it

COVID-19 and Childcare Infection Prevention Strategies

on behalf of the Patient Safety

Authority I would like to welcome you to

the webinar titled kovat 19 and

childcare infection prevention

strategies my name is Jeff Bombo and I

will be your moderator for this program

I'd like to introduce our speaker for

the webinar Joann Adkins is a registered

nurse and senior infection Preventionist

for the Patient Safety Authority in her

role at the authority she works with

Pennsylvania healthcare facilities to

improve patient safety through infection

prevention initiatives miss Adkins has

presented educational programs on

infection prevention topics at the local

state and national levels Ms Adkins is a

board-certified infection control and

epidemiology and is a fellow of the

Association for professionals in

infection control and epidemiology miss

Adkins is a 2019 recipient of Apex

heroes of infection prevention award for

education she is a member of the

Association for professionals in

infection control and prevention Sigma

type Theta Tau international nursing

Honor Society and the Pennsylvania

Association directors of nursing

administration long-term care and

central Pennsylvania Association of

healthcare quality so I'd like to tell

you what our objectives are today and

then I'll hand program over to jo-ann

our objectives are to describe everyday

preventive action the staff can take to

help prevent the spread of kovin 19 list

3 safe methods of screening children for

symptoms discuss the importance of hand

hygiene and when to perform hand hygiene

join is very well versed in these

infection control topics and I'll send

the presentation over to jo-ann Jillian

I wanted to make you all aware the Jeff

and I teamed up to do this presentation

he did background research and then I

polished and I'm doing the presenting so

this is a team effort

so no matter what level of transmission

is president of kovat in a community

every child care program should have a

plan in place to protect staff children

and their families from the spread

this slide is the link to the CDC

webpage for guidance for child care

facilities that you may want to keep to

refer back to

so one thing the guidance says is is it

is important to plan ahead the

components of an facility infection

prevention plan include everyday

preventative actions requiring sick

children and staff to stay home and how

to clean and disinfect your facility so

we're going to discuss them in further

everyday preventative actions wash your

hands often with soap and water

if soap and water is not available then

use an alcohol-based hand sanitizer but

read the label it should contain at

least 60% alcohol to effectively kill

the germs on your hands you need to

clean and disinfect frequently touch

surfaces cover coughs and sneezes always

sneeze or cough into your elbow or into

a tissue not into your bare hand and

then always wash your hands or use hand

sanitizer after coughing and sneezing

and then cover your face your mouth and

nose it's important to cover your mouth

and nose as much as possible within the

facility and also remember when you are

at home and go out into the community

always cover your mouth and nose to

protect others but remember cloth face

coverings should never be put on babies

or children under 2 years of age because

of the danger of suffocation if the

child is not able to remove the mask by

themselves they should not have a

masculine hand washing this poster

that's on this slide is available on the

CDC website for you to print out and use

within your facility but hand hygiene is

the most important measure you can use

to prevent

spread of infection wash your hands

often with soap and water and wash for

the amount of time it takes to sing

happy birthday twice if soap and water

are not readily available then use an

alcohol-based hand sanitizer containing

at least 60% alcohol if your hands are

visibly dirty then you must wash with

soap and water to remove that dirt

because if the dirt is not removed

alcohol gel the alcohol cannot get

underneath the dirt to kill the germs if

you are allowing young children to use

hand sanitizer please supervise them it

does contain 60% alcohol so make sure

they do not swallow it or lick their

hands if they're very young so when our

key times to wash after blowing your

nose coughing or sneezing after using

the restroom before eating or preparing

food after contact with animals or pets

and before and after providing care to

another person who needs assistance such

as the children in your childcare

facility so what is the correct way to

wash I just want to review that with you

if you are washing with soap and water

you want to wet your hands with warm

water not hot if you use hot water it

dries your skin and can cause tiny

cracks in your skin which is a easy

place for germs to enter and cause

infection so what your hands with warm

water apply soap and then lather your

hands and scrub briskly for 20 seconds

like I said we teach children to sing

the Happy Birthday song twice when

you're scrubbing make sure you scrub the

back of your hands around your wrists

between your fingers palms and your

fingernails then rinse your hands well

