Who should use this guidance
- Providers of childcare and play services registered with the Care Inspectorate Wales (including child minding, day care, sessional care, open access play and Flying Start provision) and approved nannies
- Unregistered childcare and play providers in Wales (less than 2 hours a day or in line with the exceptions set out in the Child Minding and Day Care (Exceptions) (Wales) Order 2010)(as amended)
This Guidance should be read in close conjunction with:
- Alert level 2: guidance for employers, businesses and organisations which outlines fundamental advice on how COVID-19 is spread and what reasonable measures employers should take in reducing the risk in their setting.
- Infection Prevention and Control for Childcare Settings Guidance from PHW which provides guidance in relation to Infection Prevention and Control practice in all Childcare Settings, including cleaning of toys and equipment and how to deal with waste.
This guidance offers advice on how settings can reduce the risk and spread of COVID-19. Underpinning this guidance are a number of key messages which remain paramount.
At all Alert Levels settings should:
- Consider how they can manage their operations to reduce the risk of transmission at the setting.
- Ensure staff and children follow good hand and respiratory hygiene practices.
- Maintain effective cleaning regimes.
- Keep occupied spaces well ventilated.
- Follow public health advice on testing, self-isolation and managing confirmed cases of COVID-19.
- Do not allow any staff or child who have tested positive, have symptoms of COVID-19 or who should be self-isolating to attend the setting.
- Ensure children who are unwell with core COVID-19 symptoms do not attend the setting until they feel well enough.
- Encourage staff to take up the LFD testing offer as well as becoming fully vaccinated.
In Wales the person or persons responsible for any premises, or the work activity being undertaken on the premises, are under a specific duty to take all reasonable measures to minimise the risk of exposure to, and the spread of, coronavirus. As part of this, settings will need to ensure that regular coronavirus risk assessments continue to be undertaken. HSE offer advice on how to undertake risk assessments. The assessment should directly address risks associated with coronavirus (COVID-19), to enable measures to be put in place to control those risks.
Measures put in place as a result of Risk Assessments should be clearly communicated to staff and parents and outlined in the relevant policies of the setting.
The Hierarchy of Risk Controls outlined in this advice and in the Guidance for employers, businesses and organisations underpins the risk assessment. All employers have a duty to consult employees on health and safety, and they are best placed to understand the risks in individual settings. Childcare staff are able to select a union representative to engage in the risk assessment process, and employers should share the risk assessment results with the workforce. In the case of settings that have closed, this should be shared before staff are expected to return.
For further advice please see the Alert level 2 Guidance for employers, businesses and organisations.
It is vital that staff have confidence that their setting has appropriate arrangements in place to ensure the health and safety of everyone. If staff are concerned, including those who may be clinically extremely vulnerable or who believe they may be at possible increased risk from COVID-19, we recommend line managers discuss any concerns individuals may have around their particular circumstances and seek to reassure staff about the protective measures in place.
Staff should have confidence to discuss their health and safety at work and any concerns they may have with their line manager. In turn line managers need to consider the right actions to mitigate and manage that risk and ensure staff are as protected as much as possible.
Staff or children at ‘increased risk’
In the context of COVID-19 individuals at increased risk are at a greater risk of severe illness from COVID-19. This category includes people aged over 70, those who are pregnant and those who have a range of chronic health conditions. Every setting should continue to carry out risk assessments and put in place controls to minimise those risks, such as the frequent hand washing, cleaning regimes, surface hygiene etc.
All pregnant women (at any stage of gestation) should undertake an individual risk assessment. This is because pregnant women may be particularly vulnerable as it may place them at a greater risk of severe illness from coronavirus and should follow the latest national guidance.
Guidance for people including children, who are clinically extremely vulnerable to developing serious illness if they are exposed to coronavirus because they have a particular serious underlying health condition is also available.
