Infection prevention and control
- hand and respiratory hygiene
- cleaning practices before reopening
- keeping the workplace clean
- case and outbreak management
- Test and Protect and self-isolating
There are a range of key practices that providers should use in relation to hygiene and the prevention and control of the spread of infection. At Level 0, maintaining one-metre physical distance, respiratory hygiene and regular hand hygiene remains the cornerstone of infection prevention.
Where possible, disposable paper towels or kitchen roll, with appropriate and frequent waste disposal, should be used. Where it is age appropriate, providers can also use hand dryers.
There are a range of resources available from the NHS to encourage children with handwashing. Hand sanitiser is not recommended for children when soap and water is available. 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.
Hand sanitiser should not be used by children under 12 months.
Handwashing should take place:
- on arrival at the setting
- before and after eating
- after using the toilet
- at regular intervals throughout the day
When moving between different areas (e.g. between different rooms or between inside and outside), where the handwashing facilities are not near the entrance to the outdoor play area the service may wish to have a supply of hand gel at the door for children
Providers must ensure that handwashing facilities are accessible for children as well as adults. Hand sanitiser should be available in locations around the premises and available to children, young people, parents, staff, volunteers and visitors at entry/exit points, reception desks, communal areas and workstations. Providers should consider the following hand hygiene measures for staff, visitors and service users:
frequent washing of hands with soap and water for at least 20 seconds
- hand sanitiser can be used as an alternative when hands are not visibly soiled or if soap and water aren’t available at all times (for example outdoors)
- washing hands or using hand sanitiser on arrival, after toileting, when moving between different areas (e.g. between different rooms or between inside and outside) as well as when exiting the premises
- COVID-19 is predominantly transmitted via the eyes, nose and mouth therefore people should be discouraged from touching their face or mask without washing their hands
- parents should encourage children, where age appropriate, not to touch their face, using distraction methods and keeping children busy, rather than making this an issue
- use a tissue or elbow to cough or sneeze. Provide families with tissue and a method of disposing of these appropriately (closed waste bin with liner)
- parents should where possible supervise children washing their hands and provide assistance if required
- always dry hands thoroughly
- clear signage should be available for those using the premises (including staff). See materials for this
- provide a nearby supply of hand sanitiser for employees or volunteers to use when handling deliveries when handwashing is not practical
- ensure staff and volunteers have access to handwashing facilities and are able to regularly wash their hands
- for mother/baby groups, where there are more than 5 adults at any one time, face coverings must be worn throughout the activity, except when sitting down
If premises have been closed for many weeks or if parts of the building have been out of use for a long period, the provider must undertake appropriate and thorough cleaning of the premises prior to reopening.
- an assessment for all sites, or parts of sites, that have been closed, before restarting work
- ensure appropriate cleaningis undertaken prior to re-opening in line with any requirements for reopening after prolonged closure. As part of this cleaning procedure, the facility should be re-stocked with adequate supplies of hand hygiene products
- ensure appropriate cleaning schedules are agreed prior to reopening with designated responsibility for undertaking regular cleaning frequencies
- checking whether you need to service or adjust ventilation systems. Advice can be sought from your heating ventilation and air conditioning (HVAC) engineers or advisers. See HSE guidance on Air conditioning and ventilation during the coronavirus outbreak and the most recent Coronavirus (COVID-19): ventilation guidance - November 2020 for more details
- opening windows and doors frequently to encourage ventilation, where possible. This does not apply to fire doors
- keep clutter to a minimum to support adequate cleaning
- this is also likely to mean enhancement of the daily cleaning regime normally used. There should be routine cleaning and disinfection of frequently touched areas and hard surfaces. This should include equipment staff use (e.g. telephones, keyboards, door handles, and tables) toilets, kitchen areas and baby change facilities.
- 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 between sessions 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. Providers should ensure that robust cleaning schedules are in place for decontamination of toys
- providers should advise that toys from home should not be brought in unless this cannot be avoided
- service users will require comfortable areas to spend time and play. However, any soft furnishings such as throws should be removed. Play mats for babies and young children should also be removed and parents encouraged to bring their own
- providers should consider whether to permit food and drink to be consumed in the setting used, unless essential for medical reasons. If providers permit use of kitchen areas to make hot drinks or snacks, or access to water, service users should bring their own cups/cutlery. Surfaces in kitchen areas should be wiped down and disinfected in between each use. Sharing of food or drink should not take place.
