Infection Prevention & Control Measures (IPAC)
Policy Number: 03.12
Current Date Approved:
April 2019
Board Approval Signature:
Last Date Revised: Feb 17 2016
Original Date Created: Jan 2014
Original Date Approved: Jan 15 2014
Background
The IPAC policy was reviewed and modified to consolidate SLCD’s Sick Child policy and the IPAC policy, to ensure that fair measures are implemented.
Purpose
St. Lawrence Co-operative Day Care Inc. (SLDC) strives to provide a healthy and safe environment for all children and staff. Surveillance is an important part to infection prevent and control, and the key to identifying an outbreak. In order to reduce the risk of communicable illness and to ensure illnesses are managed, Infection Prevention and Control Measures (IPAC) have been put in place.
Scope
To be implemented in accordance with the Ministry of Education child care licensing procedures, governing St. Lawrence Co-operative Day Care Inc.
Policy
All children and staff illnesses must be reported to the Program Supervisor or Identifiable Authority immediately.
Any changes in a child’s health or parent/guardian communication about the child’s health shall be recorded in the daily communication log.
Procedure
Health Evaluation and Monitoring
- Staff shall observe children daily, monitoring for signs and symptoms of illness, inclusive of sleeping or eating patterns, or signs that a child has lost some previously acquired skills (i.e., stopped being able to feed themselves, stopped using language).
- Staff shall observe children upon arrival to the day care centre. Staff receiving children will do a physical check to ensure the child is able to participate in the program. This check is inclusive of encouraging parents to share information about their child’s restless night, lack of appetite or other atypical behaviour.
- If a staff suspects that a child is, or may be, in need of protection, they must report this to the local children’s aid society.
Signs and Symptoms of Ill Health and Communication to Parents/Guardians
- In the event a child develops symptoms of ill health while in attendance at the Day Care Centre, the parent/guardian or emergency contact will be notified and asked to pick the child up as soon as possible.
- Where it appears that a child requires immediate medical attention, or the child’s parent/ guardian cannot pick up the child, arrangements shall be made by the operator to have the child examined by a legally qualified medical practitioner or nurse. Depending on the nature of the illness the Program Supervisor or Identifiable Authority will escort the child to the nearest walk in clinic or Sick Children’s Hospital Emergency, via walking or taxi.
- A child who becomes ill while attending the Day Care Centre will be isolated from other children until a parent or guardian or emergency contact can take the child home.
- Staff will communicate the first signs of ill health, particularly for younger children who have developed a fever, even if the threshold for asking that the child be taken home has not yet been met. Parents/guardians then have the choice to pick up their child if concerned.
- Where a child becomes ill during school hours, it is the responsibility of the school to contact the parent or guardian or emergency contact. The Day Care staff will work with the school to ensure the child has been picked up safely.
Communicable Disease
- When a child has been exposed to a communicable disease such as measles via a child who attends the Day Care Centre, the classroom staff will notify the parents/guardians as soon as possible and encourage parents/guardians to contact their physician. Both staff and parents/ guardians will observe children who were exposed to the communicable disease for any signs and symptoms during the incubation period.
Surveillance
As part of the surveillance program staff shall record the following information:
- Attendance and absence of children and staff
- Staff shall observe children daily, monitoring for signs and symptoms of illness
- Dates and times that the illness started (onset)
- Time that the ill child was picked up from the Day Care Centre
- Dates of field trips, outing and special events
Return to Day Care
- Non Gastrointestinal Illness
- Children must be symptom free of vomiting and/or diarrhea for 24 hours, a physician’s note is not required
- Gastrointestinal Illness
Definition of Gastrointestinal Illness:
A case (child or staff) of gastrointestinal illness can be defined as:
- Two or more episodes of diarrhea within a 24 hour period
- Two or more episodes of vomiting within a 24 hour period
- One or more episodes of diarrhea AND one or more episodes of vomiting within a 24 hour period
Children:
- When a child has been absent due to a gastrointestinal illness or an outbreak of gastroenteritis they must be symptom free of vomiting and or diarrhea for 48 hours. The parent/ guardian is required to speak with the Program Supervisor or Identifiable Authority to determine if a physician’s note is required upon return to Day Care.