Nannies are advised to continue to take safety precautions when looking after children in the child’s home. While Nannies may want to consider wider elements of this guidance, they should pay particular attention to the need for:
- frequent hand washing for at least 20 seconds (especially when you arrive at work and return home) and ensuring that the children in your care also practise good hand hygiene
- using a separate towel to dry your hands (do not share a towel with any family members or the child you are caring for)
- maintaining physical distancing as far as possible with family members and others you are not caring for
- maximising opportunities for good ventilation indoors and spending time outdoors as much as practicable
If you as a Nanny, or an individual in the home, are at increased risk, are extremely clinically vulnerable or unvaccinated against the virus, then you may wish to consider the risks and benefits with your employer (the family) and come to an agreement on whether or not you should continue to provide a service to the family in the circumstances. If you and the family agree that you should continue to work in the home, you should follow the current government advice on protecting yourself and others, in particular advice on self-isolation.
If you live with a family, the family (as your employer) should take all reasonable measures to protect yourself and others from coronavirus.
Hierarchy of Controls
Selecting prevention and mitigation measures should be informed by a “hierarchy of control” approach. This is a widely accepted system promoted by numerous safety organisations as a way of determining how to implement feasible and effective control solutions, leading to inherently safer systems where the risk of illness or injury has been substantially reduced. For COVID-19, the most effective controls are those which are applied to the source of infection rather than those applied to the people you are trying to protect.
This section should be read in conjunction with Alert Level 2 Guidance for businesses, employers and organisations which offers further detail on actions under the Hierarchy of Control approach.
1. Elimination aim to remove the risk (most effective intervention) to stop people becoming exposed and infected
There are different ways that this can be done but they should include:
- Ensuring staff or children who have COVID-19 symptoms, a positive COVID-19 test result or have been advised to self-isolate do NOT attend the setting.
- Ensuring that accurate records are kept of staff and children’s attendance and activity so that they can be contact traced if necessary.
- Staff undertaking regular asymptomatic LFD testing, reported online
- Staff receiving all vaccine doses as soon as recommended.
Adhere to Test, Trace, Protect requirements
Under no circumstances should children or staff attend childcare settings if they:
- Feel unwell with any of the identified COVID-19 symptoms.
- Staff should self-isolate and arrange a COVID-19 test.
- Children under 5 who have symptoms do not have to take a PCR test unless advised to do so by a Doctor or where the parents feel strongly that it is in the best interests of the child. Children with COVID-19 symptoms should not attend when feeling unwell, but can return to the setting when they fell well enough to do so. The persistence of a simple cough after the child is better in themselves is not a reason to stay home.
- Have tested positive for COVID-19.
- Are required to self-isolate:
- Settings should ensure they are aware of the current self-isolation guidance for staff and children at their setting.
Where a COVID-19 test is undertaken the childcare setting should be informed of the test result immediately. If the PCR test result is negative the staff member can return to the setting when they are well enough to do so.
Parents/carers of children should be advised in advance that a child who is unwell with COVID-19 symptoms or who has tested positive should not be brought to the setting.
Children under 5 do not spread COVID-19 in the same way as an adult or in the same way that people consider young children to spread cold and flu. Young children have small bodies, small lungs and small breath capacity which means even if they are infected with the virus they cannot spread it to others in the same way as an older young person or adult would. Thus the risk of transmission from under 5’s to others is lower than for other age groups. Similarly, children under 5 tend to have mild symptoms when they have COVID-19. Children under 5 also often find the testing process invasive and distressing and this can make getting a sample very difficult and distressing for parents and carers.
There may be circumstances where a child or adult who would normally be exempt is directed to self-isolate by TTP. These circumstances will be identified by TTP on a case by case basis.
If a child/staff member shows symptoms of COVID-19 while in a childcare setting
Settings will need to have a clear, written procedure in place for the protection of staff and children if a child or staff member develops symptoms while at the setting. A symptomatic staff member will need to go home immediately. Settings will need to consider how this may affect their ratios and may need contingency plans to cover this potential situation.
The parent or carer of a symptomatic child should be called immediately and the child collected and taken home. Young sick children will need to be cared for until they are collected.
