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Hygiene and Infection Control Policy (DOC)

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Hygiene and Infection Control Policy

Maintaining an effective level of hygiene is one of the most important and regularly implemented practices in a service. Effective hygiene strategies and practices assist services to protect all persons from, and minimise the potential risk of, disease and illness. Many of the hygiene habits developed during childhood will continue throughout life. Services should demonstrate to children the hygiene practices which reduce the likelihood of cross infection and explain the reasons for them. Experiences that promote basic hygiene awareness assist children to become competent and independent, and develop valuable life skills. A service should be committed to protecting its stakeholders through the implementation and monitoring of simple hygiene and infection control strategies. Policy Number Link to CCQA Principles <number> Family Day Care Quality Assurance (FDCQA) Quality Practices Guide (2004) – Principle 4.2, 4.3, 4.4 / Outside School Hours Care Quality Assurance (OSHCQA) Quality Practices Guide (2003) – Principle 6.2, 6.3 / Quality Improvement and Accreditation System (QIAS) Quality Practices Guide (2005) – Principle 6.2, 6.3, 6.4

Policy statement  The service promotes hygienic practices and prevents the spread of infections by implementing the following strategies: o effective handwashing; o hygienic cleaning techniques; o handling, storage and disposal of body fluids; o maintenance of a hygienic environment; o knowledge of infectious diseases and exclusion guidelines; o identifying and excluding sick children and staff/carers; and o promoting and maintaining records of children’s and staff/carer’s immunisation. <Service name> has a duty of care to ensure that all persons1 are provided with a high level of protection2 during the hours of the service’s operation.

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For the purpose of this policy, 'persons' include <children, families, staff, carers, carers' family, management, coordination unit staff, ancillary staff (administrative staff, kitchen staff, cleaners, maintenance personnel), students, volunteers, visitors, local community, school community, licensee, sponsor and/or service owner>. 2 For the purpose of this policy, ‘protection’ is defined as the service ensuring that it provides a high level of hygiene to minimise the risk of infection from disease or illness.
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Protection can include: o notifying children, families, staff/carers, local community or the relevant health authorities of a diagnosed infectious illness or disease; o ensuring staff/carers have adequate equipment or products, such as disposable gloves, detergents and soaps; o maintaining procedures, such as correct handling of body fluids; o maintaining staff/carers awareness of hygienic human contact and physical interaction with others; o increasing staff/carers awareness and knowledge of cross infection; and o maintaining a hygienic and healthy environment, such as cleaning the service daily and ensuring that the service is well ventilated.  In meeting the service’s duty of care, it is a requirement under the Occupational Health & Safety Act3 to ensure that the service’s stakeholders are protected from harm. It is understood by staff/carers, children and families that there is a shared responsibility between the service and other stakeholders to accept and implement the Hygiene and Infection Control Policy as a high priority.

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Rationale The rationale represents a statement of reasons that detail why the policy and/or procedures have been developed and are important to the service.  National Health and Medical Research Council. (2005). Staying healthy in child care: Preventing infectious disease in child care (4th ed.). Canberra: Author. It is important services understand how infections spread, and how infections survive if hygiene procedures are not carried out appropriately. This information provides the foundation to why hygiene and infection control practices are crucial in children’s services.

Strategies and practices These are examples. Services are encouraged to develop and adapt the following strategies and practices as required to meet their individual circumstances and daily best practices. Standard precautions ‘Standard precautions’ (or Universal Precautions) are used primarily in medical and health-related professions, but are also relevant to children’s services. They are a set of practices that assist health care professionals in minimising the risk of cross infection and providing a basic level of infection control.