with warm running water and dry with a

paper towel use that pain

or towel to turn off the faucet if you

turn off the faucet with your bare hands

then you've picked up all the germs that

you put on the faucet handles prior to

washing plus the germs of other people

who wash their hands before you if

you're using an alcohol hand sanitizer

an alcohol-based hand rub apply about a

quarter size amount to the palm of your

hand and then rub your hands briskly

together and make sure you rub all areas

of your hands the back of your hands

between your fingers the palms of your

hands and you continue rubbing till your

hands are dry do not dry your hands with

a paper towel you rub until the alcohol

gel is dry on your hands stay home is

sick require staff and children who are

sick to stay home and for this to occur

communication and education is vital

communicate to parents the importance of

keeping children home when they are sick

so they do not spread the illness to

other children and communicate to your

staff the importance of watching for

symptoms up kovat 19 or other illness

and notifying management if or when they

start to fill ill make sure you

establish procedures to ensure that

children and staff who come to the

center either sick or become sick while

at the facility are sent home as soon as

possible keep sick children and staff

separate from well children and staff

until they can be sent home and six

staff members should not return to work

until cleared so plan

and if somebody becomes sick within your

facility plan to have an isolation area

or a room an area could be a cot placed

in a corner of a classroom that can be

used to isolate a sick child be ready to

follow the CDC guidance on cleaning and

disinfecting your building or facility

if someone's sick if a sick child has

been isolated in your facility clean and

disinfect the surfaces in that isolation

area after they have gone home

if covin 19 is confirmed in a child or a

staff member then CDC recommends closing

off areas used by the person who is sick

open outside doors and windows to

increase air circulation in those areas

and air them out wait up to 24 hours or

as long as possible before you clean and

disinfect the reason for that is to

allow respiratory droplets that carry

the virus to settle to the floor before

cleaning and disinfecting so you're sure

that you remove them and then also clean

and disinfect all areas used by the

person who's sick such as offices common

areas bathrooms for cleaning and

disinfecting in your facility use an EPA

registered household disinfectant and

make sure you're following the

instructions on the label for safe use

many projects recommend what we call a

contact time and that's the amount of

time you should keep the surface wet to

disinfect and that should be listed on

the label

also follow precautions such as wearing

gloves and having good ventilation

during use of the product diluted

household bleach solutions may also be

used they will be an adequate

disinfectant

however color safe bleach is or

whitening agent

may not provide adequate disinfectant

because they don't have the hypo chloric

acid unexpired household bleach will be

effective against corona viruses such as

Kovan 19 when properly diluted always

follow the manufacturer's instructions

for application and ventilation and

never ever mix bleach with ammonia or

any other cleanser the contact time for

bleach is 1 minute you leave the

solution on the surface for at least 1

minute when you go to clean and

disinfect wear disposable gloves but

before you ever put gloves on always

wash your hands first average adult hand

carries thousands and thousands of germs

prior to being washed or doing hand

hygiene if you put those unwashed hands

into a glove you have put all those

germs in the perfect incubator because

it's warm its moist and it's dark and

they will multiply so clean your hands

and then put on disposable gloves clean

surfaces first with soap and water to

remove the dirt and then disinfect them

if the dirt is not removed first the

disinfectant doesn't reach the germs to

kill them plus cleaning with soap and

water reduces the number of germs dirt

and impurities on the surface you're

going to clean and then following what

this infecting will kill the germs

routinely clean high-touch areas and

high touch surfaces include your tables

your doorknobs light switches countertop

sink toys those sort of things here's

the recipe to make a bleach solution as

a disinfectant it is 1/3 cup bleach in a

gallon of water or 4 teaspoons of bleach

in a quart of water this solution is

effective for up to 24 hours chlorine

will evaporate so you

make this solution up fresh every day

the CDC also states that alcohol

solutions with at least 70% alcohol may

also be used when it comes to cleaning

soft surfaces such as your carpeting

drugs rugs or drapes clean the surface

with soap and water or cleaners that are

appropriate for use on them launder them

is possible according to manufacturer

instructions and when you launder them

use the warmest water possible and dry

completely or disinfect the surface with

an EPA registered household disinfectant

