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Staying Healthy: Healthy Environments

Following your program’s health-related policies will help keep you and the children in your care healthy and safe. Being proactive is your best course of action when it comes to health and safety. This lesson focuses on how you can clean, sanitize, and disinfect to prevent the spread of disease.

  • List ways that infectious diseases can be 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 just 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 and stressful health-related situations. As adults, we can respond to such situations by visiting a different restaurant or hotel, 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. Child development programs must provide environments that are clean and that 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 are generally transmitted without us even knowing it. Germs are transmitted as a result of:

  • Direct contact: Touching the fluid from another person's infection (e.g., saliva, nasal mucus), transmitted through environmental objects, such as toys, cabinet handles, equipment, 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, and sometimes other bodily fluids with may contain blood, enters the blood stream of another person.
  • Fecal-oral transmission: Spread to a person's mouth (oral) via hands soiled with feces that touch food, surfaces or objects. Germs from feces are invisible. Hands and surfaces may appear clean, though feces germs can still be present. Disease from fecal-oral transmission can make adults and children very ill.

There is no way to completely eliminate the transmission of germs, especially with all the play and material sharing that happens in school-age programs, but there are ways to decrease the transmission of germs among youth, staff and families. In addition to following your program's health related policies, it is essential that you adhere to your program's cleaning and sanitation requirements and follow proper hand washing procedures (see Lesson Two for more on hand washing).

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

Although we often use the words cleaning, sanitizing and disinfecting interchangeably, they each have their own meaning. 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, 2019). 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 products 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. Sinks, toilets, and countertops should be disinfected.

Keep in mind that school-age children or youth should not be near surfaces, materials, and toys (including meal and snack tables and restroom areas) while the surfaces or items are being sanitized or disinfected. Inhalation of chemicals as they are being applied can be dangerous. All chemicals should be locked and out of reach of children. However, children can help with the cleaning process as appropriate (e.g., helping to clean a table with soap and water after meal time). Giving the children jobs to assist you will help to build an understanding of the importance to keeping the environment clean and healthy for everyone.

Any products you use to clean, sanitize, or disinfect should be approved by the Environmental Protection Agency (EPA) to ensure they are safe for you to use. When you clean, sanitize, or disinfect, you should follow approved procedures. 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. School-age children can help with cleaning surfaces with a soap and water mixture, but staff members should be responsible for sanitizing or disinfecting.

The U.S. Department of Health and Human Services (DHHS) and the Centers for Disease Control (CDC) recommend that if an EPA approved disinfectant is not available, then you should use a fresh chlorine bleach solution. A fresh batch of chlorine bleach should be made every day. All bleach solutions begin to degrade after 24 hours. The DHHS and CDC provide the following guidelines on preparing and using the 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.


What do clean and healthy environments look like for school-age children? In these environments, cleanliness is a habit. Spray bottles are available for cleaning and sanitizing; soap mixtures and bleach mixtures are changed daily. Watch the video below to see ways school-age staff members maintain a clean and healthy environment.

Maintaining A Healthy Classroom

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, but universal precautions apply 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 involve 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 below.

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

  • Disposable towels
  • Gloves
  • Plastic bags, securely sealed

You should always use disposable non-porous 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 contact with other bodily fluids described above, but check with your coach, trainer, or supervisor for times your program or Service guidelines recommend using gloves.

Whenever gloves are worn, you should practice good hand hygiene. See the Apply section below for information on proper 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 program environment healthy and the Apply section provides a more detailed schedule to help support healthy practices.

Keeping Your Program Healthy

Toys and Classroom Materials

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

  • Keep a box or bin labeled "soiled toys." When a child or youth coughs, or sneezes on it, ask them to place the toy or material 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 material before returning it to the learning environment.
  • Clean activity spaces, dress-up clothes, and machine-washable cloth toys at least weekly.
  • Clean hats daily.
  • You can put plastic toys in the dishwasher to clean and sanitize them.

Classroom Surfaces

Many surfaces in your program probably serve multiple purposes. Maybe you serve snacks on a table that is later used for board games, 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 room:

  • Clean and sanitize computer keyboards after each use.
  • Clean and disinfect door knobs 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 if you have one in your classroom.
  • Clean the floors daily.
  • Clean and disinfect the drinking fountain daily.
  • Clean phone receivers daily.
  • Vacuum carpets daily.

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 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.

Coats, Hats and Personal Belongings

Lice and skin infections can 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 one's head) separate from the other children's belongings.
  • Clean out cubbies or locker spaces before they are used by another child.

Also, if you use blankets in your program (e.g., for fort building or as comforting items in your reading or library space), remember to launder them at least monthly, or weekly if they come into contact with children's skin.

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

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 School-Age 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.


A great way to keep yourself and your school-agers informed on the best ways to maintain a healthy environment is to take advantage of some the wonderful and free resources available from the Centers for Disease Control and Prevention (CDC). Explore the different resources for children and youth listed in the Online Resources on Germs and Healthy Environments activity. Answer the questions and plan ways to share the information with school-agers. Share your responses with your trainer, coach or administrator. 


It is important to know when and how to clean and sanitize materials in your school-age program. Use the Guide for Cleaning, Sanitizing, and Disinfecting from Caring for our Children (2019) to help you develop a cleaning schedule. 

Use the additional guide to help provide a healthy environment.  Review the Gloving Guidelines poster from Child Care Aware of North Dakota, and post in your program where appropriate.


To remove dirt or debris from a surface or object
To reduce the germs on a surface or object so it meets health guidelines
To destroy or remove most germs from a surface
Mucus, or a combination of saliva and mucus) that is coughed up from the lungs or respiratory track


The best definition for “sanitizing” is…
Which of the following is NOT an option for cleaning toys or learning materials
A child had diarrhea in the restroom. When should you disinfect the surfaces?
References & Resources

American Academy of Pediatrics. (2019). Caring for Our Children, National Health and Safety Performance Standards. American Academy of Pediatrics. 

Aronson, S. S., Bradley, S., Louchheim, S., & Mancuso, D. (2014). Model Child Care Health Policies, 5th 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.

Centers for Disease Control and Prevention (2020). Healthy Habits to Prevent Flu.

Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD) (2020).  How to Clean and Disinfect Schools to Help Slow the Spread of Flu.

Council on Accreditation. (2018) Child and Youth Development Early Childhood Education (CYD-ECE) Standards for Health. New York: Council on Accreditation.

Council on Accreditation. (2018). Standards for Child and Youth Development Programs. Out-of-School Time. (CYD-OST) Standards for Health. New York: Council on Accreditation.

NAEYC (n.2017). Keeping Healthy: Families, Teachers, and Children Brochure. Washington, DC: National Association for the Education of Young Children.

North Carolina Child Care Health and Safety Resource Center, (May 2009). Information available by contacting 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.