7.2.21-C19: Infection Prevention and Control (Sanitary Practices)

Purpose

Physical distancing along with cleaning and disinfecting are important steps in the prevention of infections, including COVID-19.

To avoid the spread of micro-organisms in the Child Care Centre, LEF has in place comprehensive measures for cleaning and disinfecting.

Indoor Physical Distancing

LEF recognizes that physical distancing between children in a child care setting is difficult and encourages staff to maintain a welcoming and caring environment for children.

Distancing Within Cohort

Physical distancing is encouraged, where possible, between children within the same Cohort and between staff and children in the Cohort.

Physical distancing must never compromise supervision or a child’s safety.

Arranging the Space

In the Child Care Centre, staff will endeavour to increase space between seating and play areas so that children and staff can main a distance of two metres/six feet apart. This may include:

Removing extra chairs, tables and furniture to increase space in the area to allow children to spread out.
Placing tape, signs or other visual markers on floors, tables, seats and other play areas to help both child care staff and children visually maintain physical distancing.

Shared spaces and structures that cannot be cleaned and disinfected between Cohorts should not be used.

Arranging Sleep Equipment

Whenever possible, LEF will endeavor to increase the distance between cribs, cots/resting mats/playpens (“Sleep Equipment) or place the children head to toe or toe to toe if the space is limited. Every other Sleep Equipment could be removed or if only every alternate Sleep Equipment is to be used, the ones not to be used could be marked accordingly.

Planning Activities

Recognizing that physical distancing is difficult with small children and infants, Educators are encouraged to take the following into consideration when planning activities:

Spreading children out into different areas, particularly at meal and dressing time.
Planning activities that encourage individual play and increasing space between children.
Using visual cues to promote physical distancing.
Encourage children to greet each other using non-physical gestures (e.g. wave or nod or a verbal “Hello”) and to avoid close greetings (e.g. hugs, handshakes).
Regularly remind children to keep "hands to yourself”.
Avoid activities that involve shared objects or toys.
Reinforce no sharing policies and procedures. This includes the current practice of not sharing food, water bottles, share food, feeding utensils, soothers, bottles, sippy cups, or other personal items. Label these items with the child’s name to discourage accidental sharing.
Limit the number and types of personal items that can be brought into the Child Care Centre.
Provide individual cubbies or bins for each child’s belongings.
Personal items must be clearly labelled with the child’s name to prevent accidental sharing.
Avoid activities involving singing, shouting, or speaking loudly indoors.
When possible, moving activities outside to allow for more space.

Distancing While Interacting with Infants/Toddlers

Educators are encouraged to:

To supervise and hold bottles for infants not yet able to hold their own bottle to reduce the risk of choking, even if this makes distancing impossible.
When holding infants and toddlers use blankets or cloths over clothing and change the blankets or cloths between children.
Mouthed toys must be removed immediately for cleaning and disinfecting and must not be shared with other children.

Indoor Distancing Between Cohorts

Shared indoor space will only be used by one Cohort at a time. Educators are responsible for following the protocols laid out in this Policy 7.2.21-C19 when cleaning and disinfecting.

Shared spaces and structures that cannot be cleaned and disinfected between Cohorts should not be used.

Cleaning and Disinfecting

Cleaning

Cleaning refers to the physical removal of foreign material (i.e. dust, soil) and organic material (i.e. blood, secretions, micro-organisms). Cleaning removes, rather than kills micro-organisms.

Warm water, detergent and mechanical action (i.e. wiping) is required to clean surfaces. Rinsing with clean water is required to complete the cleaning process to ensure the detergent film is removed.

Cleaning must happen in a progression from low-touch to high-touch surfaces and from top to bottom.

The appropriate PPE must be worn while cleaning. Please refer to the Health and Safety, PPE Policy 7.2.30

Procedures for Cleaning:

Use detergent and warm water to clean visibly soiled surfaces
If required, rinse the surface with clean water (warm to tepid temperature preferred) to ensure detergent is removed
Let the surface dry

Disinfectants

A disinfectant is a chemical solution used in the disinfecting process that kills most micro-organisms that can cause disease.