The child should be moved away from other children and cared for separately with appropriate adult supervision. If it is not possible to isolate the child, move them to an area which is at least 2 metres away from other children. Ideally, a window should be opened for ventilation. Disposable gloves, apron and a fluid-resistant surgical mask should be worn if the child requires personal care or close contact. If a risk assessment determines that there is a risk of splashing to the eyes, for example from coughing, spitting, or vomiting, then eye protection should also be worn.
If a child needs to go to the toilet while waiting to be collected, they should use a separate toilet if possible. The areas where a person suspected of having COVID-19 has been, including toilets, must be cleaned and disinfected. Gloves and aprons should be used when cleaning the areas where a person suspected of having COVID-19 has been. See section on Decontamination and Cleaning below.
If clinical advice is needed, this can be found at 111 Wales (or by calling 111).
If a member of staff has helped a child or staff member who was taken unwell with symptoms of COVID-19 they do not need to go home unless they develop symptoms) themselves. They should wash their hands thoroughly for 20 seconds after any contact with someone who is unwell and where possible should change into clean clothing.
Should there be a delay in a parent collecting a symptomatic child, please contact the local environmental health officer via your local council’s website.
Notify Care Inspectorate Wales (CIW)
Providers should use their Care Inspectorate Wales (CIW) online account to notify CIW when they reopen after a period of closure or if there are any confirmed cases of COVID-19 amongst children and staff using the service. In the case of childminders, this also includes other family members living at the premises.
Side effects of children receiving a routine vaccination or teething
Childhood vaccines may cause mild fever in children. This is a common and expected reaction, and isolation is not required unless coronavirus (COVID-19) is suspected. Further information is available in what to expect after vaccinations and vaccination tips for parents. Whilst teething can cause some known side effects such as flushed cheeks and sore gums, NHS guidelines state that fever is not a symptom of teething. Parents and carers should monitor side effects from a vaccination or teething, and if they are concerned about their child’s health, they should seek advice from their GP or NHS 111. If coronavirus (COVID-19) is suspected, the child should start self-isolating and be tested.
Asymptomatic testing offer for schools and settings (with Lateral Flow Devices LFDs).
In order to quickly detect asymptomatic adults and reduce the likelihood of clusters and outbreaks in settings and the disruption that brings to settings the Welsh Government made rapid-result coronavirus tests available to all staff working in childcare settings from February 2021.
Test at home kits are available to all open settings in order for staff to take regular tests.
Testing is voluntary, but those who are eligible for tests are strongly encouraged to participate to further reduce the risk of asymptomatic transmission within the workplace.
Further information and advice on the testing offer is available.
The advice above applies to childminders as well as all other childcare settings.
Childminders should be familiar with self-isolation advice and what they need to do if they or a household member has symptoms, tests positive or is asked to self-isolate.
Childminders are also advised to contact their local Environmental Health Teams or PHW Health Protection Teams (0300 00 300 32) for advice on whether they can offer childminding services from the home while someone in their household has been advised to self-isolate or has tested positive. This supports the provision of advice specific to a childminder’s individual circumstances.
2. Substitution – aim change the risky activity for a less risky one
There are different ways that this can be done but they should include:
- outdoor activities where possible
- individual food bags rather than communal catering
- using other technologies to replace face-to-face interactions, for example phone/video meetings instead of visitors on site.
- using barriers or screens where staff and parents usually interact. If used ensure they are cleaned and disinfected in line with cleaning procedures.
- limiting movement of people, one way systems, crowd control, limit number of people accessing areas such as toilet facilities at the same time
- provide signage for physical distancing, floor tape or paint to mark out queuing systems, one way systems etc.
Social distancing within childcare settings with young children will be harder to maintain than in other settings. But staff are encouraged to maintain a social distance with other members of staff and with parents/carers/visitors.