- set clear use and cleaning guidance for toilets to ensure they are kept clean. Read more about toilet cleaning
- where baby changing facilities are provided, set clear use and cleaning guidance to ensure they are kept clean and clear of personal items and that physical distancing is achieved. It is preferable for parents to bring their own personal changing mats if possible, with good hygiene practice in place for washing hands and disposing of waste
- areas used by service users, any staff rooms and any kitchen equipment should be cleaned frequently between uses. A cleaning schedule should be designed with training to implement the schedule
- cleaning of the staff areas should be considered as part of the overall cleaning strategy. Staff should use their own cup and cutlery and ensure these are thoroughly cleaned straight after use
- adequate collection and disposal arrangements should be made available for any additional waste created by enhanced cleaning practices
- the premises should be kept clear and all waste should be removed. All personal belongings (e.g. water bottles, mugs, stationery, etc) must be removed at the end of each session
- if you are cleaning and disinfecting after a known or suspected case of COVID-19 then refer to the guidance on cleaning in non-healthcare settings, this includes guidance on when PPE might be appropriate and how to dispose of waste
- all toys and equipment that children access during indoor activities should be cleaned when groups of children change – e.g. between sessions 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
- soft toys should also be removed or washed after use by each child/cohort
- implement cleaning procedures for any goods and merchandise entering the premises, including containers
- if staff and volunteers have to use touch-based security devices such as keypads to enter the business through controlled areas, either seek alternatives or implement cleaning arrangements
- limit or restrict the use of high-touch items and equipment such as, for example, printers or whiteboards
Advice is available from the HSE on air conditioning and ventilation. Good ventilation can help reduce the risk of spreading coronavirus, so providers should focus on improving general ventilation, preferably through fresh air or mechanical systems.
The opening of doors and windows, where it is safe to do so, should be encouraged to increase natural ventilation and also to reduce contact with door handles. This should not include fire doors.
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).
Your organisation/setting should suspect an outbreak if there is either:
- two or more linked cases (confirmed or suspected) of COVID-19 in a setting within 14 days - where cross transmission has been identified
- an increase in staff absence rates, in a setting, due to suspected or confirmed cases of COVID-19
If an organisation suspects a COVID-19 outbreak, they should immediately inform their local NHS board Health Protection Team (HPT). Your organisation/setting may be then contacted by them, as they may get information from NHS Test & Protect or other sources.
In the event of an outbreak:
- continue to follow the general guidance above to reduce risk
- the organisation should not make unilateral decisions about managing situations where they suspect an outbreak is occurring but should seek urgent advice from their local Health Protection Team about issues relating to testing of suspected cases and contacts and taking steps such as closing parts of facilities
- the local Health Protection Team will undertake a risk assessment and conduct a rapid investigation. They will advise on the most appropriate action to take
The Health Protection Team or Incident Management Team will declare when the outbreak is over.
Test and Protect, Scotland’s approach to implementing the 'test, trace, isolate, support' strategy is a public health measure designed to break chains of transmission of Coronavirus (COVID-19) in the community.
Staff, visitors or users who develop symptoms consistent with COVID-19 must follow the Test and Protect guidance.
This guidance includes advice for employers. Those who do test positive for COVID-19 will be asked to continue to self-isolate for 10 days following symptom onset and their close contacts, identified through contact tracing, will be asked to self-isolate for 10 days. From 18 February, if you have been identified as a close contact of someone who has tested positive for coronavirus you will be asked by Test and Protect to take a test. You should do this at the start of your 10-day self-isolation period.
Taking a test is not an alternative to self-isolating. You will still need to isolate for the full 10 days even if you test negative for coronavirus..
Providers should also develop a clear procedure for what to do should a user, visitor or staff member display symptoms of COVID-19 when in the premises, adhering to HPS Covid-19 guidance for non-healthcare settings.
There should be a particular focus on protecting people who are clinically vulnerable and more likely to develop serious illness as a result of exposure to COVID-19. Actions to minimise the spread of COVID-19 should include:
- advising anyone who is displaying symptoms of COVID-19, or is self-isolating due to living with someone who is displaying symptoms or as a result of contact tracing or someone who has tested positive should also self-isolate, to stay at home to minimise the risk of spreading COVID-19 and not attend the activity or service.
- anyone who becomes unwell with symptoms of COVID-19 should return home and advised to follow guidance on what to do if you develop symptoms at NHS Inform (or call 111 if they don't have internet access and need clinical advice). In an emergency, call 999 if they are seriously ill or injured or if their life is at risk.
If any person develops symptoms of COVID-19, then that face-to-face service should not go ahead, and providers should consider alternative methods for the individuals to maintain contact where appropriate.
List of symptoms: NHS Inform coronavirus symptoms
- a high temperature
- a new, continuous cough
- loss or change to your sense of smell or taste
Providers should plan as much as possible to minimise the operational impact of individual staff or volunteers being required to self-isolate and may wish to keep a record of absences of staff and volunteers where this is due to suspected or confirmed COVID-19.
Service or activity providers are asked to keep a temporary record of contact details for a period of 21 days for any users or visitors (e.g. trainee volunteers, delivery persons or contractors) to the setting they are using where they do not already have up to date contact details for them. This is to support contact tracing as part of NHS Scotland’s Test and Protect system, in the event of an outbreak linked to a particular service, activity or setting.
There is guidance on supporting Test and Protect by collecting data on users and visitors. This guidance includes what information to collect, how to collect that information and how to store the data securely. The guidance also contains a template Privacy Notice that should be made available to all users and visitors to the setting, service or activity. This ensures that those providing their details are informed as to what will happen to their data.
There are information governance arrangements in place if data is shared with NHS Scotland on the basis of individuals being identified as at risk of being close contacts by the Test and Protect service. In no circumstance should a service provider use this collected data to directly contact users, volunteers or staff, even in the event of a known outbreak within the premises.
Guidance on environmental decontamination (cleaning and disinfection), where it becomes apparent that a person using or working at the venue has a possible COVID-19 infection, can be found in the HPS COVID-19: guidance for non-healthcare setting.