Disinfectants Approved for Covid-19 Pandemic

Accelerated Hydrogen Peroxide (AHP) has been approved by Toronto Public Health for use in our Child Care Centres as a disinfectant during the COVID-19 Pandemic. During this time chlorine bleach will not be used in any Child Care Centre.

The AHP disinfecting products to be used in the Child Care Centres are:

Oxivir Five 16 Concentrate,
Oxivir TB Ready-to-Use (RTU) Spray or Wipes, or
Optim 33TB RTU Spray or Wipes.

All are considered high-level disinfectants which is defined as the complete elimination of all micro-organisms in or on a surface.

Disinfectant wipes have combined cleaners and disinfectants in one solution. They must be discarded if they become dry. Wipes are not recommended on heavily soiled surfaces.

Disinfectants for High Touch Surfaces, Large Structures and Equipment

For general disinfecting of high touch surfaces, large structures and equipment that cannot be immersed in a disinfectant solution, staff must use Oxivir TB RTU or Optim TB RTU, which comes ready to use in spray bottles or wipes. The contact time for disinfecting is 1 minute.

Note: Most areas are best cleaned with Oxivir TB or Optim 33TB RTU and do not require a final rinse if children do not come into contact with them.

Disinfectants for Toys

For all other toy cleaning and disinfecting, staff must use Oxivir Five 16 Concentrate, which has to be mixed and tested before use in accordance with the manufacturer’s instructions. The contact time is 5 minutes.

Any items children may come into contact with, requires a final rinse in water after the required contact time is observed.

Disinfecting Procedures When Using Oxivir TB Ready-To-Use (RTU) Or Optim 33TB RTU Spray & Wipes

Put on PPE: rubber or heavy-duty nitrile gloves and mask, if the employee has scent sensitivities. Please refer to the Health and Safety, PPE Policy 7.2.30.
Spray or wipe on Oxivir TB RTU or Optim 33TB RTU -1 Minute solution and leave on the surface for the appropriate disinfecting contact time (1 minute). Ensure the spray setting is on stream and not mist
Once the 1-minute disinfecting contact time has elapsed, the surface has now been disinfected
Any surface children may come in contact with requires a final rinse with a single-use paper towel (i.e. lunch tables, high chair tray, floor, toy shelves)
If the surface continues to be wet, you may wipe it dry with a single-use paper towel.

Requirements for Cleaning Products and Disinfectants

All disinfectants and cleaning products must:

Be labelled.
Be stored in in a locked cupboard inaccessible to children.
Have and Drug Identification Number (DIN) and Safety Data Sheets (SDS) up to date (within three years), stored in the WHMIS (blue) binder.
Have a pre-determined shelf-life.
Have a recommended and short contact time.
Have an efficacy statement that indicates the effectiveness of a disinfectant against different types of micro-organisms and may describe a disinfectant as being bactericidal, fungicidal, virucidal or sporicidal.
Must not contain phenols because they can cause Hyperbilirubinemia (jaundice) if not rinsed properly.

Surfaces should be cleaned and disinfected more frequently during outbreaks of communicable diseases, including when a COVID-19 case has been confirmed

Stocking of Supplies

The Supervisor will monitor the cleaning and disinfecting supplies regularly to ensure the Child Care Centre is well stocked, including soap, paper towels, and disinfectants.

Staff Responsibilities

All C&E Employees share in the responsibilities for environmental cleaning and disinfecting of the Child Care Centre.

Staff must:

Be able to provide a description of the products used, what the contact times are, how it is dispensed and proper usage.
Check expiry dates of cleaning and disinfectant products prior to use.
Wear the required PPE. Please refer to the Health and Safety, PPE Policy 7.2.30

Personal Belongings

Upon entry to the Child Care Centre, any hard surfaces of personal belongings must be cleaned and disinfected:

for staff: water bottles, travel mugs, cell phones, lunch containers, etc.
for children: water bottles, containers, etc.

Upon arrival to the Child Care Centre, diaper cream/lotion container must be disinfected with a disinfecting wipe.

Pacifiers

Pacifiers must:

Be cleaned with soap and water only upon entry to the Child Care Centre.
Be individually labelled and stored separately (not touching each other),
Not be shared among children.