While consistent contact groups are no longer required, widespread mixing of staff and children is a risk factor for viral spread and should be minimised. Caution should be still be applied, with widespread face to face contact of staff and children minimised. Settings may wish to consider the movement of children around the childcare setting, including one way route systems where possible to minimise contact and reduce the risk, as well as how your emergency evacuation procedures might need to change to reflect operations. Settings will also need to maintain records of attendance for staff and children for contact tracing purposes.
Settings should keep staffing arrangements as consistent as possible. Those on work placements or students in regular attendance can be included as ‘staff’. Where settings do need to use staff from other settings or agency staff, the setting should ensure this is agreed on a weekly basis, not daily, to limit contacts.
Attending more than one setting
Attendance at more than one setting is permissible and requires the continued implementation of control measures as well as detailed record keeping to facilitate contact tracing in the event of an outbreak.
If a child is accessing both education and childcare, and this is taking place across two settings or sites, it will be important to ensure schools and childcare settings all understand the transition arrangements and are clear on when the child will be in each setting and what collection and transport arrangements are in place. The same rules would apply if a child attends more than one childcare setting. Children aged 11 and over should wear face coverings while being transported by the setting.
Where a staff member works across more than one setting during the same day, they are advised to ensure that they practice effective hand hygiene, change their clothes if possible and ensure they do not share resources between settings. All staff should be supported to take up the offer of vaccine if possible and to become fully vaccinated.
For children and young people who require additional support – such as children with a statement of special educational needs or who have additional learning needs or disabilities – settings should work with the local authority as well as with parents to decide how best to continue supporting these children to stay healthy. Advice for schools is available and should be used where appropriate.
Use of outdoor space
Children should spend as much time outdoors as possible as this can limit transmission and more easily allow for distance between the groups. Young children (those of primary school age or younger) can interact outside without social distancing. However, adults will need to continue to distance from one another.
Use of outdoor equipment should be followed by hand washing, and appropriately cleaned between groups of children using it.
Taking trips outside the setting
Trips and visits can play an important role in enriching development as well as support children’s wellbeing.
Maximising time spent outdoors by children has physical, mental and developmental benefits and generally the risk of transmitting COVID-19 is lower outdoors compared to indoors. However, mitigating measures e.g. maintaining good hand hygiene, are still needed outdoors. Settings are encouraged to consider this in the planning of any visits.
Settings wishing to undertake domestic day visits should continue to undertake the usual risk assessment processes when planning visits. This risk assessment should include arrangements if a child develops COVID-19 symptoms during the visit. Travel time should be minimised wherever possible and consideration should be given to the travel and transport advice. Children aged 11 and over and adults may still be required by a destination venue to wear face coverings and/or socially distance, and this should be borne in mind when planning visits.
The Outdoor Education Advisers Panel has also developed guidance which may be useful for settings considering undertaking visits.
During operating hours, settings should consider which visitors they allow into the setting.
Essential visitors would include inspectors, learning support assistants, maintenance workers, healthcare workers and so on. Local authority staff may also need to visit the setting from time to time, in relation to funded schemes or wider support services.
Parents who are considering using a setting for the care of their child would not be considered essential visitors (but visits to the setting can be arranged outside of operating hours if risk assessments allow). From time to time parents may also need to attend the setting to meet staff by invitation in relation to their children’s care.
Settings should be clear on their approach to visits and ensure that any measures identified as part of risk assessments are communicated to those visiting before the visit itself.
Where precautions are taken and risk assessments allow, settings are able to facilitate parents/carers visiting a setting in the evenings or at weekends (outside normal operating hours) when considering using a setting for the care of their child.
These visits are at the discretion of each setting and should be undertaken with appropriate measures in place, such as limiting the duration and the number involved in the visit (both staff and family members) socially distancing, practicing hand and respitatory hygiene and the wearing of face coverings.
This type of visit needs to be reflected in your coronavirus risk assessment. A record of the visit should be kept along with contact details of the visitors for contact tracing purposes. Settings will need to explain this in advance to those visiting.
Children, staff or parents who should be self isolating should not take part in a visit.
