When the Government decided to allow early years settings to welcome back all children from 1 June 2020, the rationale was that young children were less likely to be affected by coronavirus. Despite the suggested lower risk to children, the need for exemplary infection control practice has never been more important.
Ofsted statistics show a steady increase in the number of instances (adults and children) of coronavirus in registered early years settings, from three on 8 June to 686 by 9 November 2020. As a notification may include more than one confirmed case, the number of notifications received does not necessarily correlate with the number of confirmed cases in a setting.
While these numbers remain low compared with the overall prevalence of the virus, there is a sector-wide call for home testing kits to be made available to all providers, not just maintained nursery schools, as was the case at the time of going to press.
Personal protective equipment
Providers should be reassured that they have always been one step ahead when it comes to good practice in infection control and hygiene. Single-use gloves and aprons are used routinely in nurseries for dealing with soiled nappies or bodily fluids. Meanwhile, staff will already have experience of procedures for responding to a contagious illness through strictly enforced exclusion times defined by Public Health England.
Despite well-established infection control and hygiene practice, coronavirus has led to a big increase in the single-use personal protective equipment (PPE) used routinely in early years settings for everyday activities. This increase may provide visible reassurance to staff and parents that enhanced safety measures are in place, but PPE is not strictly necessary. The Government guidance, ‘Actions for early years and childcare providers during the coronavirus outbreak’, maintains that ‘childcare settings will not require PPE beyond what they would normally need for their work’, and that ‘face coverings are not necessary when adults are interacting with children’. The exceptions are where a practitioner is attending to a child who becomes ill with suspected coronavirus, or where a child already has routine intimate care needs that involve the use of PPE.
Most providers have existing suppliers for PPE, and despite reported shortages back in the spring of 2020, it appears that supply is now meeting demand. However, one consequence of the increased single-use PPE in circulation is that settings that had made valiant efforts to reduce, reuse and recycle have instead found themselves increasing, rather than reducing, their contributions to landfill. Single-use aprons and gloves are considered non-recyclable in traditional recycling systems – but there are ways to overcome this. Recycling experts TerraCycle can supply a Zero Waste Box that can be filled with PPE and returned to it for sorting and processing into raw materials that can be reused (see Further information).
Infection control
To support infection control and hygiene in settings, a system of controls detailed in the Government guidance builds on what providers already have in place. The guidance rightly states that there cannot be a ‘one size fits all approach’ and that leaders are best placed to understand the needs of their settings.
Even so, this has inevitably caused concern for providers looking to the guidance for clarity. Questions such as which activities should be suspended and how provision, including sand and water play, can go ahead safely remain largely unanswered (see FAQs, right). The system of controls is comprehensive but still requires a degree of confidence when making decisions about the right actions to take. Providers must navigate a host of links to additional guidance within guidance that is not always specific to early years and is often open to interpretation.
On the plus side, providers are finding innovative ways (see Case study) to offer rich and varied activities while minimising the risk of infection spreading.
The system of controls, grouped as ‘prevention’ and ‘response to any infection’, are summarised briefly here:
- Minimise contact with individuals who are unwell.
- Where recommended, use face coverings.
- Clean hands thoroughly more often than usual.
- Ensure good respiratory hygiene – ‘catch it, bin it, kill it’.
- Introduce enhanced cleaning.(Actions 1-5 must always be in place in settings. They are already well established in the early years, so should not place an additional burden on providers in terms of practice or resources.)
- Minimise contact between groups where possible.
- Where necessary, wear appropriate PPE.
Action number 6 ‘must be properly considered, and settings must put in place measures that suit their circumstances’. The Government acknowledges that it is unrealistic to expect young children to practise ‘social distancing’. Providers have diligently organised groups of children by staggering sessions and mealtimes or organising the physical environment to minimise groups of children mixing. Equally, they have kept children’s emotional well-being at the heart of their provision by ensuring that their innate need to play and socialise remains a priority.
Action number 7 applies in specific circumstances, e.g. changing nappies, dealing with bodily fluids and isolating a child showing symptoms.
CASE STUDY: Milton solution and hibernating toys
Rachel Fasham, manager of Early Birds nursery in Bude, Cornwall, describes how a reflective approach to infection control and hygiene has seen staff incorporate some simple new routines with the children that have become established practice.
She says, ‘Tidy-up time now involves children gathering up toys that can be easily cleaned and placing them in individual bowls of soapy water. They are washed with child-friendly soap and many different types of brushes. This is a sorting activity, so the kitchen toys are placed in one child’s bowl and the Duplo in another. Books and wooden toys that cannot be washed go into “hibernation” for 72 hours.
‘When the children leave, the toys are sprayed with a Milton solution, along with all surfaces and touchspots. A multipurpose five-litre pressure sprayer purchased online for under £20 has proved to be invaluable. The nursery smells fresh and clean the next day, which is reassuring for staff and parents.’
FURTHER INFORMATION
- Ofsted statistics, https://bit.ly/3mQsPhs
- Zero Waste Box, https://zerowasteboxes.terracycle.co.uk/pages/about-zero-waste-box
- Government guidance: https://bit.ly/3mSvjfA; https://bit.ly/39MFDSD; and https://bit.ly/2VLJWp2
Melanie Pilcher is quality and standards manager at the Early Years Alliance
FAQs
1. What is a deep clean and when do I need to do one?
A. A deep clean includes the thorough cleaning of all surfaces, floors, soft furnishings, including curtains, blinds and carpets and other resources, and is normally advised where there has been a confirmed case of coronavirus. It is unnecessary in day-to-day childcare provision where frequent cleaning of frequently touched surfaces using regular cleaning products is sufficient.
2. Can we have sand and water or playdough play?
A. As would be the case for diarrhoea and vomiting, sand and water play should be suspended, as should playdough and cookery. Many have found creative ways to ensure that play with malleable materials can continue safely. Children can use individual trays (cat-litter trays work well) with their own set of play tools. Some settings have used their EYPP allocation to purchase additional resources.
3. Is adding anti-bacterial washing-up liquid to the water tray ok?
A. Anti-bacterial washing-up liquid is not made for little hands and should not be used. If splashed in the eyes, it can cause irritation. There are plenty of liquid soaps and bubble baths made for children that can be added to individual water trays for bubble play or to colour water. They also have the benefit of cleaning little hands too.
4. Can we sing with the children?
A. There is no reason why singing should stop, but there are some additional precautions you can take: face all children in the same direction, ensure the practitioner leading the activity from the front sits two metres apart from the children, avoid songs that encourage the children to project their voices, and have singing and other circle time outdoors if possible.
5. We have a toothbrushing scheme in our setting, will this have to stop now?
A. Public Health England has confirmed that supervised dry brushing (no toothpaste or water) is fine, but wet brushing is not recommended because of the increased risk of droplets and contact transmission. Dry brushing will still encourage children to develop the routine and habit of cleaning their teeth, which is the purpose of supervised toothbrushing in early years settings.