Of the three nurseries featured in 'Nurseries Undercover', the recent BBC1 fly-on-the-wall documentary about poor quality daycare, two had experienced tummy bug 'epidemics', made worse by poor hygiene in the setting.
While most childcare workers know the basics of good hygiene such as the importance of fresh air, a controlled indoor temperature and suitable ventilation, it is sensible to review a setting's health promotion procedures from time to time to make certain that everybody is maintaining and practising good hygiene.
So, how can we ensure high standards of hygiene and reduce the spread of unwanted bacteria and bugs that lead to unnecessary tummy upsets, coughs and colds?
Bugs, colds and other infections are spread in childcare settings through several sources often related to inadequate or careless hygiene. So the first thing that managers need to do is ensure that measures are taken to protect the health of everybody, especially the children.
Hygiene standards Standard 7 of the DfES report National Standards for Under-eights Daycare and Childminding states that the registered person should promote the good health of children and take positive steps to prevent the spread of infection. Across the Atlantic, the Child Care Information Exchange reminds us that 'Childcare workers spread disease by changing diapers (nappies), feeding children, wiping noses, playing on the playground and in playrooms with objects that the children handle, drool on, and put into their mouths'
and that both caregivers and children's hands are often visibly soiled by partly-eaten food, reusable play materials such as finger paints, sand, dough and water and shoes that are taken on and off several times a day.
It is easy to understand, therefore, how young children themselves may contribute to the spread of bugs and infections when they are involved in these activities. So, let's look at some of the ways a manager can ensure risks are reduced so that nasty bugs and infections are prevented.
Hand washing One obvious and major deterrent in the prevention of infection is the very simple yet effective strategy of hand washing - at the following key times: Childcare workers
* On arrival at the setting, or when moving from one group to another
* Before and after preparing food, especially raw poultry, meat, etc; eating; feeding a child; giving medicine to a child.
After:
* changing nappies, (even if gloves are worn)
* using the toilet, or assisting a child to use a potty or the toilet
* contact with body fluids - mucus, blood, vomit, sores, through things such as nose wiping, sneezing etc.
After:
* handling pets and other living things
* handling rubbish
* playing in sand, etc.
Children Before and after:
* eating
* playing in shared water tray.
After:
* using the toilet or potty
* engaging in messy activities such as finger painting, dough play, gardening
* contact with body fluids such as blood and mucus
* handling pets
* sand play.
Food preparation and storage The key to success in keeping food safe is having a sound knowledge and understanding about promoting hygiene and reducing opportunities for cross-infection. It is important that good food hygiene is maintained constantly when foods are being prepared, stored or served.
There are many potential sources of unhealthy bacteria in the kitchen and it is, therefore, essential that attention to cleanliness is applied consistently, with food preparation areas, floor, cupboards, shelves, storage areas and cooking and eating utensils kept scrupulously clean.
The same approach should also be taken to cleaning cloths, brushes, bins, mops and other materials so that sources of germs and other micro-organisms are reduced.
In addition to keeping everything clean, it is also important to ensure that hygiene measures such as having a mesh covering on windows to exclude insects, or regular emptying of bins to discourage infestations, are also adhered to.
Food handling is an issue that should be monitored constantly and should be undertaken by a person who has a food handling certificate, gained by demonstrating competence in this area.
The same rigour should be applied to the preparation of baby formula and other infant foods as to those prepared in the kitchen and baby-feeding equipment should be cleaned using a recommended sterilising method.
Bathrooms and changing areas Perhaps a more obvious source of germs are bathrooms and baby-changing areas where it is easy to see how quickly germs could multiply if good hygiene is not maintained.
In changing areas, settings should:
* clean changing mats, surfaces and storage areas in changing areas regularly
* check supplies of toiletries and other materials such as baby wipes and nappy bags regularly to ensure that everything is immediately to hand when required
* monitor cleaning at intervals throughout the day and check supplies on a daily basis.
In nursery bathrooms the need for vigilance is increased further because urine and faeces often have to be cleaned from potties and from the toilets themselves. Therefore:
* clean toilets regularly after use. This should include the toilet pan, seat, sluice sink (if necessary) and the floor area, always ensuring that this does not become a hazard to other children who could slip on a wet floor
* keep sinks and taps scrupulously clean
* check bathrooms frequently to ensure cleaning has been carried out properly
* provide storage for toiletries and sufficient waste disposal points
* empty potties immediately after use and rinse them thoroughly in a sluice or separate area where they can be thoroughly cleaned out, ready for further use
* encourage staff to teach children the importance of washing their hands carefully after using toilets and potties and how to wash their hands properly - taking time to lather them thoroughly and clean around the nails with a nailbrush
* display a simple sign stating, 'Now wash your hands' as a reminder for everybody about the importance of this essential activity
* make available at all times a good supply of protective clothing including disposable gloves and aprons.
Playrooms Playrooms, which are the hub of any nursery, are often the places where children and adults spend most time. While these are usually much easier to keep clean than bathrooms, or the kitchen, it is important to remember they may occasionally be responsible for the spread of germs unless strict routines are followed, particularly when children are unwell.
The playroom should be cleaned regularly and all toys, materials and equipment, especially anything that is mouthed or sucked by children, should be cleaned thoroughly on a regular basis.
Routines should include the use and disposal of paper hankies for runny noses, correct cleaning and disposal of body fluids and the use of rubber gloves and protective clothing when 'accidents' need to be dealt with, and encouraging children to cover their mouths when they cough.
It is also worth remembering that even when an item such as playdough is not intended for consumption children may want to eat it. It is important, therefore, to teach them not to do so and to ensure their hands are washed thoroughly after playing with it so that traces are cleaned from under nails and between fingers. Adults should also be encouraged to keep their nails short so that germs, which are difficult to wash away, do not lodge behind them.
Bibliography
* Aronson, S (2003) 2002 Update on Hand Hygiene in Child (Day) Care Settings, Child Care Information Exchange 3/03-58 (mail.ccie.com/library/5015058.pdf)
* Bruce, T and Meggit, C (1996) Child Care and Education, Hodder & Stoughton, London.
* DfES/DWP (2003) National Standards for Under-eights Daycare and Childminding, DfES publications
* Fackler, A Safety and Hygiene, birth to two years (2003), www.peacehealth.org/kbase
Management strategy
While much advice about hygiene may seem very obvious it is important that managers:
* have a clear policy which is understood by all who work in the setting
* seek advice from the Environmental Health Department about specific hygiene issues such as those relating to diarrhoeal illness
* organise staff to ensure that the rules of good hygiene are understood and maintained
* ensure lines of responsibility for the supply of materials such as soap, disinfectant and protective clothing are made clear
* plan how good hygiene will be developed in the setting and set standards for everybody involved.
Finally, it is also important to:
* measure your setting's performance and, in the rare case where lapses occur, be ready to learn from experience.