Childminders can also facilitate parent/carer visits to their settings as outlined above. In addition, childminders will need to consider the presence of their own family during parent/carer visits, ensuring that they do not come into close contact with visitors. In addition to the advice above, visits should not take place if the visitors, the childminder or a member of the childminder’s family is self-isolating.
Visits are at the discretion of the setting and can only be undertaken where risk assessments allow.
On occasion it may be necessary to invite a parent to attend the setting to discuss matters relating to their child’s care. Again, such visits should be undertaken at the discretion of the setting, and after determining whether or not it is possible for the meeting to take place remotely.
3. Engineering controls – aim to try to lower the risk by changing the way the activity takes place
Different approaches can be taken to do this such as:
- using anti-microbial surfaces
- reducing shared surfaces
- providing new hand wash stations
- regular handwashing and sanitising
- increasing fresh-air ventilation in poorly ventilated spaces
- encouraging vaccination take up of your workforce
- physical distancing of staff
- limit time spent and/or numbers in rooms before ventilation
- one way systems to reduce face to face contact
- use of screens and barriers
- workforce planning to maintain operational capacity
- training and signage to promote adherence
- effective communications and feedback on improvements for safety
- removing unnecessary restrictions when it is safe, in order to promote adherence to necessary ones
Those in control of a premises have a legal duty to ensure effective ventilation. See advice on air conditioning and ventilation from the Health and Safety Executive (HSE).
The HSE has updated and expanded its advice to help employers provide adequate ventilation in their workplaces and premises during the pandemic. The guidance builds on helping providers to identify and take action in poorly ventilated areas. It also provides guidance on other factors to consider when assessing the risk from aerosol transmission, and determining whether adequate ventilation is being provided to reduce this risk.
Settings should be maximising the fresh air in a space and this can be done by:
- natural ventilation
- mechanical ventilation
- a combination of natural and mechanical ventilation, for example where mechanical ventilation relies on natural ventilation to maximise fresh air
Read the updated guidance on air conditioning and ventilation and find out how adequate ventilation can be provided in the workplace, helping to protect workers and other people from transmission of coronavirus.
There is also advice available for building services, particularly around ventilation of buildings, both in use and when returning to buildings which have been closed from the following:
- Chartered Institution of Building Services Engineers
- The Building Engineers Services Association, and
Ventilation and the new variants (technical details for those with mechanical systems)
Ventilation is a key mitigation measure to control the far-field (more than 2m) transmission of COVID-19 by aerosols between people who share the same indoor space. Ventilation is not likely to have significant impacts on close range transmission by droplets and aerosols (within 1-2m) or transmission via contact with surfaces (high confidence).
Higher viral load associated with people who have the new variant could have significant implications for transmission via the air, as previous scientific modelling suggests that viral load is a major determinant of airborne transmission risks. SAGE, before the emergence of new variants, advised that for most workplaces and public environments adequate ventilation equates to a flow rate of 8-10 l/s/person based on design occupancy, although guidance for some environments allows for lower flow rates of 5 l/s/person. Since the emergence of new variants, SAGE has recommended where possible, increasing ventilation flow rates mentioned above by a factor of 1.7 (70%) to account for the increase in transmissibility.
For some existing and older buildings, ventilation systems may not have been designed to meet current standards and additional mitigations may be needed. As a precautionary measure it is recommended that ventilation is included as part of any workplace or public indoor environment COVID secure risk assessment, and the necessary mitigation measures are adopted.
In most buildings, maintaining comfortable temperatures and humidity above 40-60% relative humidity is likely to be beneficial to reducing the survivability of the virus. However, this is likely to be less important than the ventilation rate mentioned above (medium confidence).
Steps that will usually be needed:
- checking whether you need to service or adjust ventilation systems, for example, so that they do not automatically reduce ventilation levels due to lower than normal occupancy levels.
- most air conditioning systems do not need adjustment, however where systems serve multiple buildings or you are unsure, advice can be sought from your heating ventilation and air conditioning (HVAC) engineers or advisers.
- removing any fans from, for example, workstations, to avoid the recirculation of air.