Staff:
- Staff who becomes ill while working at the Day Care Centre will be sent home safely
- A staff who has been absent due to a gastrointestinal illness or an outbreak of gastroenteritis must be symptom free of vomiting and or diarrhea for 48 hours. The staff is required to speak with the Program Supervisor or Identifiable Authority to determine if a physician’s note is required upon return to work.
Refer to the “Outbreak Policy” for more information.
- Communicable Disease – Refer to the attached Toronto Public Health Chart
- When a child has been absent due to a communicable disease, the parent/guardian is required to speak with the Program Supervisor or Identifiable Authority to determine if a physician’s note is required upon return to Day Care.
- All communicable illnesses related to children will be posted on a “Notice of Illness Form” in a conspicuous place of the Day Care Centre
- A staff who has been absent due to a communicable disease is required to speak with the Program Supervisor or Identifiable Authority to determine if a physician’s note is required upon return to work.
Inclusion and Exclusion from Day Care (Refer to attached Toronto Public Health Chart)
Centre Policies and Toronto Public Health (Guidelines for Common Communicable Diseases) are referred to determine inclusion and exclusion of children from day care when:
- The illness prevents the child from participating comfortably in the program
- The illness results in greater care need than the staff are able to provide
- The child has any of the following conditions including but not limited to:
| Reportable Diseases to Toronto Public Health | Non Reportable Diseases to Toronto Public Health | Other |
|---|---|---|
| Chicken Pox | Head Lice | Fever (100 degrees Fahrenheit) |
| Gastroenteritis - diarrhea or vomiting | Pinworms | Unusual lethargy Difficulty breathing Rash (with or without a fever) |
| Gastroenteritis Outbreak | Scabies | Severe or persistent diaper rash |
| Measles | Common Cold | - |
| Mumps | Hand, Foot and Mouth Disease | - |
| Pertussis | Impetigo | - |
| Rubella | Fifth Disease | - |
| Hepatitis A | Conjunctivitis (Pink Eye) | - |
| - | Ringworm | - |
| - | Scarlet fever | - |
| - | Strep Throat | - |
| - | Molluscum Contagiosum (skin disease) | - |
Hand Hygiene
- Hand Washing
- A current Toronto Public Health “Hand Washing” procedure will be posted above or near every hand washing sink.
- A hand washing sink must be designated in each classroom with: running water, liquid soap in a dispenser, and paper towel
- The Program Supervisor or Identifiable Authority will review the Day Care Centre’s “Hand Washing Procedure” with all staff every January, April, July and October. This will ensure staff practice hand hygiene and ensure staff are aware when to assist and supervise children practicing hand hygiene
- Staff will educate and demonstrate to children how to wash hands and when to wash hands.
- Visibly soiled hands must be washed with running water and liquid soap.
- Hand Sanitizing – Alcohol Based Hand Rub (ABHR)
- A current Toronto Public Health “Hand Sanitizing” procedure will be posted above or near every hand washing sink, in addition to near where an ABHR is applied.
- Staff will educate and demonstrate to children how to use and when to use an ABHR
- All ABHR must be between 70% to 90% alcohol based
- Visibly soiled hands must be washed first before applying an ABHR
- Children must be given written consent by parent/guardian in order to use an ABHR
- Non-alcohol based waterless antiseptic agents must not be used
- Glove Use
- A current Toronto Public Health “Glove Use” procedure will be posted in all washrooms, diapering areas and classrooms
- Gloves must be accessible in all washrooms, diapering area, kitchen and classrooms.
- Gloves must be worn when it is anticipated that hands will be in contact with mucous membranes, broken skin, tissue, blood, bodily fluids, secretions, excretions, or contaminated equipment and environmental surfaces.