Toys

Use of Toys

Educators are encouraged to:

Provide toys which are made of materials that can be cleaned and disinfected (e.g., avoid plush and stuffed toys).
Have designated toys and equipment (e.g., balls, loose equipment) for each Cohort. Introducing an identification system to prevent the sharing of items between Cohorts (e.g. colour coding) could be considered.

Frequency of Toy Cleaning and Disinfecting

Toys that are mouthed or that are otherwise contaminated by body secretions must be separated, cleaned with water and detergent and then disinfected immediately after the child is finished mouthing it, and before handling by another child.
All toys must be cleaned and disinfected after each use and at least once daily.
All toys must be cleaned and disinfected before use by another Cohort.

Procedures for Toy Safety, Cleaning and Disinfecting

Toys are inspected for damage, cracked or broken parts, as they may compromise cleaning.
Any toy that is found to be damaged, cracked or broken should be discarded.
Toys are cleaned and disinfected using the following method:
- Toys must be washed and rinsed according to the manufacturer’s instructions (e.g., in hot, soapy water) prior to disinfection.
- If possible, toys will be cleaned and disinfected using the three-compartment sink method. The two-compartment sink method is acceptable if for washing and rinsing is done in the first sink. If no sink is available, the three-bin method will be used.
- Alternatively, toys can be cleaned and disinfected using a commercial dishwasher provided the rinse cycle reaches a minimum of 82 degrees Celsius. The kitchen dishwasher can only be used if it is not being used for other purposes (i.e. washing dishes, food preparation).
- Disinfectant wipes may be used to disinfect equipment and play structures that are too large for a sink or a dishwasher.
- When using disinfectant, staff will follow manufacturer’s recommendations regarding dilution and contact times.
- Toys must be dried in a designated area that is separate from bathrooms, change tables and protected from sources of contamination.
- Once toys are cleaned and disinfected, staff will initial in the appropriate space on the corresponding cleaning schedules: 7.2.21–9 to 12.

Sensory Play Material

Individual Spaces

Items will be used the program that will encourage sensory exploration. During the COVID-19 Pandemic, Child Care Centres, sensory activities will be set up for children to have their own individual spaces. These can be set up on the same table, allowing children to interact with each other.

Procedures for Safe Play with Sensory Material

In an effort to reduce the risk of disease transmission to children when playing with sensory materials:

Children will practice hand hygiene before and after sensory play.
Materials will be in good repair, inspected regularly and discarded if necessary.
Materials will be free of visible contamination and cleaned according to the following cleaning schedule.

Educators will provide individualized bins or packs for art material and supplies for each child. These must be labelled to prevent sharing.

Sensory play materials that cannot be readily disinfected must be discarded after use.

Water Table and Sensory Bins

Toys used for water play must not be able to retain moisture
Toys used for water play will be cleaned and disinfected daily.
Individual sensory bins and tubs that contain dry material will be cleaned and disinfected when they are emptied and replenished and after use by a child.
Individual water tables will be drained, cleaned and disinfected after each use and after use by a child.

Diapering

LEF follows the guidance from Toronto Public Health in regards to diapering and toileting procedures. Please refer to Infection Prevention and Control in Child Care Centres.

Diapering surfaces must be disinfected after each use (even if a paper liner is used).

For creams and lotions during diapering, staff should never put hands directly into lotion or cream bottles, but use a tissue or single-use gloves.

Educators will wear PPE while performing diaper changes. Please refer to the Health and Safety, PPE Policy 7.2.30.

Sleep Equipment

Cots and cribs must be:
- Labelled and assigned to a single child.
- Cleaned and disinfected before being assigned to another child or when soiled.
Crib mattresses must be cleaned and disinfected when soiled or wet and before being assigned to a child

High touch surfaces on cots and cribs must be disinfected at least twice per day and as often as necessary.

Cots must be stored in a manner which there is no contact with the sleeping surface of another cot.

Sleeping mats are stored so contact with the sleeping surface of another mat does not occur.
Bedding (sheets and blankets) is assigned to each child and laundered daily on a “hot” setting, and when soiled or wet.