- opening windows and doors frequently to encourage ventilation, where possible, and if it is safe to do so.
Childcare settings should as explained above ensure adequate levels of ventilation. Where centralised or local mechanical ventilation is present, re-circulatory systems should be adjusted to full fresh air. If this is not possible, systems should be operated as normal. Ventilation should commence ahead of session and continue after sessions have finished. Where ventilation units have filters present enhanced precautions should be taken when changing filters. Childcare settings with ventilation systems can consult HSE guidance on ventilation systems.
Where settings rely on natural ventilation including opening windows and doors to provide a supply of fresh air, this practice should continue to improve ventilation. It is however recognised that there will be a need to optimise the amount of fresh air entering a room whilst balancing this with thermal comfort (maintaining a reasonable temperature) and the risks associated with open windows. The Fire Safety Risk Assessment should always be reviewed before any internal doors are held open.
In winter the need for ventilation remains an important strategy for reducing our risk of exposure to the virus and it will be important to maximise airflow through the use of vents, windows and doors whilst maintaining a comfortable environment. Opening windows in the morning before people come into work or before sessions start for at least five minutes and in the evening when everyone has gone home will allow air to circulate. In cooler weather windows should be opened just enough to provide constant background ventilation, and opened more fully during breaks to purge the air in the space. Open all windows for a few minutes during the day to allow for cross ventilation – that is for stale air to flow out and fresh air to come in. Opening internal doors can also assist with increasing the throughput of air (as long as they are not fire doors and where safe to do so).
Windows and doors do not have to remain fully open to obtain the levels of fresh air required to provide good ventilation, they can be partially opened. Staff may need to be advised how to achieve the most appropriate ventilation in any setting and should start by consulting the HSE guidance. Additional ventilation can be achieved by ventilating rooms more fully between uses.
Whilst improving ventilation is a key control settings should continue to ensure that the wider controls of social distancing, hand washing, respiratory hygiene and enhanced cleaning as outlined in this guidance are implemented and maintained.
If buildings have been closed or had reduced occupancy water system stagnation can occur due to lack of use, increasing the risks of Legionnaires disease. Read HSE guidance covering water management and legionella.
You will need to check any water supplies - mains water supplies that have to be reconnected (because they were turned off when a premises was closed) will need running through to flush away any microbiological or chemical residue that might have built up while it was disconnected. The Drinking Water Inspectorate, who are the Regulators and technical experts in England and Wales, has produced this advice on maintaining drinking water quality when reinstating water supplies after temporary closure due to the COVID-19 outbreak.
Where settings transport children, the following mitigating actions should be considered where possible in order to reduce mixing and support contact tracing:
- use the same vehicle every day
- transport the same group of children every day
- transport to and from one setting
- allocate seats so that children can keep the same seats each day
- children aged over 11 should wear face coverings while being transported.
4. Administrative Controls - aim to lower any remaining risks of exposure.
There are different ways that this can be done but they should include:
- effective cleaning regimes
- increasing training on quality and effectiveness of cleaning
- providing hand sanitiser
- avoiding widespread sharing of toys and equipment if possible and ensure regular cleaning
- ensuring staff are maintaining physical distance between them and are maintaining hand and respiratory hygiene practices,
- ensuring one-way systems for moving through spaces
- provision of signage for physical distancing, floor tape or paint to mark out queuing systems etc.
- advising visitors of any measures in place pre-arrival and reinforcing with further communications when on site.
Hand hygiene is essential before and after all direct contact with a child, and after cleaning equipment and the environment. Hands should be washed thoroughly for at least 20 seconds with soap and water. An alcohol-based hand sanitiser can be used if hands are not visibly dirty or soiled and if soap and water are unavailable. Please refer to the Alert level 2 Guidance for employers, businesses and organisations for further advice.
Children should be supervised if using hand sanitiser, given risks around ingestion and potential splashes to face and eyes. Small children and those with complex needs should continue to be helped to clean their hands properly. Skin-friendly cleaning wipes can be used as an alternative.
