Infection prevention and control
There are a range of key practices that providers should consider in relation to hygiene and the prevention and control of the spread of infection:
- cleaning practices
- enhanced hygiene
- tooth brushing
- personal protective equipment (PPE)
- when a child or staff member becomes ill
- test and protect
- outbreak management
If the setting has been closed for many weeks or if shelter areas or buildings have been out of use for a long period, the provider must undertake appropriate and thorough cleaning of the premises prior to reopening.
Consideration should be given to the cleaning strategy to be adopted in the setting once it reopens. All cleaning should be carried out in accordance with COVID-19 – guidance for non-healthcare settings and Infection Prevention and Control in Childcare Settings guidance.
This may be an extension of the cleaning regime normally used in fully outdoor early learning and childcare settings, with touchpoints such as table tops, chairs, doors, light switches, equipment, sinks, and toilets cleaned more regularly. There should be routine cleaning and disinfection of frequently touched objects and hard surfaces. This should include equipment staff use, (e.g. telephones, keyboards, door handles, and tables). Settings should ensure regular (at least twice daily) cleaning of commonly touched objects and surfaces (e.g. desks, handles, dining tables, etc.). Toys and equipment that children access should be cleaned when groups of children change – e.g. between sessions (if groups are changing) and at the end of the day or in the morning before the session begins using standard detergent and disinfectant that are active against viruses and bacteria.
It is recommended that children access toys and equipment that are easy to clean.
Resources such as sand, water and playdough can be used with regular cleaning of the equipment used. Water and playdough should be replaced on a daily/sessional basis, when groups change.
Children should be discouraged from bringing toys from home to the setting. We recognise however that some children may require a transitional object or toy as a comforter, and consideration should be given as to how to safely manage this to ensure children are supported in their transition from home to the setting to feel reassured and comforted.
Each setting should be cleaned daily or when children’s groups of children change, in preparation for a new group of children being in the next day/session. This may require a review of cleaning arrangements to ensure additional cleaning hours are available.
Children will require comfortable areas to play, however any soft furnishings such as throws should be removed, unless clearly required. If required, they should be used for individual children and should be washed after use. Where children sleep or nap in the setting, children should have individual bedding, stored in individual bags and this should be laundered frequently and as a minimum weekly.
Where possible parents should provide the necessary clothing for outdoor play. Where this is not possible, children should not share outdoor clothes or footwear. Items belonging to the service should be allocated to one child within each session and laundered/cleaned before use by another child.
Surfaces in dining or snack areas should be wiped down and disinfected in between use by each group of children.
All crockery and equipment used in the provision of meals and snacks for children should be cleaned with general-purpose detergent and dried thoroughly before being stored for re-use.
Cleaning of staff areas should be considered as part of the overall cleaning strategy. Staff should use their own cup/cutlery and ensure these are cleaned straight after use.
Arrangements should be implemented for enhanced hand and respiratory hygiene by adults and children in the setting.
Where possible, disposable paper towels or kitchen roll should be used. Where it is age appropriate services can also use hand dryers. Where this is not practical, individual towels must be available for each child, and these must be laundered each day. There are a range of resources available from the NHS to encourage children with handwashing. NHS Education for Scotland (NES) has produced a video to demonstrate the correct way to wash your hands, which is available here. Antibacterial hand gel is not recommended for children when soap and water is available. Antibacterial hand gel should not be used by children under 12 months.
During this period ELC services must ensure that handwashing facilities are accessible for children. They may wish to have a supply of antibacterial hand gel available to parents and staff at the entrance to the setting. Staff should ensure enhanced hand hygiene measures are in place including washing their own hands and the hands of all children. In particular:
- ensure all staff and children frequently wash their hands with soap and water for 20 seconds
- handwashing should take place
- in arrival at the setting
- before and after eating
- after toileting
- at regular intervals throughout the day
- when moving between different areas (e.g. between different rooms or between inside and outside)
- encourage children not to touch their face, where it is age appropriate to do so. Use distraction methods and keep children busy, rather than making this an issue.
- use a tissue or elbow to cough or sneeze into, and dispose of tissues appropriately
- supervise children washing their hands and provide assistance if required.
- never share water in a communal bowl when washing hands
- always dry hands thoroughly using paper towels where possible, or with single use washable towels where this is not practical
Tooth brushing can continue where there are adequate facilities to do so. Settings operating toothbrushing should follow the Childsmile updated guidance.
The use of PPE by staff within childcare facilities should continue to be based on a clear assessment of risk and need for an individual child or young person, such as personal care where staff come into contact with blood and body fluids. Following any risk assessment (individual or organisational), where the need for PPE has been identified should be readily available and staff should be trained on its use as appropriate.
No additional PPE measures are required for general use in school aged childcare settings. Staff should continue to follow existing guidance on the use of PPE. Examples of this follow:
Staff carrying out intimate care should wear an apron and gloves.
Staff should have access to disposable single use gloves for spillage of blood or other body fluids and disposing of dressings or equipment. Local infection control procedures that outline safety and protocols should be stringently followed. This includes procedures for the disposal of soiled items; laundering of any clothes, towels or linen; and cleaning equipment for children and young people, such as hoists and wheelchairs.
Hand hygiene is essential before and after all contact with a child receiving intimate or personal care, before putting on PPE, after removal of PPE and after cleaning equipment and the environment. Hands should be washed with soap and water.
Specific guidance COVID-19: guidance for first responders has been developed and published for first responders who, as part of their normal roles, provide immediate assistance requiring close contact until further medical assistance arrives. This guidance sets out clearly what you are required to do if you come into close contact with someone as part of your first responder duties. It covers the use of PPE and CPR.