and then vacuum as usual when it comes

to clothing towels or other items all

laundry is considered contaminated with

germs so you need to protect yourself

launder the items according to

manufacturer's instruction in the

warmest water possible and dry in a hot

dryer always wear disposable gloves when

handling dirty laundry from a person who

is sick to protect yourself but dirty

laundry from someone who's sick can be

washed with other people's items because

it's all considered contaminated do not

ever shake dirty laundry because you

will what we call aerosol eyes or throw

those germs up into the air where they

can either be breathed in or settle on

other surfaces after you put the dirty

laundry in the washer remember to clean

and disinfect your hamper and then

remove your gloves and wash your hands

right away for cleaning and disinfecting

your outdoor areas

remember ultraviolet light is a very

strong disinfectant and we get that from

the Sun outdoor areas like play gap

playgrounds and parks require normal

routine cleaning but

not require disinfection do not spray

disinfectant one outdoor playgrounds

it's not an efficient use of your supply

and it's not proven to reduce the risk

of Kovan 19 however high touch surfaces

that are made of plastic and metal such

as grab bars or railings should be

cleaned routinely because sticky fingers

can leave dirt on their surfaces and

then germs will adhere to that sticky

surface wooden surfaces such as benches

tables or ground covers like mulch or

sand is not recommended for disinfection

or cleaning and sidewalks and roads

should not be disinfected as the spread

of kovat 19 from these surfaces is very

low and disinfection is not effective

but I want to speak specifically about

toys toys that cannot be cleaned and

sanitized should not be used and this is

the time to not allow toys to be brought

in from home because you do not know how

they are being cleaned toys the children

have placed in their mouths or that are

contaminated by body secretions should

be set aside until they are cleaned by a

person wearing gloves clean them with

water and detergent rinse them and then

sanitize them with an EPA registered

disinfectant rinse again and allow them

to air dry or they can be washed in a

dishwasher and always be mindful of

items that children are likely to put in

their mouths such as play food dishes

and utensils machine washable cloths

toys should be used by one child at a

time and then laundered or should not be

used at all if you can't clean them in

between children's then do not have them

available

do not share toys with other groups of

infants or toddlers unless they are

washed and sanitized before being moved

from one group to another

toys that need to be cleaned that are

dirty

need to be placed in a separate

container preferably covered and marked

soiled toys the ideal method to clean

these toys is to then wash them with

soapy water but try to have enough toys

so that the toys can be rotated through

cleanings what I have set up in my

church is we use a five-gallon bucket

from either one of the Home Depot's or

Lowe's that has a lid the dirty toys go

in that bucket and the lid is secured on

top that prevents other children from

inadvertently picking up a dirty toy

social distancing strategies some of the

recommendations from the CDC for social

distancing is child care classes should

be the same group each day and the same

child care providers should remain with

that group each day if you have many

children of health care workers or first

responders you may want to consider

creating a separate group or classroom

for them as they are frontline staff

that may be exposed to Kovan this is the

time to cancel or postpone special

events such as field trips holiday

parties or festivals they also recommend

limiting the mixing of children and ways

to do that or by staggering playground

times keeping groups separate for

special activities such as art or music

and at nap time space out their mats or

cribs as far as possible at least 6 feet

if possible and consider placing the

children head-to-toe in order to further

reduce the

chill for spread you may want to also

consider staggering arrival and drop-off

times of children and/or have childcare

providers come outside the facilities to

pick up the children as they arrive

I call this curbside drop-off and pickup

if you plan for curbside drop-off and

pickup limits a direct contact between

parents and staff members by adhering to

the social distancing recommendations

diapering this slide this picture that's

on this slide is also a poster you can

print out from the cdc website and i

have those links at the end of this

presentation

but when diapering a child always wash

your hands and then wash the child's

hands before you begin and put on gloves

safe diapering procedures are to wash

your hands and put on the gloves remove

the soiled diaper clean the child

dispose of the soiled diapers and wipes

replace the diaper wash the child's

hands clean up the diapering station and

then wash your hands and those steps are

listed on this poster even if you were

wearing your gloves you need to

disinfect the diapering area and wash

your hands because taking off the gloves