Clothing and Linens

Gloves must be worn when handling dirty or soiled clothing and linens. Hand hygiene protocol will be followed at all times including washing hands before and after handling both dirty and clean items. See Hand Hygiene Policy 7.2.56.
Laundry done off-site will be placed in plastic bags and picked up on a bi-weekly basis or as necessary. Refer to Laundry Policy and Procedure 7.2.21-14.
A child’s dirty or soiled items will be placed in plastic bags and the Primary Contact will be responsible for the laundering of those items.
For items that will not tolerate soaking, they should be disinfected using a cloth applied with disinfectant, allowing adequate contact time with the disinfectant.
For cleaning blood or body fluids, refer to Toronto Public Health’s “Blood and Body Fluids” information sheet.

Sofas and Upholstered Furnishings

Sofas and other upholstered furnishings will be covered to protect them from spills. These covers will be washed on a monthly basis.

Surfaces

High-touch Surfaces

High-touch surfaces are those that have frequent contact with hands.

Examples include door knobs, light switches, computer keyboards, shelving, containers, hand rails, , pencil sharpeners, sinks, faucet handles, toilets, toilet flush handles, water fountain knobs, etc. as well as high-touch surfaces on cribs and cots, play kitchens and gross motor mats.

These surfaces should be cleaned and disinfected at least twice per day and as often as necessary (e.g., when visibly dirty or contaminated with body fluids).

Other Shared High-touch Items

Other shared items, like phones, IPADs, IPODs, attendance binders etc., must be disinfected between users.

Low-touch Surfaces

Low-touch surfaces are those that have minimal contact with hands. Examples include walls and window sills, doors and sides of furnishings.

Low-touch surfaces require cleaning and disinfecting on a daily basis and when soiling or spills occur.

Specific Surfaces

Tables and countertops used for food preparation and food service are cleaned and disinfected before and after use and before and after eating.
Floors must be cleaned and disinfected as required, i.e., when spills occur, and throughout the day when rooms are available, i.e., during outdoor play.
Spills must be cleaned and disinfected immediately.
Installed carpets are:
- Cleaned promptly if spills occur If a spill of blood/bodily fluid occurs on a carpet, follow the steps below along with professional steam/wet cleaning of the carpet.
- Vacuumed as necessary.
- Shampooed/steam cleaned according to the following schedule (and as needed):
  - Infants – every 3 months
  - Toddler – every 6 months
  - Preschool and School age – every 6 months.

Note: all mats and area rugs must be removed during the COVID-19 Pandemic.

Handwash sinks in staff and children washroom areas must be cleaned and disinfected at least two times per day and as often as necessary (e.g., when visibly dirty or contaminated with body fluids).

In Case of Blood/Bodily Fluid Spills

Using the steps below, the surface must be cleaned first then disinfected:

Isolate the area around the spill so that no other objects/humans can be contaminated
Gather all supplies, perform hand hygiene, then put on single-use nitrile gloves
Scoop up the fluid with disposable paper towels (check the surrounding area for splash/splatter) and dispose of in separate garbage bag
Clean the spill area with detergent, warm water and single-use towels
Rinse to remove detergent residue with clean water and single-use towel.
Discard used paper towels and gloves immediately in a tied plastic bag.
Spray Oxivir TB Ready-to-Use Disinfectant or Optim 33TB RTU in and around the spill area and allow the appropriate 1-minute disinfecting contact time.
A final rinse is required if children come into contact with the area.
Remove gloves as directed and discard them immediately.
Perform hand hygiene as set out in Hand Hygiene Policy 7.2.56.

If the spill includes broken glass, ensure a brush and dustpan is used to pick it up and discard. Disinfect the brush and dustpan after use. NEVER use hands to clean up the glass.

If the spill occurs on a carpet, follow the above steps along with professional steam/wet cleaning the carpet.

Refer to the 'Blood and Bodily Fluid Spills' poster for further guidance.

Choice of Materials

The ease of cleaning is an important consideration in the choice of materials used in the Centres. It is important to choose finishes, furnishings and equipment that are easily cleaned.