There are legislative Acts and regulations for each state and territory that address the issue of Occupational Health and Safety. Services are advised to seek information that is relevant to their jurisdiction.
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The precautions support the assumption that all body fluids4 are potentially infectious, therefore all persons are treated equitably when implementing hygiene practices to minimise cross infection and protect everyone. Some of these practices, which are relevant to children’s services, are:  handwashing;  hygienic cleaning techniques;  using protective products and equipment, such as gloves;  safe handling and disposal of body fluids;  safe storage of materials that have come into contact with body fluids; and  maintaining a hygienic environment. (School of Medicine, Flinders University, 2002) Handwashing  Brief and concise detail of the service’s strategy.  Services should consider the following reflective questions: o Why, how, when and where do children and staff/carers wash and dry their hands? o How does the age and developmental level of a child affect how they wash and dry their hands? o How does the service support children, with additional needs, to wash and dry their hands? o How do children and staff/carers wash and dry their hands when they have abrasions, cuts or open wounds? What practices are implemented? o Where there is no running water available, how does the service ensure that effective handwashing, or a similar practice, is able to be implemented? o How does the service communicate effective handwashing to stakeholders? For example, are there posters displaying handwashing techniques or signs near sinks to remind people to wash their hands.  Services should state how hygiene practices are maintained during excursions, especially during vacation care or where the excursion venue has no handwashing facilities. If antiseptic gels or wet-wipes are required, what is the service’s rationale for using a particular alternative to handwashing?  If the outside school hours service uses facilities owned and maintained by an external operator, for example a service on the same grounds as a primary school, the service should consider the following reflective questions: o How does the service ensure that adequate handwashing facilities and products, such as soap and paper towels, for children and staff are available? o How does the service encourage children to wash their hands effectively when staff are unable to supervise children in bathrooms or toilets? o What type of strategies do staff implement to ensure that children maintain effect hygiene strategies?

For the purpose of this policy, body fluids are defined as mucus, saliva (including air-borne droplets), urine, faeces, and blood.
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Concepts of cleanliness  Brief and concise detail of the service’s strategy.  Services should consider the following reflective questions: o What is the service’s definition of clean and dirty? For example, does the service consider the top end of a nappy change mat (where a child’s head is placed) cleaner or dirtier than the end where a child’s nappy is changed? Identifying what is clean and dirty will assist services in developing cleaning hygienic practices and procedures that support the concept of ‘clean to dirty’. o How do the concepts of clean and dirty affect the service’s current hygienic practices and procedures? For example, after changing a nappy, in which direction is the nappy change mat cleaned? Top to bottom or bottom to top? Why is best practice to clean the nappy change mat from the top to the bottom? How does this support hygienic practice? o Are there separate cleaning products and equipment for certain procedures? How does this support hygienic practices and procedures? For example, are cleaning cloths colour coded so that a cloth used for cleaning the bathroom is not used for cleaning mealtime tables? Is the mop used for cleaning the kitchen floors used for cleaning the toilet areas? o Are there licensing regulations that affect the services hygiene practices and procedures? Services are advised to seek information from their state or territory health and/or licensing departments. Personal Protective Equipment (PPE) Use of gloves  Brief and concise detail of the service’s strategy.  Services should consider the following reflective questions: o When do staff/carers wear gloves and is there a written procedure? o How is handwashing used in conjunction with glove wearing? Use of dangerous products The term ‘products’ is a broad term and services may decide to address the chemicals used for handwashing, cleaning and washing in another policy.  Services can link this section by stating: Please refer to the service’s Dangerous Products Policy. Safe handling of body fluids or materials in contact with body fluids5  Brief and concise detail of the service’s strategy.  Services should consider the following reflective question: o How does the service handle different body fluids? o How do staff/carers transfer materials, which have come in contact with body fluids, to a storage space? For example, a child has had a toileting accident outdoors. How do staff/carers transfer the clothing from the child to a bucket? o How do staff clean body fluids from a child? Does this reflect the service’s toileting and/or nappy changing procedures?
For the purpose of this policy, ‘materials in contact with body fluids’ can be defined as cloth nappies, children’s clothing, staff/carer clothing, tissues, face wipes, cleaning cloths, paper towels, kitchen tea towels, linen used for resting or sleeping, cushion covers, dramatic props and dress ups, children’s toys and resources, such as puppets, teddy bears, felt books.
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How do staff/carers clean materials that have come in contact with body fluids? For example, how do staff/carers remove the body fluids from the child’s clothing? Is there a sluicing procedure? How is the clothing cleaned? Is it stored until the child is collected? Does the service launder the clothing?

