Infection prevention and control
The provider must undertake appropriate and thorough cleaning of the premises prior to reopening, including areas that may have been closed or out of use for a number of weeks.
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 (which includes advice on, amongst other things, detergents/ cleaning products) and Infection Prevention and Control in Childcare Settings guidance.
This should be an extension of the cleaning regime normally used in ELC settings, with touchpoints such as table tops, chairs, doors, light switches, banisters, 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.
Careful consideration should be given to the cleaning regime for sensory rooms and soft play areas, to ensure safe use.
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. These should not be shared with other children.
It is advised at this time that settings should restrict sharing resources between home and nursery. If resources from the setting (for example, story bags) are taken home by a child, these should be quarantined for 72 hours upon return to the setting and must be cleaned before the next usage. Under most circumstances, the amount of infectious virus on any contaminated surfaces is likely to have decreased significantly by 72 hours. We know that similar viruses are transferred to and by people’s hands. Therefore, frequent hand hygiene and regular decontamination of frequently touched environmental and equipment surfaces will help to reduce the risk of infection transmission. It is also important to ensure any containers in which equipment is transported back to the setting are cleaned thoroughly. Settings should develop quarantine procedures for returned resources if they choose to share resources between home and setting for a particular reason. For example, trolleys can be used as they are easy for staff to wheel into a dedicated quarantine area and can be easily labelled.
Each setting should be cleaned at least daily or when 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. Soft furnishings such as throws, if required, 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 an integral part of the overall cleaning strategy. Staff should use their own cup/cutlery and ensure these are cleaned straight after use.
ELC settings must ensure that risk assessments are updated appropriately for the autumn/winter period, to consider issues around ventilation and heating/warmth that are relevant to their specific environments. They should consider areas of the setting where air flow (including pockets of stagnant air in occupied spaces) and/or temperature may be problematic, and the strategies that may be used to address these issues and mitigate risks appropriately.
The primary effective method of increasing natural ventilation remains the opening of external doors, vents and windows. All settings must ensure the opening of doors and windows to increase natural ventilation where it is practical, safe and secure to do so, while maintaining appropriate internal temperatures.
Potential approaches to help achieve an appropriate balance of ventilation and internal temperature in the colder months may include:
- partially opening doors and windows to provide ventilation while reducing draughts
- opening high level windows in preference to low level windows to reduce draughts
- refreshing the air in spaces by opening windows, vents and external doors at times which avoid user discomfort (e.g. between sessions or when children are outdoors)
The suitability of solutions will depend on a range of local factors including building type, occupancy patterns and weather conditions.
All settings must ensure as a minimum, that adequate levels of ventilation are provided in line with existing guidance (Care Inspectorate “Space to Grow”, and the Workplace (Health, Safety and Welfare) Regulations 1992).
For all settings, an adequate level of ventilation is likely to be indicated by a CO2 concentration of no greater than 1,500 ppm as measured by a CO2 monitor. Where settings have a CO2 monitor we advise you use this to assess your setting periodically.
For the private and voluntary sector, a minimum temperature of 16 C is required under the Workplace (Health, Safety and Welfare) Regulations 1992.
In local authority settings where School Premises Regulations apply, the minimum ventilation rate in a nursery classroom is 2 air changes per hour and minimum temperature is 17 C.
Keeping doors open (with appropriate regard to safety and security) may also help to reduce contact with door and window handles. However, internal fire doors should never be held open (unless assessed and provided with appropriate hold open and self-closing mechanisms which respond to the actuation of the fire alarm system). The Fire Safety Risk Assessment should always be reviewed before any internal doors are held open
Where it is not possible to keep doors and windows open, and centralised or local mechanical ventilation is present, systems should wherever possible be adjusted to full fresh air. If this is not possible while maintaining appropriate internal conditions, systems should be operated to achieve statutory requirements as a minimum. Where ventilation units have filters present, enhanced precautions should be taken when changing filters. Ventilation systems should be checked or adjusted to ensure they do not automatically adjust ventilation levels due to differing occupancy levels. HSE guidance on ventilation systems can be found on the HSE website.
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, called Washing hands with liquid soap and warm water.
Antibacterial hand gel is not recommended for children when soap and water is available. A Health Protection Scotland 2018 SBAR (Situation, Background, Assessment, Recommendation) on hygiene requirements in outdoor nurseries in Scotland states that the use of alcohol-based hand rubs (ABHRs) and non-AHBRs should be discouraged in children under the age of five.
Health Protection Scotland guidance on infection prevention and control in childcare settings advises that if there is no running water, hand wipes can be used. If wipes are being used in situations where running water is not available, it is recommended that hands are washed with soap and water at the earliest opportunity.
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/carer who require to approach the entrance to pass over children, and to staff and essential visitors 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
- On 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, dispose of tissues appropriately and ensure that bins are emptied regularly of waste.
- Supervise children washing their hands and provide assistance if necessary.
- Never share water in a communal bowl when washing hands
- Always dry hands thoroughly
Tooth brushing can continue where there are adequate facilities to do so. Settings operating tooth brushing 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 using the HSE Personal Protective Equipment (PPE) at Work guide, appropriate PPE should be readily available and staff should be trained on its use as appropriate. Where the use of PPE is risk assessed as being required, staff should be trained in how to put on and take off PPE (as required by Health and Safety Regulations), and suitable waste facilities provided.
No additional PPE measures are required for general use in ELC settings. Staff should continue to follow existing guidance on the use of PPE. Examples of this include:
- Staff carrying out intimate care should wear a disposable, single-use plastic 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 and adequate training provided. This includes procedures for putting on and taking off PPE, the disposal of soiled items; laundering of any clothes, including uniform and staff clothing, 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.
In cases of suspected COVID-19, use of PPE should be based on risk assessment. Risk assessments must be consider all factors affecting the protection of staff and children including any additional distress and impact on wellbeing of child. The following use of PPE may be considered:
- A fluid-resistant surgical mask should be worn by staff if they are looking after a child who has become unwell with symptoms of COVID-19 and 2m physical distancing cannot be maintained while doing so.
- If the child or young person who has become unwell with symptoms of COVID-19 needs direct personal care, gloves and aprons, fluid-resistant surgical mask should be worn by staff .
- 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.
Where the use of PPE is being considered within a setting the specific conditions of each individual setting must be taken into consideration and comply with all applicable legislation, including the Health and Safety at Work etc. Act 1974, Personal Protective Equipment Regulations 1992 and the Management of Health and Safety Regulations 1999 which outlines the process of, and legal requirements for, risk assessment.
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 a first responder is required to do if they come into close contact with someone as part of their first responder duties. It covers the use of PPE and CPR.