it's possible to pick up germs that were

on the gloves themselves when it comes

to washing feeding and cuddling children

it is important to come to comfort and

cuddle crying sad or anxious infants and

toddlers and they often need to be held

for that so cuddle carefully if you are

holding an infant turn their face or our

toddler turn their face away from yours

towards your shoulder to help get a

little bit of separation between

yourself and the child's face protect

yourself by wearing an overly

urghhh button-down long-sleeve shirt and

if you have long hair pull it up off

your collar so the children are not

grabbing your hair with their dirty

hands what we use in my church is we

went to a thrift store and bought men's

double and triple x long-sleeve

button-down dress shirts that are easy

to launder and that's what our child

care people wear if the child touches

your neck or your face or your hands

with their hands that have their

secretions on them either they're runny

nose or we're crying make sure you wash

those areas anywhere the date that have

been in contact with their secretions if

a child's clothing or soiled by

secretions change it if the button-down

shirt you're wearing has secretions on

it take it off put it in the laundry and

wash your hands and then put another

shirt on contaminated clothing if it's

being sent home for a child should be

placed in a plastic bag and tied shut or

washed in a washing machine immediately

there should be multiple changes of

clothing on hand at your facility for

the children and their providers when it

comes to bottles child care providers

should wash their hands before and after

handling the bottle and bottles bottle

caps nipples and other equipment used

for bottle feeding should be thoroughly

cleaned and washed with soap and water

or washed in the dishwater washer after

each use

food preparation if you normally do

group dining this is the time to

separate it out and serve the meals in

the classrooms if you normally do family

style meals do not do that now plate

each child's meal so that multiple

children are not touching the same

utensils the food preparation person

should not also be diapering children

this tanks used for food preparation

should not

used for any other purposes caregivers

should ensure children wash their hands

prior to and immediately after eating

and the caregivers should wash their

hands before preparing food and after

helping children eat the symptoms of

covin 19:00 are the same for the most

part between children and adults based

on the available evidence children do

not appear to be at higher risk for

Kovan 19:00 than adults and while

children and infants have been sick

adults make up most of the known cases

so far

children with confirmed Kovan 19 have

shown symptoms such as fever runny nose

cough and they may also have vomiting

and diarrhea children with underlying

medical conditions and special

healthcare needs may be at higher risk

for severe illness so we need to screen

healthcare our our facility workers our

childcare workers and the children for

covin 19 so what we do is you assess for

a fever greater than 100 point 4 you

look for symptoms such as fever vomiting

diarrhea coughing difficulty breathing

or sore throat and queries of parents if

the child has been in contact with

somebody who is positive or suspected of

Kovan 19 within the past 14 days there

are three safe screening methods for

staff the first is social distancing and

that's where you ask parents to take the

child's temperature before coming to the

facility or upon rima arrival and the

parents also confirm that the child does

not have symptoms and then the childcare

worker makes a visual inspection of the

child for symptoms this is done

maintaining a distance of 6 feet if you

can't maintain that separation then you

need to wear protective equipment

another safe screening method is a

barrier or partition the staff man

stands behind this barrier and you want

to protect what we call the t-zone which

is your eyes your nose in your mouth

which is lined with mucous membranes

this staff member takes the tiled

child's temp by reaching around this

barrier and inspects the child for signs

or symptoms but always keeps their face

behind the petition at all times and

then the third method is personal

protective equipment if you're within

six feet of the child but that's

elective less effective control and more

difficult to implement because of

shortages with personal protective

equipment and the trainings that's

required to wear some of it safely this

is your resource page I told you they

has links to what I think will be

valuable information for you the top two

are the posters for hand hygiene or

diapering and you can print them out

they are shared governance there is no

charge for that there is a link here to

a really nice article about talking to

children about kovin 19 and then the

bottom two links are the CDC guidance

for child care facilities so what

question do you have thanks Joanne that

concludes the slide presentation of our

program now we would like to begin our

question and answer period if you have

questions please type them in the Q&A