However, thorough handwashing with soap and water is more effective than the use of hand sanitisers. Hands should be dried thoroughly after hand washing using disposable paper towels. Paper towels should be disposed of in a lidded bin and not allowed to overflow. Bins should be emptied often and at least daily.
The use of air dryers is not recommended.
Hand washing or sanitising should be done for example:
- on arrival at the setting;
- after use of the toilet;
- before and after eating;
- after returning indoors from outdoor play;
- after being in physical contact with other children;
- after sneezing or coughing.
Encourage staff and children not to touch their face.
For sneezes and coughs ‘Catch it, bin it, kill it, wash your hands’ is key. Disposable single use tissues should be used to cover the nose and mouth when sneezing, coughing or wiping and blowing the nose. Used tissue should be disposed of promptly in a separate double bagged waste bin and disposed of safely. Bins should be emptied, cleaned and disinfected regularly throughout the day.
Consider how to encourage young children to learn and practise these personal hygiene habits through games, songs and repetition.
Some children with additional learning needs (ALN), and disabilities may require additional support in following public health advice, or may find frequent handwashing distressing. Staff will know where this is likely to be the case and should consider how they can best support individual children.
Equipment and facilities
Equipment, toys and surfaces, including those across all areas of the setting such as toilets, sinks, taps and changing areas, tables and handles should be cleaned and disinfected frequently in line with Infection Prevention and Control for Childcare Settings Guidance (please see appendix 9). Outdoor equipment and entrance gates should also be cleaned and disinfected frequently. Children should wash their hands between activities.
Cleaning routines including times, dates, and name of person responsible for the cleaning should be recorded to meet the requirements.
We realise that childcare staff are required to provide close contact care for small children, including toileting, nappy changing and feeding. In these situations, staff should follow Infection Prevention and Control for Childcare Settings Guidance using aprons and gloves as necessary.
Symptomatic individual/positive case: decontamination and cleaning
Where a symptomatic individual or a positive case has attended the setting the principles of the COVID-19 cleaning advice should be followed in conjunction with the sector specific advice outlined in the Infection Prevention and Control for Childcare Settings Guidance. Additional cleaning and disinfecting must be undertaken of areas with which a symptomatic individual (or those with a positive test result) has come into contact.
Except for public areas where those with symptoms or a positive test result have passed through and spent minimal time and which are not visibly contaminated with body fluids, all surfaces that the symptomatic person has come into contact with must be cleaned and disinfected in accordance with the Infection Prevention and Control for Childcare Settings Guidance once the individual has moved from the area. These surfaces include:
- objects which are visibly contaminated with body fluids;
- all potentially contaminated high-contact areas such as toilets, door handles, telephones, grab-rails in corridors and stairwells.
The clothes of staff and children who have come into contact with a symptomatic child or positive case should be washed on a hot wash in accordance with the guidance on contaminated laundry in Infection Prevention and Control for Childcare Settings Guidance. It is therefore suggested that staff keep a change of clothes in the setting.
When items cannot be cleaned using detergents or laundered, for example, upholstered furniture and mattresses, steam cleaning should be used.
Any items that are heavily contaminated with body fluids and cannot be cleaned by washing should be disposed of.
In cleaning the areas where an individual with possible or confirmed COVID-19 has been, disposable gloves and an apron should be worn as a minimum. Hands should be washed with soap and water for at least 20 seconds after the gloves and apron have been removed. All staff should understand how to put on and remove PPE in order to ensure staff limit the spread of COVID-19. Guidance is available at appendix 6 of the Infection Prevention and Control for Childcare Settings Guidance.
Waste from areas where possible cases of COVID-19 have been should be disposed of in accordance with the Infection Prevention and Control for Childcare Settings Guidance and the principles outlined in the COVID-19 cleaning advice.
Waste should be stored safely and kept away from children. You should not put your waste in communal waste areas until negative test results are known or the waste has been stored for at least 72 hours.