- Gloves must be single use only
- Hand washing must be practiced before putting on and taking off gloves
- Gloves must be removed immediately and discarded into a waste receptacle after each use
- Gloves should be appropriate for the type of activity
- To reduce hand irritation:
- Use appropriate gloves when handling chemical agents
- Gloves for as short a time as possible
- Clean and dry hands before and after wearing gloves
- Use gloves which are clean and dry
Diapering and Toileting
- A current Toronto Public Health “Toilet Routine” and Diaper Routine” procedures will be posted in all diaper and toileting areas
- A separate diaper change area and change table will be designated
- Hand washing sinks must be provided in diaper changing areas and washrooms
- Washrooms and diapering areas must be equipped with: running water, liquid soap in a dispenser, paper towel, single use appropriate gloves and appropriate disinfectant
- All washroom/diapering surfaces must be free of cracks or rips
- Appropriate storage for personal hygiene items, i.e., diapers, creams, ointments. Personal hygiene items must be labelled and stored appropriately.
- Appropriate storage for personal hygiene items, i.e., diapers, creams, ointments. Personal hygiene items must be labelled and stored appropriately.
- Washrooms, fixtures and diaper change surfaces must be maintained in a sanitary condition
- Diapering surfaces must be disinfected after each use and this should be used for diapering only i.e., not drying toys
- A separate garbage container for diapers will be provided
Expressed Breast Milk (EBM)
- Shall store EBM in a refrigerator at a temperature of 4 degrees Celsius or colder, until used
- Shall thaw frozen EBM in a refrigerator and ensure it is used within 24 hours, do not use a microwave to thaw EBM
- Shall ensure bottles and containers are properly labelled with: (date, name of infant/child and name of mother)
- Shall supervise children drinking EBM from a cup to prevent unintended consumption by other children. Discard any leftover EBM not consumed by the child
- Must apply routine practices when handling EBM
- Must apply routine practices when handling EBM
- Must wear gloves while handling EBM i.e., dispensing into a cup or from a container
Must wear gloves while handling EBM i.e., dispensing into a cup or from a container
Environmental Cleaning and Disinfecting
- Cleaning and disinfecting of all classroom toys, equipment and laundry must be done according to Toronto Public Health requirements
- The classroom team is responsible for ensuring that all cleaned and disinfected items are recorded on the disinfecting log sheet
- The “Bleach Solutions for Disinfecting” Procedure from Toronto Public Health will be followed when cleaning and disinfecting. This procedure will be posted in each classroom, washroom and kitchen
- The “Blood and Body Fluid Spills” Procedure from Toronto Public Health will be followed when cleaning and disinfecting. This procedure will be posted in each classroom, washroom and kitchen
- The frequency of cleaning and disinfecting will be enhanced during an outbreak
- Unclean or mouthed toys will be placed in a separate bin immediately for cleaning and disinfecting
- All toys that are shared will be toys that can be easily cleaned
- Toys will be nonporous and able to withstand mechanical cleaning and repeated exposure to disinfectants
- Homemade play dough must be discarded after a single use
- Cleaning Agents
- Shall be labelled
- Shall be stored in a secure location and inaccessible to children
- All agents which say “keep out of reach of children” , shall be inaccessible to children
- Shall have a Drug Identification Number (DIN) and a Material Safety Data Sheet (MSDS). All MSDS must be stored in the same location of the cleaning agents
- Must be used as per manufacturer’s directions
- Must have a predetermined shelf life
- Using a Cleaning Agent
- Wear appropriate personal protective equipment (PPE) for the task
- High Touch Surfaces
- High touch surfaces are those which have frequent contact with hands, some examples include:
- Door handles
- Cribs/cots
- Light switches
- Computer keyboards and remote controls
- High touch surfaces require more frequent cleaning and disinfecting than minimal contact surfaces
- Cleaning and disinfecting is generally done once a day or more frequently if the risk of environmental contamination is higher, for example toys in an infant room during an outbreak.
- Surfaces that cannot be immersed will be cleaned with a cloth and then wiped with a cloth containing the appropriate mixture of bleach and water, refer to “Bleach Solutions for Disinfecting” Procedure.