box found at the bottom of your screen

by hovering at the bottom of your screen

you will see three dots click the dots

to open the Q&A panel and direct your

questions to all panelists and we will

try to answer as many questions as we

can and we do have a couple of questions

the first is some childcare centers and

preschools do not allow alcohol based

sanitizer do you have recommendations

for non alcohol-based sanitizers then

they would wash the child's hands with

soap and water recommendations are

either alcohol-based hand sanitizers or

a regular hand wash with soap and water

okay next question is what if a child is

sick and they have siblings

they also get sent home if the child is

showing symptoms of Kovan 19 then

chances are the siblings have also been

exposed we don't know without testing if

that's what they truly have but I would

err on the side of caution and send them

home ok our next question is regarding

safe screening methods on slide 25 are

you recommending screening before entry

into the care center or school with

questions and temperature checks

screening should if screening is done by

social distancing ideally the parents

would take the temperature prior to the

child coming but the barrier partition

control should be right at the entrance

to the facility it could be right inside

the door but the screening should be

done the children should not go back to

the group rooms or their classrooms

without being screened ok and a final

question I see right now is what type of

protection will you have to use for

working 9 hours or 8 hours we're talking

within a child care facility yes yes it

would be a cloth face covering as much

as possible now we realize when the

worker is eating they would be in a

separate room and not around the

children so of course masks would not be

on and if they're going to be in very

very close contact with those children

where there's the chance of getting

secretions from them laughing coughing

sneezing then I would put one of those

large button-down shirts on if the

center doesn't have enough cleaning

supplies or PPE equipment should they

still open that would be up to the

center if you do not have a way to clean

and disinfect or you do not have a way

to protect your workers with PPE then I

do not think it would be prudent to open

what about if a child does not have a

fever but has symptoms like a runny nose

they still need to accept the child that

would be what they would have to

determine within your facility this is

when communication is important we know

that we're going into allergy season so

there's going to be a lot of people with

runny nose that's when I would look in

addition to the runny nose does the

child look ill are they having a cough

are they having the fever this is when

you set up your plan in your policies

and communicate to the parents or the

Guardians what you consider to be the

signs and symptoms that would exclude

the child from being within your

facility is it recommended for children

to bring their lunches into the facility

or should they make food on-site at the

facility if they have the capabilities

nothing in the guidance addresses that

if the children are bringing food in

from the outside then realize the

containers themselves may be considered

contaminated and need to be wiped off

before they're placed within your

kitchen or your refrigerator or wherever

you store them if a child or staff has

symptoms concurrent with Kovan 19 and is

removed immediately does the entire

class have to be sent home no but the

parents need to be notified that this

child was sent home with symptoms so

that they can then observe their

children for any signs or symptoms if

it's that person is taking temperatures

as a plastic is a plastic face shield

enough of a barrier that a plastic face

shield would protect their eyes their

nose their mouth or mucous membranes yes

if it's a full face shield would be a

barrier do recommend shortening of the

hours of care and the number of children

and I can't make a recommendation on I

that's beyond what I is an IP feel

comfortable making a recommendation on

that would be something I think the

facility themselves would have to

determine okay the next question is

define routinely

for toy cleaning is this daily yes

routinely is daily and if it is

something that the child is going to be

either contaminating with their hands

because they had their hands in their

mouth and touch that object or they had

that object in their mouth then that

needs to be cleaned between children the

big equipment that I know is outside

that you're not cleaning continually

that needs to be cleaned daily the high

touch areas but the toys that the

children are playing with very closely

need to be cleaned between children as

we had on that slide especially if it's

something that gets put in mouths or

their hands are in their mouths and then

their secretions are going on that toy

that needs to be done between children

the next question is any regulatory body

inspecting childcare centers and schools

for compliance for these measures and

interventions that we have presented not

that I am aware of the people with of

the licensed facilities would know