Cleaning Schedules

Educators must maintain logs to track cleaning and disinfecting activities for each room/area, individual/play items and sleeping equipment, using the forms 7.2.21-8-C19, 7.2.21-9 to 7.2.12 and Carpet Cleaning Schedule 7.2.21-7.

Food Storage and Preparation

Purpose

This section sets out the correct procedures for food storage, preparation and service which contribute to the retention of maximum nutritive value and prevention of illness.

Special Dietary or Feeding Arrangements

Infants or children with special dietary or feeding arrangements must be fed following the written instructions of the Primary Contact. Refer to Infant Feeding Plan 7.4.27 and Permission to Serve New Foods for Infants 7.4.27-1

Food and Drink

All food or drink must be stored and served to retain maximum nutritive value and prevent contamination.
There should be no food provided by the family/outside of the regular meal provision of the program (except where required and special precautions for handling and serving the food must be put in place).
Child Care Centres must provide a prepared lunch for every child one year or older who is present at mealtime, unless otherwise approved by a ministry director in the case of kindergarten groups or older.

Children receiving care for six hours or more, must be given two snacks in addition to any meals.

All meals, snacks, and beverages provided must meet requirements set out in Health Canada documents “Eating Well with Canada’s Food Guide”, “Eating Well with Canada’s Food Guide – First Nations, Inuit, and Metis” or “Nutrition for Healthy Term Infants” where applicable.

Drinking water must be available at all times.
Children should neither prepare nor provide food that will be shared with others.
Where possible, children should practice physical distancing while eating

Menus

Planned menus must be posted in a place that is visible to Primary Contacts for the current and following week. Any substitutions must be noted on the posted menus. Refer to Catering Report 7.2.31, Weekly Menu – Child Care Centres 7.2.31-1, Weekly Menu – Before & After Care/Extended Day Programs 7.2.31-3, and Record of Menu Changes 7.2.31-4

Menus must be kept for 30 days after the last day they apply to.

Allergies and Restrictions

A list of all children enrolled who have allergies and restrictions and what those are must be posted in the cooking and serving areas, in each play area or playroom and in any other area children may be.

Food Safety

Child Care Centres will comply with Toronto Public Health’s direction for safe food storage, preparation and service procedures, including correct temperatures for fridge and freezer, location of

food within the fridge and sanitation/dish washing procedures.

C&F Employees must follow proper hand hygiene when preparing food and for all individuals before and after eating. Refer to Hand Hygiene 7.2.56.

Staff will keep the following records:

Record of Dishwasher – Wash/Rinse 7.2.21-1
Record of Food Temperature 7.2.21-2. This record must be posted on the Parent Information Board.
Record of Fridge/Freezer Temperature 7.2.21-3
Record of Fridge/Freezer Temperature B&A Care Program 7.2.21-4
Kitchen Cleaning Schedule 7.2.21-8-C19

Every Child Care Centre will have at least one C&F Employees who with food handler’s certification.

Food Provision

During the Covid-19 Period, Child Care Centres will change meal practices to ensure there is no self-serve or sharing of food at meal times.

Serving utensils should be used to serve food.
There should be no sharing of cutlery. Disposable cutlery and pre-packaged food may be used, if staffing levels are low.
Meals should be served in individual portions to the children.
There should be no items shared (e.g. serving spoon, salt shaker, condiments).

Transportation of Food

LEF relies on a third party to deliver the food made in its commercial kitchen at 116 Industry Street, Toronto, to the Child Care Centres locations.

Third Party’s Responsibilities

LEF expects the delivery agency to comply with the Canadian Institute for Food Safety’s Guidelines for Food Deliveries During COVID-19. It can be found at https://www.foodsafety.ca/blog/guidelines-food-deliveries-during-covid-19.

The third-party delivery agency will be asked to confirm their compliance with these Guidelines prior to resuming food deliveries.

LEF’s Responsibilities

Staff receiving the food delivery will follow the Guidelines for Food Deliveries During COVID-19 set out above, including disinfecting and cleaning all containers used to transport food.