The types of PPE required in specific circumstances are set out below:
- Routine activities: No PPE is required when undertaking routine educational activities outdoors.
- Suspected COVID-19: Gloves, aprons and a fluid-resistant surgical mask should be worn by staff if a child or young person becomes unwell with symptoms of COVID-19 and needs direct personal care.
- Eye protection should also be worn if a risk assessment determines that there is a risk of splashing to the eyes such as from coughing, spitting, or vomiting.
- Gloves and aprons should be used when cleaning the areas where a person suspected of having COVID-19 has been.
- Intimate care: Gloves and aprons should continue to be used when providing intimate care to a child or young person. This can include personal, hands-on care such as washing, toileting, or first aid and certain clinical procedures such as assisted feeding.
- Fluid-resistant surgical masks and eye protection should also be worn if a risk assessment determines that there is a risk of splashing to the eyes such as from coughing, spitting, or vomiting.
- Gloves and aprons should be used when cleaning equipment or surfaces that might be contaminated with body fluids such as saliva or respiratory secretions.
If a child becomes unwell while in the setting, a ventilated space must be available for the child to wait in until they can be collected by their parent. Where space allows, you should prevent contact between any other children in the setting. Care must be taken however to ensure the appropriate levels of supervision of all children. Read the advice on what to do if someone is symptomatic
All staff and parents and carers should be advised that people who have symptoms, or who have household members who have symptoms, should not attend the setting, and should follow advice to self-isolate and book a test.
Managers and staff must be aware of Test and Protect arrangements should someone become unwell. If a member of the staff team has symptoms, they must contact the NHS to arrange to be tested at 0800 028 2816 or www.nhsinform.scot You can find more information on the COVID-19 Test and Protect webpage
All ELC settings are considered complex settings and cases will be prioritised and escalated to specialist local health protection teams.
All parents should be asked to mention childcare arrangements if contacted by or contacting the Test and Protect service.
If a parent/carer or staff member is contacted by a contact tracer and told to self-isolate for fourteen days, the person should leave the setting to self-isolate at home straight away and, if possible, wear a face covering on route and avoid public transport. The Scottish Government has published advice for employers on how to support people who are asked to self-isolate.
If a child or staff member tests positive, the contact tracer will take into account the close contacts the person has had within the setting.
It will be important that ELC providers keep clear records of children, adults and staff attending their settings, and of the composition of groups undertaking activities. These records will help to ensure rapid response and contact tracing should a positive case occur. This will enable employers to maintain records on staffing capacity in individual settings and to make judgements about whether it will be necessary to close settings temporarily due to high levels of staff absence. All providers should plan as much as possible to minimise the operational impact of individual staff or groups of staff being required to self-isolate.
he management of outbreaks of infectious disease in settings is led by local health protection teams (HPTs) alongside partners, such as local authorities and the care inspectorate. Managers should ensure before opening that they know how to contact their local HPT and who will usually be responsible for doing so.
If settings have two or more confirmed cases of COVID-19 within 14 days, or an increase in background rate of absence due to suspected or confirmed cases of COVID-19, they may have an outbreak. In this situation settings should make prompt contact with their local HPT and local authority. If an outbreak is then confirmed, settings should work with their local HPT to manage it. The HPT will make recommendations to the incident management team on self-isolation and on testing of children and staff and the arrangements for doing this.
If an outbreak is confirmed, settings should work with their local HPT to manage it. Actions that settings may need to be involved in include (but are not restricted to):
- attendance at multi-agency incident management team meetings
- communications with children, parents/carers and staff
- providing records of school layout / attendance / groups
- implementing enhanced infection, prevention and control measures
The HPT will make recommendations to the incident management team on self-isolation and on testing of children and staff and the arrangements for doing this. Any discussion of possible closures should take place between settings and local HPTs. Settings should maintain appropriate records to support outbreak control measures, e.g. child and staff attendance, details of groups, visitors, and clinically vulnerable/extremely vulnerable children who are attending settings.
Managers must notify the Care Inspectorate in the event of any confirmed or suspected outbreak of an infectious disease. Notifications and guidance are available through eForms.
Scotland has an excellent programme of community surveillance. This allows us to monitor actively trends in the pandemic, both nationally and more locally.
There will also be specific surveillance in respect of educational staff and children/young people. This will draw on Covid related information from a range of sources and will cover all school ages and ELC changes.
We are also developing an additional surveillance programme within a sample of schools. This would involve working over a period of time with substantial numbers of children and workers at a representative sample of schools throughout Scotland, using repeated PCR/serology testing and survey data to establish symptoms and infections in the school population to inform the ongoing development of guidance. The principal focus of this at least initially would be children, young people and staff in S4, S5 and S6. Participation would be voluntary and careful consideration is being given to ensuring acceptability in school populations.
Additionally, an additional surveillance study will look at risk in different occupational groups which will improve our understanding of the likelihood of COVID-19 infection and illness within the education workforce, and the effectiveness of measures to reduce transmission.
Taken together, these sources will allow regular reporting on indicators such as: overall incidence and swab positivity for Scotland; incidence and swab positivity for school-age children; number and proportion of all cases that are among school workers; hot spots by local authority area; number of clusters or outbreaks that are under investigation within educational settings; and, if feasible, antibody prevalence among children and school workers.
These data will inform decision-makers at different levels as they consider any adjustments to make to arrangements – including this guidance – or any investigations to be conducted at certain localities to explore what local responses are required.