Protective measures in childcare settings: Keep Childcare Safe

Childcare is provided in a wide range of settings and caters for children between the ages of 0 to 12. Although the protective measures recommended in this guidance are aimed at registered settings and environments primarily caring for pre-school aged children, many of the same principles apply to childcare provision for older age groups of children, including after-school and holiday schemes - both registered and unregistered. Settings providing childcare for older children are also advised to refer to the guidance for schools and to form a judgment on which measures are most appropriate and relevant to their particular operating model during the Covid-19 outbreak and the ages of children in their care.

The measures set out in this guidance are to be considered over and above the requirements contained within the National Minimum Standards for Regulated Childcare. 

This guidance may be updated in light of medical and scientific advice and as we learn more about the practical implications of the measures.

Changes in normal routines can be stressful for children. Practitioners should consider how they introduce new routines in a playful way and provide reassurance to children.

• Social distancing measures should be employed so far as is reasonably practical but it is accepted that this will be harder to maintain in a childcare setting where babies and pre-school aged children are being cared for than in other settings. Therefore, infection prevention and control measures must be increased
• Read and consider the guidance before re-opening or expanding your provision
• As employers, childcare settings have legal obligations under employment law. They should carry out risk assessments on an ongoing basis to plan appropriately for individual circumstances
• Implement measures that limit the number of contacts that children and adults have
• Follow Infection Prevention and Control Guidance for Childcare Settings including:
  • thorough and regular cleaning and disinfecting of the  environment, for example, at a minimum, daily cleaning and disinfection of toilets, taps, furniture, equipment, surfaces and door and gate handles. Plastic or wooden toys should be disinfected after use
  • effective personal hygiene procedures, especially frequent handwashing by staff and children
• Follow Public Health Wales guidance if a child/staff member or a member of child/staff member’s family is showing symptoms of COVID-19
• If a child receiving childcare becomes symptomatic whilst at the setting, the child should be cared for away from other children and a parent/carer should be called for immediately and the child collected and taken home
• Plan how you are going to tell parents/carers about your new arrangements for implementing protective measures. and how you are going to involve the children
• Remember that the needs, rights and experiences of all children at the setting should remain a key consideration when planning and operating protective measures.

This guidance is intended to ensure provision in childcare settings is as safe as possible for staff and children. Social distancing, hygiene and self-isolation of those showing symptoms, or living with someone showing symptoms(or self-isolating because they have been contact traced as a result of being in contact with someone who has tested positive for coronavirus) will minimise the risk of transmission of infection. While staff may feel apprehensive about the risks, it is important to remember that with adherence to guidelines, provision can be made far safer.

Every setting must carry out a risk assessment to ensure children and staff are kept safe prior to reopening or expanding their provision and on a weekly basis thereafter. The assessment should directly address risks associated with coronavirus (COVID-19), so that sensible measures can be put in place to control those risks for children and staff. 

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.

All Wales COVID-19 workforce risk assessment tool

The All Wales COVID-19 Workforce Risk Assessment Tool has been designed for use for all health and social care staff thought to be vulnerable or at risk, regardless of ethnicity. The tool addresses individual risk factors.

Work is underway to adapt this Tool to support the childcare/education workplace. Ahead of that work the Tool can also be used to support members of staff to consider their own health and wellbeing status, and helps employees and employers identify, assess and discuss the risks and the actions they can take to mitigate them.

Limiting social contacts is an important part of reducing the likelihood of seeing large outbreaks of the virus.  It is important that we continue to reduce mixing between people and groups of people.  Keeping people in small, consistent groups of adults and children which remain the same throughout the week, and separate from other groups, helps to do this and avoids creating chains of transmission.

In returning to childcare, children should attend just one setting wherever possible, and should remain in the same small, consistent group within that setting, as far as possible.  This will help reduce the likelihood of the virus moving between groups within that one setting, or moving between groups in different settings.

If a child attends more than one setting, for example school and wrap-around or out of school childcare, the child should remain in the same, small group across both settings wherever possible.  Mixing children from different groups, or different schools, is not consistent with the need to minimise overall levels of contact.  Parents and settings will need to discuss these risks and consider how to manage them to reduce the spread of the virus.  This will mean parents, schools and settings working together and in line with the guidance provided.

Settings are also asked to consider how they can minimise the risks of wider contacts, restricting chains of transmission.  For example childminding settings should consider how they can work with parents to agree ways to manage any necessary journeys, including pick-ups and drop-offs at schools, to reduce the need for a provider to travel with groups of children.

Social distancing within childcare settings with young children will be harder to maintain than in other settings. Settings should therefore implement the following measures to minimise the number of contacts that children and adults have, whilst ensuring children are kept safe and well cared for.