- High touch surfaces are those which have frequent contact with hands, some examples include:
- Sleep Equipment
- All cribs and cots will be labelled and assigned to a single designated child
- All cribs and cots will be cleaned and disinfected before being transferred to another child
- Crib mattresses shall be made of a cleanable material
- Crib mattress and cots shall be cleaned weekly or when soiled or wet
- All sleeping mats will be stored so the sleeping surface has no contact with another child’s mat
- All bedding will be assigned to each child and washed weekly or when soiled or wet
- How to Clean and Disinfect
- Two compartment sink, follow Toronto Public Health “Bleach Solutions for Disinfecting” procedure • Bleach Solution consists of the following: 1 part Bleach to 99 parts Water
- Place this mixture in a squeeze bottle, this mixture will be changed daily
- Staff will implement recommendations from Toronto Public Health to ensure the bleach and water mixture measures accordingly
- Use of a commercial dishwasher, follow Toronto Public Health “Bleach Solutions for Disinfecting” procedure
- All toys must be clean before being sanitized in dish washer and must be air dried prior to use or storing.
- Communicate with staff and parents in respect to “Infection Prevention and Control” measures being implemented at the Day Care Centre.
Kitchen
- A minimum of two (2) staff must have their Food Handlers Certificate to ensure children, volunteers, students and staff are protected from health risks, such as food poisoning, allergic reactions, and other health risks that could occur from consuming contaminated food.
- When receiving catered food, a temperature check must be taken on all hot food items and recorded in the logbook. Food items must then be put away in their respective space. Any temperature concerns must be communicated to the Program Supervisor or designate immediately.
- All food, whether refrigerated or in the cupboard, must always be stored in a space that is clean and organized.
- All hot food coming out of the kitchen must have a temperature check taken before leaving the kitchen and recorded in the logbook. Any temperature concerns must be communicated to the Program Supervisor or designate immediately.
- All substituted foods must be clearly labelled to ensure the respective child receives the correct food. All children must be supervised during meal times to monitor for allergies and reactions.
- Fridges and freezers must be equipped with accurate indicating thermometers. Temperatures must be recorded daily in the logbook.
- The dishwasher must be able to sanitize at high heat; washing and rinsing temperatures must be recorded daily in the logbook.
- The dishwasher must be drained and restarted when being used for cleaning and sanitizing toys.
- All appliance maintenance concerns must be communicated to the Program Supervisor or designate immediately.
- A kitchen cleaning log must be kept to ensure that regular cleaning of the kitchen is maintained.
Parent Involvement Policy
As a Co-operative Day Care Centre, families are encouraged to participate in the children’s learning and development.
Section 6, article 2 of our bi-laws states that, “All members of the Co-operative shall be required to donate a minimum of one hour per month in such services to the Co-operative as shall be agreed upon by the directors”.
Parents are encouraged to maintain open and ongoing communication with staff. Families may participate in curriculum and volunteer in the program as needed adhering to the volunteer policy. The staff are responsible for the children at all times. If you have a concern please bring it to their attention.
Confidentiality and Discretion
People love talking about each other. In a child care setting, there is a lot to talk about. However, it is also a place where sensitive information is exchanged and emotions are close to the surface, especially when children are involved.
Observing confidentiality is one of the toughest problems a child care centre faces. Even two parents talking about the children in a school can inadvertently say something they’ll regret. We often remark on the personalities of the children in the school. It is hard not to notice if a child is developing differently from our own child or to comment on their behaviour, or a parent’s attitude. Noticing is fine, but learning how to talk about it in a respectful manner is something we have to work at.
Discretion is mostly an editing process – it’s learning how to think before speaking so that information is filtered or not even shared. It can also be learning how to manage conflict effectively because we all say things we regret when we are angry. If your editor fails, say “I’m sorry; I should not have said that. I was not thinking”. When you hear something about a family and a child, or a staff, consider first how to react and whether or not it is private information.
As members of a co-operative child care centre, it is imperative to be discrete. It is surprising sometimes how things get turned around. Remember that old game “Telephone” where you would whisper a secret to the person next to you and they would pass it on around the circle? By the time the message came back, it was inevitably different than what you had said. Unlike the game, gossip and hearsay can be detrimental to the Centre and those associated with it.
Taken from R. Lantz, P.C.P.O Nov. 3, 2000