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    Objectives
    • Provide ongoing training to staff members on handwashing and universal health precautions.
    • Model general hygiene practices.
    • Observe and provide feedback on general hygiene practices.

    Learn

    Learn

    Teach

    Handwashing is one of the best ways to prevent the spread of illness. However, many staff members do not follow proper handwashing procedures. You will need to make sure that staff members know the best ways and times to wash their hands.

    When handwashing occurs as it should, children and youth will be healthier and staff will miss fewer days of work. All direct care staff taking this Healthy Environments course will have read about handwashing in this lesson. Nevertheless, you may need to provide follow-up support. Assess staff’s understanding of this important habit as you review and discuss with them their Explore and Apply activities.

    Model

    You can model healthy habits for staff and children. The skills you and 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). Make sure you wash your hands:

    • Each time you enter a classroom or program
    • Before and after helping a child with toileting or diapering
    • After using the restroom
    • Before and after touching animals
    • Whenever your hands are visibly dirty or soiled
    • After sneezing, coughing into your hand, or blowing your nose
    • After helping a child who has sneezed
    • After coming in from outdoors
    • Before and after assisting with food service or eating
    • Before and after feeding an infant or young child
    • Before and after helping a child, youth, or staff member who has been injured
    • After removing disposable gloves
    • Before and after administering medication
    • After handling garbage or cleaning

    Also be sure that you always follow proper handwashing procedures. Wash your hands with liquid soap and water for at least 20 seconds, and always turn off the faucet with a paper towel. Display visual representations, such as photos or a handout, showing each step in handwashing. It is best to use photos of children in the classroom demonstrating the steps. Discuss with your administrator when and under what conditions children, youth, or staff members may use alcohol-based hand sanitizers (i.e., on field trips when water is not available).

    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, 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), and they should wear gloves. Staff should wash hands immediately after contact with blood, body fluids, excretions, or wound dressings and bandages. Once again, it is important that staff wear gloves if they may come into contact with blood or body fluids which may contain blood.

    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 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 available in the Learn Activities section below.

    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. A resource that illustrates the appropriate procedure for removing gloves to reduce contamination is available in the Apply Activities section below.

    Observe

    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. A poster showing proper handwashing procedures should be posted by every adult and child sink for reference (see Apply section). In addition, handwashing supplies should always be well stocked and accessible. Use the Hand Hygiene Monitoring Tool in the Apply section of this lesson to carefully observe this important health habit. When you are in the classroom, monitor when and how hands are washed. Record what you see on the Hand Hygiene Monitoring Tool. Then discuss your observation with the staff member. Provide positive feedback about what you saw. Then discuss ways the staff member can make sure he or she uses proper handwashing techniques each and every time.

    Case Example: Hand Hygiene

    Let's take some time to follow a case example about a classroom that struggled with hand hygiene. Watch the Case Example: Hand Hygiene video and then read about how a coach or trainer might respond to these teachable moments.

    Case Example: Hand Hygiene

    Think about how you might promote healthy handwashing habits in these scenarios.

    Case Example Step 1: Make a Plan

    The trainer, coach, or administrator and the classroom team sat down together and looked at the data from the Hand Hygiene Monitoring Tool. The team did not realize that they had missed so many important opportunities for handwashing. The trainer, coach, or administrator and the team developed a plan for improving their use of hand hygiene practices. Here's a sample of their plan:

    Goal: To teach children how and when to wash their hands

    Steps :

    1. Invite our trainer, coach, or administrator (or program health consultant) to come talk to the children about germs and handwashing. She will teach: when to wash hands, how to wash hands, and why it's important.
    2. Continue teaching by playing a game at group time about handwashing. Make picture cards that show activities that require handwashing (using the toilet, having snack, petting an animal, sneezing into your hand, etc.) and activities that don't require handwashing (reading a book, giving a hug, etc.). Have children guess whether they need to wash their hands before or after doing these activities.
    3. Hang posters around the room that use pictures to show the handwashing steps (post one over the box of tissues, one in the restroom, one near the door). Take pictures of children in our classroom following the steps and use them to create our own posters.
    4. Add handwashing into our lesson plans for cooking activities.
    5. Ask our trainer, coach, or administrator to do surprise visits and give us feedback on whether we followed all handwashing procedures every time.

    Case Example Step 2: Provide Feedback

    This classroom's trainer, coach, or administrator used the Hand Hygiene Monitoring Tool during several classroom visits. As you heard in the video, the trainer, coach, or administrator noticed that a child did not wash his hands after wiping his nose at the table. The trainer, coach, or administrator also noticed that children and staff members did not wash their hands before a cooking activity. Staff members also did not remind children to wash their hands after licking their fingers. The trainer, coach, or administrator then used that data to help the staff develop an improvement plan about handwashing. Based on the video you saw, a trainer, coach, or administrator might say:

    • I noticed a few children have the sniffles in your class. I'm worried about those germs getting passed around during family style dining. How might we keep each child's hands clean while they pass food?
    • Healthy habits are so important; and washing hands before cooking is one of the most important habits. Next time you do a cooking activity, what steps will you take to make sure all children's hands are clean before cooking?

    Case Example Step 3: Offer Resources

    The trainer, coach, or administrator continued to observe in the classroom and used the Hand Hygiene Monitoring Tool to make sure staff members and children washed their hands. The trainer, coach, or administrator provided the posters available in the Apply section for staff members to post in their rooms.

    Additional Examples of Hand Hygiene

    The Range of Hygiene Practices video provides examples of staff members who fall along a continuum of compliance with handwashing procedures. You could practice using the Hand Hygiene Monitoring Tool to record what you see. Then read about ways you might address the issue with each staff member.