Safe storage of materials in contact with body fluids  Brief and concise detail of the service’s strategy.  Services should consider the following reflective question: o How does the service store materials in contact with body fluids? For example, clothing that is soiled with blood or faeces. o Does the service soak materials that have come into contact with body fluids? Which type of body fluids? o What equipment is used to store materials? Does this equipment reflect the service’s occupation health and safety standards? For example, are the buckets used for soaking materials out of reach of children and do they have lids?  Services can link some practices in this section by stating: Please refer to the service’s Occupational Health and Safety Policy. Safe washing of all materials  Brief and concise detail of the service’s strategy.  Services should consider the following reflective questions: o How does the service wash materials? o How are materials dried after washing? o How can children’s play and learning experiences be incorporated in the practice of washing and drying materials? For example, how can children assist staff/carers to hang out washed clothing or linen, wash toys or art and craft equipment? Are children able to assist staff/carers when folding materials? o How often are different materials washed in the service? For example,  cleaning cloths;  clothing used in dress ups;  cloths used during nappy changes;  cushion covers;  face cloths;  kitchen tea towels;  linen used during rest or sleep; and  soft toys. Safe disposal of body fluids or materials in contact with body fluids  Brief and concise detail of the service’s strategy.  Services should consider the following reflective questions: o How does the service dispose of body fluids? o Are there different types of disposal practices for specific materials? For example, how does the service dispose of nappies; gloves; wipes; paper towels; tampons/sanitary napkins; tissues; and toilet paper.

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Maintaining clean and hygienic environments  Brief and concise detail of the service’s strategy.  The service can state how it maintains the hygienic status of each play and learning environment and includes objects. For example, o babies rest and sleep areas, such as cots; o mouthed toys, dummies, bottles and teats; o children’s bathrooms and nappy change areas; o kitchen and laundry; and o mealtime and/or snack areas.  The service can decide if it includes the procedures for cleaning each area in this section, along with any products used to maintain a clean and hygienic environment.  Services should consider the following reflective questions: o How often is the service cleaned throughout the day? o If there are different environments to clean, such as a babies nursery compared to an older care room, are there different cleaning practices and what are they? o Who performs cleaning tasks in the service? o Is the service cleaned daily and by whom? For example, by a contract cleaner, ancillary staff or other. Immunisation  Services can link this section by stating: Please refer to the service’s Immunisation and Health Related Exclusion Policy. Exclusion guidelines for an infectious disease  Services can link this section by stating: Please refer to the service’s Immunisation and Health Related Exclusion Policy. Protective behaviours and practices Staff, carers, students and volunteers as role models  Brief and concise detail of the service’s strategy.  Children learn through example and modelling is an important way to teach children about behaviours and practices.  Staff/carers, students and volunteers must comply with the Hygiene and Infection Control Policy. Staff/Carer professional development opportunities  Brief and concise detail of the service’s strategy.  The service can describe how it aims to maintain and strengthen the skills and knowledge of staff/carers in relation to hygiene and infection control. Meeting children’s individual needs through common daily procedures Common daily procedures, such as toileting, nappy changing and nose wiping need to meet recommended hygiene and infection control practices. However, these procedures also require positive interactions between children and staff/carers, and an understanding of individual needs. It may be useful to discuss common daily procedures as a holistic process rather than in separate policies.  Services can link this section by stating: Please refer to the service’s Supporting Children’s Individual Needs Policy.

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Communication with different stakeholders Children  Brief and concise detail of the service’s strategy.  It is important for the service to discuss how it will meet the individual needs of, and protect, children.  Services should consider the following reflective questions: o How is handwashing addressed in play and learning experiences? o How are children involved in learning about the importance of handwashing? For example, children can produce their own handwashing signs for the service. Families  Brief and concise detail of the service’s strategy.  It is important for the service to discuss how it will meet the individual needs of, and protect, families. Staff/Carers  Brief and concise detail of the service’s strategy.  It may be useful for services to state how it supports staff/carers to implement best practices where they work alone with children.  Services can link this section by stating: Please refer to the service’s Child Protection Policy.  Services should consider the following reflective questions: o How do services support staff/carers to minimise the risk of cross infection? Management/Coordination unit staff  Brief and concise detail of the service’s strategy.  Services should consider the following reflective questions: o How does the service promote hygienic practices? For example, the service may display written and visual information for children, families and staff/carers. o How does the service promote the awareness of hygiene practices and infection control? For example, the service may arrange for health care professionals to visit the service to discuss with stakeholders about safe and effective hygiene practices. Privacy and confidentiality  Brief and concise detail of the service’s strategy.  The right for children and families to be afforded a level of privacy and confidentiality in regards to children’s health is paramount.  Services can link this section by stating: Please refer to the service’s Privacy and Confidentiality Policy. Experiences   Brief and concise detail of the service’s strategy. The service can describe how it plans to encourage the modelling of positive hygiene and infection control practices, such as washing hands after going to the toilet and washing before handling food.