better than I do how often they're

inspected these I was what Jeff and I

were presenting were the guidelines as

put out by the CDC their recommendations

for a safe environment within a

childcare setting but I do not know if

there is a regulatory body that inspects

that or not the next question do toys

need to be submerged in soap and water

it says they should be cleaned with soap

and water they should be scrubbed well

and then rinsed well

I'm guessing they're talking about a toy

that may have batteries or electronics I

would make sure that toy is washed well

and then disinfected you next question

is what is the privacy concerns with

sharing information related to suspected

and confirmed code with 19 cases in

facilities for staff and students for

parents of children to limit

transmission and exposure to the greater

population if you have a child who was

sent home ill then it would be prudent

to let other parents know that there was

a child of one home ill you do not know

yet and you're not relaying by HIPAA

concerns what that illness was same as

in a hospital when we put an isolation

sign up the sign does not list what

illness the person has it just lists

what the precautions are if someone

comes back positive for kovat then the

Department of Health would be notified

and they would assist with the contact

tracing okay our next question would

preschoolers be asked to wear masks

while in care as much as possible that

is what the guidance is saying but no

child under the age of two because of

the danger of suffocation now we know

you're not going to be able to keep the

mask on a full of preschooler at all

times but they are saying that masking

should be done as much as possible or

the childcare centers providing will

they provide test kits to child care

centers to the staff and when and how

often should the staff be tested I have

not heard any information on that from

the guy from the Department of Health

the guidance I have received so far is

not showing any information on that then

maybe something the childcare facility

wants to check with the state next

question what do we do outdoors when

children are touching sticks and stones

etc in the yard it's the same as I said

about the playgrounds UV is a very

strong disinfectant make sure when

they're coming back in from outside

they're washing their hands well you're

certainly not going to be able to

disinfect your yard or sandbox or

anything like that so they need to wash

their hands well when they come back in

before they touch anything but you would

not be able to disinfect that thing

that's when you depend on the UV light

from the Sun our next question would you

recommend cleaning and disinfecting any

toy when used by a single child whether

in mouth or not I personally would

disinfect it because children are little

germ factories they carry lovey germs

and they can transmit it from one child

to another on that toy so if possible

yes I would disinfect them now depending

on the side size of your child care

facility trying to keep track of

everything that a very active little

picked up may be very difficult okay for

those children three and younger without

the language and social cues as is

recommended to limit their re-entry into

the center or trickled in as they are

more difficult to manage that population

for those children three and younger

without the language and social cues is

it recommended to limit their reentry

into the center or trickled in as

they're more difficult to manage that

population oh if they're coming in from

like outside playing I'm assuming and

instead of having them coming in masse

one of the things they recommended for

entry is we want to try to maintain

social distancing as much as possible

which is six feet

you would want to try to trickle them

into the facility to try to maintain

that distancing as often children are

assigned snack day where parents bring

an unopened store-bought snacks for the

classes as practice still acceptable

like I said you would have to remember

that the outside container is considered

contaminated if that is a practice

you're going to continue I would have it

brought into the facility and placed

into some type of tote or container

right at the entranceway then a staff

member with glove could take it out of

that original packing container and put

it into something clean be it a bag on a

tray whatever and take it to your

kitchen and then dispose of that outside

container to stay up to date on all

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may have up to twenty children enrolled

six-feet social distancing during center

player walking to and from playground

seems impossible like I said you try to

maintain social distancing as much as

possible make sure that if you cannot

maintain that social distancing that

they're masked because they would be an

age group that could be mask and make

sure they're doing frequent hand hygiene

soon

questions at this time I want to thank

everyone for joining us today lots of

good questions

um again the presentation will be

available on YouTube web page in a few

weeks this concludes our webinar um and

we again thank you for listening to our

webinar today