    A Range of Hygiene Practices

    It is important to help all staff follow hand hygiene practices.

    Scenario Review

     

    Scenario

    You saw:

    • All children are gathered at the table for snack.
    • Teacher brings cups of water over to the table from the sink.
    • Children are interested in the cups and end up putting their hands in the cups.
    • Teacher passes dirty cups out to children.

    You Say

    What you might say:

    • "Snack is a great time to build community, so it's great that the kids are all gathered together with you. That's a big time for germs, though. Let's think of some ways to prevent the spread of illness."
    • "The kids were so interested in the water at snack today. How could we build on that interest in a way that doesn't spread germs?"
    • "I noticed some issues with the water during my visit today. Let's talk with your team to brainstorm ways to make sure children are supervised closely once they sit at the table."

    You Do

    What you might do:

    • Provide child-safe pitchers, so water can be served "family style" once children and teacher are seated.
    • Provide extra help during snack as staff experiment with new snack time procedures that ensure better hygiene.
    • Bring in sensory table suggestions to try, so children will have a healthy way to explore water.

    Scenario

    You saw:

    • The staff member recognized an opportunity to wash hands (prior to eating) and followed through.
    • The staff member talked soothingly throughout the interaction and described what she was doing to the infant.
    • The staff member washed the infant's hands for the appropriate length of time and followed all procedures (i.e., turned faucet off with towel).

    You Say

    What you might say:

    • "You modeled really important healthy habits today. It's so important to help kids learn to wash their hands before eating--even from the youngest age."

    You Do

    What you might do:

    • Encourage the staff member to invite new infant staff into her classroom to observe health practices.

    Scenario

    You saw:

    • The staff member wore a glove while helping a child with a scrape.
    • The staff member promoted some independence by encouraging the child to clean the scrape herself.
    • The counter top was contaminated by the glove; the staff member did not dispose of glove right away.

    You Say

    What you might say:

    • "You took a great first step helping the little girl today. It's important to wear gloves whenever we deal with blood. Let's talk about the steps that are important once you've had contact with blood…"
    • "It's important to watch out for your own safety when you are helping children. We should protect ourselves every time by being very careful about wearing gloves and washing hands."

    You Do

    What you might do:

    • Provide additional training on bloodborne pathogens, gloving procedures, etc.
    • Provide posters to hang in the room about gloving procedures and handwashing.
    • Continue to monitor and provide feedback.

    Scenario

    You saw:

    • Staff member is engaged in a meaningful conversation with two siblings.
    • A third child begins to offer a cookie to the children.
    • No children in the interaction have washed their hands.

    You Say

    What you might say:

    • "The cookie exchange happened fast today, but it's important to make sure kids know they should wash their hands before every snack. Sometimes all it takes is a quick reminder."
    • "It's important to be consistent about handwashing. Let's think of ways we can make sure kids get the message."

    You Do

    What you might do:

    • Help staff think of ways to make sure snack happens in specific locations that are convenient to handwashing.
    • Review the program's policies on external food.
    • Help provide reminders to children about handwashing.

    Scenario

    You saw:

    • Snack area is near sinks.
    • Sinks and towel dispenser are automated, so children don't have to touch surfaces.
    • All supplies are stocked and available.

    You Say

    What you might say:

    • "Your snack arrangement really promotes independence. The kids know to wash their hands and get their own food."
    • "I saw every child wash their hands without any reminders today."

    You Do

    What you might do:

    • Talk to maintenance about any problems with the automated sinks and dispensers if sensors are not sensitive enough.

    No matter what you see in classrooms or programs, continue to teach, model, and observe healthy habits. When staff members are ready, spend some time in their classrooms or programs. Use the Hand Hygiene Monitoring Tool to observe and provide feedback. When staff members consistently follow all procedures, every time, they have demonstrated competency on this lesson.

    Explore

    Explore

    It can be helpful to practice difficult conversations to build confidence when monitoring hygiene in your program. Download and print the Tough Talk activity. Read the scenario. Then imagine the conversation you would have with Travis. Write what you would say in the text boxes on the left. Write what you think he would say in the boxes on the right. Try it once with a cooperative response from Travis. Then try writing your responses as if Travis had become upset, angry, or defensive. Compare your responses to the Tough Talk Answers form.

    Apply

    Apply

    It is important that you monitor and support compliance with handwashing procedures. Use the Hand Hygiene Monitoring Tool to focus your observation during a classroom visit. Record the instances of correct and complete handwashing. This brief checklist can be used to support staff that have completed the Healthy Environments course but may need additional support on handwashing procedures. This checklist can also be used by Training & Curriculum specialists and Program managers to provide feedback to staff members that do not provide direct care to children in the program. (If staff need support with this process, consult Lesson Two of their track in the Virtual Lab School. Or you may want to direct them to CDC posters at https://www.cdc.gov/handwashing/posters.html). Provide feedback to the staff member about what you saw. Add these observation forms to a staff member’s training file to document competence and progress with this skill.  

    It is also important, when you or staff wear gloves, to apply and remove them appropriately. Review the attached Gloving Procedures from Caring for our Children (4th Edition). Ensure this guide is posted in your program where appropriate. 

    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
    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

    As a trainer, coach, or administrator, you model healthy habits for staff and children. When should you wash your hands?

    Q2

    During a visit to an infant classroom, you see Shanice change a diaper, remove her gloves, and rejoin a group of children playing on the rug. What do you say or do?

    Q3

    True or False? To decrease the chance of contracting an infectious disease, staff should wear gloves and wash their hands before and after helping a child or co-worker who has been injured, and after handling bodily fluids of any kind.

    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 http://nrckids.org

    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. (2002). Healthy Young Children: A manual for programs. 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

    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: National Association for the Education of Young Children.