Expressed Breast Milk

Children attending Child Care Centres may be fed expressed breast milk. Safe handling, thawing, storage and administration policies will be as follows, to ensure quality of expressed breast milk and minimize the risk of infection to children and Educators:

Frozen expressed breast milk must be thawed in a refrigerator and used within 24hrs. A microwave will not be used.
Refrigerated expressed breast milk will be kept at a temperature of 4C or colder, until used.
Bottles and containers will be properly labeled with: Date, name of child and name of mother.
Clean hand before and after handling expressed breast milk.
Wear gloves while handling expressed breast milk, e.g. when dispensing into a cup or from a container.
Children will be supervised while drinking expressed breast milk to prevent unintended consumption by other children.
Contact Toronto Public Health if another child consumes expressed breast milk intended for someone else.
Discard any left-over expressed breast milk not consumed by the child.

Pest Control

Child Care Centres within the TDSB/TCDSB sites will follow the guidelines from the respective Board with respect to pest control. The Supervisor will report any instances of pests to caretakers and/or school principals.
At Donald C. MacDonald Child Care Centre, the LEF maintenance department is responsible for regular preventive practices with a third-party company. The Supervisor will assist with monitoring and record instances of pests in the appropriate log book.
At Silverthorn Child Care Centre, the City of Toronto is responsible for pest control. The Supervisor will report any instances to the Building Manager and record instances of pests in the appropriate logbook.

Visiting Animals

Visiting animals will not be allowed at any of our Child Care Centres.

With respect to service animals entering Child Care Centres, refer to LEF’s Accessibility Standards for Customer Service Policy 2.13.

Posting of Information

Mandatory Postings

The Supervisor is responsible for ensuring the posters and material mandated by Toronto Public Health Child Care Centres are posted in the required locations in the Child Care Centre:

Posters for the COVID-19 Screening Area

COVID-19 Posters

Where to Post

Physical Distancing
Protect Yourself
Information about COVID-19
Wash Your Hands
Cover Your Cough
Poster for Entrances

At designated screening station.

For posters, refer to https://www.toronto.ca/wp-content/uploads/2020/03/97a9-COVID-19-CoverYourCough.pdf

Posters and Information for the Child Care Centre

Posters	Where to Post
Blood and Bodily Fluid Spills (TPH)	One poster in a visible location
Communicable Diseases Reporting Contact Information (TPH)	By the telephone and all entrances to the Centre
Cover Your Cough (TPH)	In each classroom
Diaper Routine (TPH)	At diaper change area
Emergency Telephone Numbers	By the telephone
Glove Use (TPH)	Where gloves are used (e.g. in washrooms and diaper change areas)
Guidelines for Common Communicable Diseases (TPH)	On Parent Information Board
Hand Sanitizing (TPH) * Two versions available: for adults and for children	At each hand sanitizer location
Hand Washing (TPH) * Two versions available: for adults and for children	ONLY at designated hand washing sinks
Sensory Play Activities (TPH) Children will have individual materials for sensory experiences	At sensory play table area
Toilet Routine (TPH)	In children’s washrooms
Toy Cleaning and Disinfecting (TPH)	In areas where toys are cleaned and disinfected

Making Other Material Available

Other material must be made available at each Child Care Centre:

Record of Food Temperature 7.2.21-2.
The article titled: “A Bite in the Playroom: Managing Human Bites in Day Care Settings” (www.ncbi.nlm.nih.gov/pmc/articles/PMC2851373/)

Inspections by Toronto Public Health

The Supervisor will ensure that a record is kept of all inspections carried out by Toronto Public Health and that a copy of any report from the medical officer of health is kept on the premise of the Child Care Centre and a copy is sent to their Ministry of Education program advisor

Further Information

For further information on any Toronto Public Health policies and regulations, Supervisors and staff are to contact their local Toronto Public Health Unit or their website - www.city.toronto.ca/health

For related information, refer to Outdoor Safety Policy 7.2.20-C19.

Review and Signature

Infection Prevention and Control (Sanitary Practices) 7.2.21-C19 must be reviewed and signed at least annually by all C&F Employees.

7.2.21-C19: Infection Prevention and Control (Sanitary Practices)
Effective Date: July 2, 2020	Revised:
Prepared and Approved by Executive Director