Germs are spread in different ways, including coughing, sneezing, skin-to-skin contact, and touching contaminated surfaces. Research indicates that some viruses and bacteria can live from 20 minutes to two hours or more on doorknobs, tables, and other surfaces.
Young children explore and learn about their environment using their senses, including touch. In childcare settings, germs are easily spread because children touch everything within their reach, share toys, and use common areas for eating and toileting.
Illnesses that can be spread by contact with a contaminated surface include conjunctivitis (pink eye), impetigo, ringworm, scabies, head lice, the common cold, and flu. Some illnesses, like hand-foot-mouth disease, infectious diarrhea, and E. coli, are spread by touching feces or a surface contaminated with feces and then touching the mouth.
CLEANING...SANITIZING...DISINFECTING...WHAT’S THE DIFFERENCE?
One of the most effective ways to prevent the spread of communicable illnesses in your childcare program is cleaning and sanitizing surfaces. Although “cleaning” and “sanitizing” are sometimes referred to interchangeably, they involve different processes, solutions, and results. In fact, it is not possible to clean and sanitize at the same time.
The first step involves cleaning, which should remove visible dirt and debris. The second step is sanitizing, which removes enough germs that it is unlikely that contact with the surface will result in infection.
Some information for childcare providers also refers to a third step, disinfecting, which is designed to remove virtually all of the germs from a surface and is often recommended for body fluid spills. Disinfecting is similar to sanitizing, but uses a stronger bleach solution.
Cleaning is the process that removes visible soil and debris, including body fluids, food, and dust. A cleaning solution consists of detergent and water and the method is to scrub, wash, and rinse. The scrubbing action decreases the number of germs on surfaces, but does not eliminate them. It is also important to rinse the surface before sanitizing.
Disposable or single-use cleaning cloths keep germs from moving from place to place. Sponges, which can hold bacteria and are difficult to clean effectively, are not recommended.
Cleaning removes dirt and can make a surface appear to be clean and even germ-free, but cleaning with detergent is not effective for removing germs. Sanitizing with a bleach and water solution is necessary to achieve a surface that is nearly free of germs.
Sanitizing is a component of the standard precautions, which are guidelines that were originally designed to prevent the spread of blood borne disease, but also are useful for preventing the spread of other infectious diseases in childcare programs.
Caring for Our Children’s recommendation for sanitizing tables, toys, and water play areas is ¼ cup of bleach to one gallon of water. Toys that cannot be washed and sanitized should be excluded from use. For manually washing dishes and utensils, the recommendation is 1 tablespoon of bleach to a gallon of water.
For surfaces involved in toileting and diapering, Caring for Our Children recommends a solution of ¼ cup of bleach to one gallon of water. After the bleach-water solution is applied to the surface, it should be left on the surface for at least two minutes or allowed to air dry. Children should not be present when surfaces are being sanitized.
How Frequently to Clean and Sanitize?
Caring for Our Children provides specific guidelines for cleaning and sanitizing surfaces in classrooms and food areas, toileting and diapering areas, and for the general childcare facility. For example, counter tops, tabletops, floors, and door and cabinet handles should be cleaned and sanitized daily and more frequently if soiled.
Food preparation and food service surfaces should be cleaned and disinfected before and after contact with a food activity and between preparation of raw and cooked foods. Utensils, surfaces, and toys that go into the mouth or have been in contact with body fluids should be cleaned and sanitized after each child’s use.
Disposable, one-use utensils and toys are another alternative. Toilet and diapering areas require daily cleaning and sanitizing, and changing tables should be cleaned and sanitized after each use.
The Caring for Our Children standards recommend increasing the frequency of cleaning and sanitizing when outbreaks of illness occur, when there is known contamination or visible soil, or when the health department recommends increased cleaning to control certain infectious diseases. Young children touch everything they can reach, so assume all surfaces that are accessible to children are contaminated.
A solution of water and household bleach is effective for sanitizing surfaces. It is also inexpensive, accessible, and convenient. However, it is important to follow safety procedures when dealing with bleach.
To store bleach properly and preserve the chlorine’s effectiveness, keep it out of direct sunlight and away from heat. Bleach and bleach solution should be stored in a locked cabinet out of children’s reach, away from food and medicine. It should also be clearly labeled.
Establish a specific site for mixing the bleach solution, and assign a person to mix the solution. It is also important to post instructions, measurements, and cautions for mixing the bleach solution so all staff will know the correct mixing procedure. Make sure to keep the mixing area stocked with disposable gloves and an apron or smock to protect clothing.
Fresh bleach solution should be mixed each day. Keep in mind that extreme caution should be used when mixing the bleach-water solution. NEVER mix bleach or bleach solution with any other cleaners, especially those with ammonia, toilet cleaner, or even vinegar.
Sanitizing solution can be applied using a spray bottle, which is effective for diaper changing areas and toilets. It can also be applied with cloths rinsed in sanitizing solution, which is appropriate for food preparation areas, toys, books, and activity centers. Smaller toys can be dipped into a container of the bleach solution.
When the application method is cloth or dipping, more bleach is needed because some germs are released into the solution, which could contaminate it. Items should remain in the dipping solution for at least one minute.
Preventing the transmission of illness in childcare settings is a challenge. To decrease the spread of germs in childcare settings, use the two-step method of cleaning and sanitizing. The result will be a cleaner, more sanitary facility and healthier staff and children.
By Marna Holland, EdD
Parent Educator, Asheville City Schools Preschool, Asheville, NC
Caring for Our Children: National Health and Safety Performance Standards. National Resource Center for Health and Safety in Child Care and Early Education; nrc.uchsc.edu/CFOC/
Cleaning and Sanitizing: What’s the Difference and How Are They Done? North Carolina Child Care Health and Safety Resource Center; ncchildcare.dhhs.state.nc.us/pdf_forms/bleach_solution_fact_sheet.pdf
Communicable Disease Chart for Schools and Child Care Centers, www.dshs.state.tx.us/idcu/health/schools_childcare/resources/ChildCareChartNotes.pdf
Recommendations for Cleaning, Sanitizing and Disinfecting. Health and Safety Notes, California Childcare Health Program; www.ucsfchildcarehealth.org/pdfs/healthandsafety/recommenEN_adr.pdf
Standard and Universal Precautions in the Child Care Setting, Health and Safety Notes, California Childcare Health Program, www.ucsfchildcarehealth.org/pdfs/healthandsafety/standardprecen020305_adr.pdf