., Schmidt, WP., Michie, S., Granger, S., Curtis, V. (2009). Experimental pretesting of hand-washing interventions in a natural setting. Am J Public Health. 99(2):S405-11.

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

    North Carolina Child Care Health and Safety Resource Center (May 2009). For more information, contact 800-367-2229

    Ritchie, S. & Willer B. (2008). Health: A guide to the NAEYC early childhood program standard and related accreditation criteria. Washington, DC: NAEYC.

    Talan, T.N. and P. Jorde Bloom. (2011). Program Administration Scale: Measuring early childhood leadership and management, 2nd ed. New York: Teachers College Press. Retrieved from http://mccormickcenter.nl.edu/program-administration-scale-pas-2nd-ed/