If storage for at least 72 hours is not appropriate, arrange for collection as a Category B infectious waste either by your local waste collection authority if they currently collect your waste or otherwise by a specialist clinical waste contractor. They will supply you with orange or purple clinical waste bags for you to place your bags into so the waste can be sent for appropriate treatment.
5. Personal protective equipment (PPE) – aim to protect the worker from residual exposure through use of PPE
Attention must be paid to avoiding infection control during wear, removal, storage and disposal. PPE is manufactured to a regulated standard and is intended to provide the wearer with a known level of protection for health and safety purposes. The face coverings that are generally available everywhere are not considered PPE.
- Fluid resistant surgical face masks (where indicated by guidance)
- Gloves and aprons
- Eye protection
Personal Protective Equipment (PPE) in childcare settings
The information below is based on current advice. We will keep this under review and update if required, based on scientific evidence.
- Gloves and aprons should be used when providing intimate care to a child, including hands-on care such as washing, toileting, or first aid and certain clinical procedures such as assisted feeding.
- Fluid-resistant surgical mask and eye protection should also be worn if a risk assessment determines that there is a risk of splashing to the eyes such as from coughing, spitting, bottle feeding or vomiting.
- Gloves and aprons should be used when cleaning equipment or surfaces that might be contaminated with body fluids such as saliva or respiratory secretions.
Gloves, fluid repellent gown, FFP3 mask and eye protection are required in cases where aerosol generating procedures such as suction are undertaken.
Where there is suspected coronavirus (COVID-19) in a childcare setting:
- Gloves, aprons and a fluid-resistant surgical mask should be worn if a child becomes unwell with symptoms of COVID-19 and needs direct personal care.
- Eye protection should also be worn if a risk assessment determines that there is a risk of splashing to the eyes such as from coughing, spitting, or vomiting.
- Gloves and aprons should be used when cleaning the areas where a person suspected of having COVID-19 has been.
Handwashing should always be practiced before putting on and after removing PPE.
All staff should understand how to put on and remove PPE in order to reduce the risk of onward transmission of infection. Further guidance is available here in appendix 6 of the Infection Prevention and Control for Childcare Settings Guidance
Childcare settings are not considered to be public spaces and therefore the wearing of face coverings is not mandatory in a childcare setting. Face coverings are not considered to be PPE and are not required in a childcare setting. However, where the setting feels their use would be needed, careful consideration should be given to how to do this appropriately and ensure the needs of children are met, particularly those with additional needs.
The guidance on use of face coverings in the Alert Level 2 Guidance for, employers, businesses and organisations should be followed.
Settings should also ensure adequate waste bins on premises for those who choose to use single-use face coverings. Face coverings or visors are not PPE and would not prevent an individual being identified as a close contact by the TTP team.
Settings may wish to consider advising parents to wear face coverings when dropping off and picking up children where maintaining a social distance between staff and parents is difficult. Settings should also consider their advice on face coverings for essential visitors and make their policy on this clear before visits take place.
Where a setting is located on a school site they should ensure they understand and abide by the school policies on the use of face coverings and may wish to consult the school operational guidance.
Where settings are based on mixed-use sites, they should consult and adhere to the guidance provided for the site and the policies of the landlord on the wearing of face coverings in communal areas.
Any person who may not be able to adapt to face coverings as directed (e.g. young children, or those with special educational needs or disabilities) should not wear them as it may inadvertently increase the risk of transmission. If parents want children to wear face coverings the practicalities of how this can be managed within the setting should be discussed. Children under the age of 3 should not wear face coverings at all for safety reasons.
If staff in childcare settings wish to wear face coverings, they may do so, as long as they follow the advice for safe and hygienic use. However, the impact on communication with children and children’s general well-being is critical to any considerations around whether staff wear face coverings.
Face coverings and implications for deaf children
The impact of wearing a face covering when caring for a deaf child should be carefully considered, as communication for many deaf people relies in part on being able to see someone’s face clearly. The National Deaf Children’s Society has provided the following communication tips via social media and their website which childcare staff may find useful in this regard.