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Services should consider the following reflective questions: o How are play and learning experiences related to children’s age and development? For example, when children are toilet training and learning the process of washing hands.

Excursions  Brief and concise detail of the service’s strategy.  Services should consider the following reflective questions: o How does the service ensure that infection control practices are implemented on an excursion? o How does the service ensure that there are handwashing facilities available at the excursion venue or location? For example, after toileting and before handling food, and if not, what strategies will the service implement? For example, when there is no running water a service may decide to use antiseptic gels. o How do staff/carers safely handle, store or dispose of body fluids on an excursion? Community  Brief and concise detail of the service’s strategy. Policy review    The service will review the Hygiene and Infection Control Policy and procedures, and related documents, including behaviours and practices every <timeframe>. Families are encouraged to collaborate with the service to review the policy and procedures. Staff/carers are essential stakeholders in the policy review process and will be encouraged to be actively involved.

Procedures The following are examples of procedures that a service may employ as part of its daily practices. Examples:  Documenting and monitoring immunisation records.  Employee induction procedure.  Policy development and review procedure.  Procedure for non-compliance of the Hygiene and Infection Control Policy and procedures by a: o child; o staff/carer; o family member; o student/volunteer; or o visitor.  Student and volunteer induction procedure.

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Measuring tools The service may further specify tools that assist in measuring the effectiveness of the policy. Services can utilise a variety of methods to ensure that hygiene practices and infection controls guidelines are understood, endorsed and implemented by stakeholders. For example:  The services can measure the knowledge and practices of staff/carers by: o establishing staff/carer, student and volunteer induction procedures whereby a ‘buddy’ is assigned to demonstrate the service’s practices and procedures; or o implementing an informal training session by placing an agenda item at meetings to discuss a routine or procedure, such as nappy change. Staff/carers can demonstrate a nappy change routine and discuss: the hygiene practices; the safety of children being changed; any difficulties; and the importance of interactions. Staff/carers can then initial and date the minutes of the meeting to establish that they observed and are aware of the service’s nappy change procedure.  The services can measure the knowledge of families by: o placing a survey or quiz in the newsletter about the service’s hygiene practices; o encouraging participation in policy review; or o indicating on the enrolment form during orientation that the family has been informed about the policy and practices.  The services can measure the knowledge and practices of children by: o incorporating hygiene strategies and practices in play and learning experiences and plans; or o creating a quiz for school age children to complete. Links to other policies The following are a list of examples:  Child protection  Employment of child care professionals  Enrolment of new children and families to the service  First aid  Illness  Immunisation and health related exclusion  Maintenance of buildings and equipment  Medication  Occupational health and safety  Privacy and confidentiality  Records management  Staff/carers as role models  Supporting children’s individual needs

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Sources and further reading        Childcare and Children’s Health. (2005). Infection control and some common infections in young children. Childcare and Children’s Health, 8 (3), 1-4. Frith, J., Kambouris, N., & O’Grady, O. (2003). Health & safety in children’s centres: Model policies and practices (2nd ed.). NSW: School of Public Health and Community Medicine, University of New South Wales.6 Matthews, C. (2004). Healthy children: A guide for child care (2nd ed.). NSW: Elsevier. National Health and Medical Research Council. (2005). Staying healthy in child care: Preventing infectious disease in child care (4th ed.). Canberra: Author. Oberklaid, F. (2004). Health in early childhood settings. NSW: Pademelon Press. Owens, A. (2003). Handwashing and nose wiping. Childcare and Children’s Health, 6 (2), 1-2. Flinders University School of Health. (2002). Health advisory information: Standard and additional precautions. Retrieved May 21, 2007, from http://som.flinders.edu.au/students/HAI_Stand_Add.htm <date> <date> <signatures>

Policy created date Policy review date Signatures

This publication is produced on behalf of Early Childhood Australia New South Wales (NSW) Branch and the NSW Children’s Services Health and Safety Committee. Services should be aware that the publication may refer to practices that reflect NSW licensing regulations or health department exclusion guidelines.
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