Settings should:

• risk assess appropriately to evidence their approach to social distancing which may mean limiting the number of children they can safely care for
• ensure that children and staff where possible only mix in a small, consistent group
• children should be cared for in consistent groups of no more than 8, while adhering to NMS ratios
• sessional nurseries that have different cohorts of children at different times of the day may wish to consider having smaller group sizes to limit the number of children staff are in contact with
• as far as possible, the same members of staff should be assigned to each group and these should stay the same during the day and on subsequent days
•  keep your staffing arrangements as consistent as possible. Where you do need to use staff from other settings or agency staff, ensure this is agreed on a weekly basis, not daily, to limit contacts
• keep groups of children separate from other groups where possible
• stagger interaction between different groups of children and consider the movement of children around the childcare setting, including one way route systems where possible to reduce large groups of children gathering
• ensure that only essential visitors attend the setting and encourage children and staff to walk or cycle where possible, and avoid public transport at peak times
• consider staggering children arriving and leaving the childcare setting to avoid parents gathering during drop off and pick up points
• consider putting markers in outside spaces for parents to space out for drop off and collection if possible
• if large spaces (Halls) are utilised to accommodate children these must be demarcated and managed accordingly to keep groups/ individuals apart as per social distancing requirements
• prevent the sharing of food, drink, utensils, and where possible equipment and toys
• consider how your emergency evacuation procedures might need to change to accommodate new child/staff groupings
• inform parents about the measures you are taking and seek their help to implement them
• make as much use as possible of the available outdoor space for activities

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 - work with the local authority as well as with parents to decide how best to continue supporting these children to stay healthy.

Children should spend as much time outdoors as possible as this can limit transmission and more easily allow for distance between the groups. Outdoor equipment should not be used unless the setting is able to ensure it is appropriately cleaned between groups of children using it, and that multiple groups don't use it simultaneously.

The present advice is that it is not necessary to screen children’s temperatures. The child’s parents/carers should check their temperature before bringing their child if they suspect the child is unwell. In any case, asymptomatic screening will not identify all cases of COVID-19. We will keep this under review. Staff should of course be vigilant for signs of fever and other symptoms. No child with symptoms should be sent to the provision at all and it is vital that parents/carers are encouraged to act accordingly.

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 20 seconds with soap and water. An alcohol-based hand rub can be used if hands are not visibly dirty or soiled and if soap and water are unavailable. However, thorough handwashing with soap and water is more effective than the use of hand sanitisers.

Hand washing/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’ 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.

Play with sand, water, plasticine/play dough and cookery and other messy play activities should be restricted and only participated in if the relevant guidance around hygiene and cleaning in the Infection Prevention and Control for Childcare Settings Guidance can be adhered to. If this cannot be adhered to, these activities should not be undertaken. Activities should not involve contact between children. 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. Providers should consider removing soft toys and toys that are hard to clean (such as those with intricate parts). Outdoor equipment and entrance gates should also be cleaned and disinfected frequently.

Cleaning routines including times, dates, and name of person responsible for the cleaning should be recorded to meet the requirements. Please see appendix 9 of Infection Prevention and Control for Childcare Settings Guidance for further information on keeping equipment clean.

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.

The guidance on Linen/Laundry in Infection Prevention and Control for Childcare Settings Guidance should be followed. Those who travel to work should change into their uniform/work clothes in the childcare setting, and then bag the clothing and travel home in clothes that have not been worn while caring for the children. Work clothing should be laundered after each use and employers should consider whether staff have sufficient sets of uniforms to enable this.

Ideally, parents/carers should be encouraged to provide clean clothes for children every day but this may not be possible and should be handled sensitively.

Settings should tell parents, carers or any visitors, such as suppliers, not to visit the childcare setting if they are ill or displaying any symptoms of coronavirus.

Settings should ensure all indoor spaces are as well ventilated as possible, by opening windows or use of ventilation units.

The Chief Medical Officer for Wales has been clear that there is no evidence to support the widespread wearing of non-medical face coverings in the community. Non-medical face coverings are only recommended where social distancing cannot be maintained. They are not a replacement for far more effective measures such as social distancing and hand hygiene.

Social distancing is not always possible in child care settings, especially with the youngest children and that is why infection prevention and control measures must be increased. No-one who may not be able to handle face coverings as directed (e.g. young children, or those with special educational needs or disabilities) should wear them as it may inadvertently increase the risk of transmission.

The Minister for Health and Social care made a statement about face coverings on 9 June 2020.

This is based on scientific advice which also acknowledges that some people such as young children cannot wear face coverings.

The below information 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, 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.
• Handwashing should always be practised before putting on and after removing PPE.
• In cases where aerosol generating procedures such as suction are undertaken, gloves, fluid repellent gown, FFP3 mask and eye protection are required.

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.

Please also refer to the paragraph below If a Child Shows Symptoms of COVID-19 while in a Childcare Setting.

All staff should understand how to put on/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 should not require children to wear face coverings as incorrect handling may inadvertently increase the risk of transmission.

Face masks and implications for deaf children

The impact of wearing a face mask 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, which childcare staff may find useful in this regard.

If a child or a member of their family is showing symptoms of COVID-19 (a new, continuous cough, high temperature, loss of smell or taste), they must not attend the childcare setting. This also applies to staff working in the setting.  Anyone with symptoms of Covid-19 should self-isolate for 7 days. All other household members must stay at home and not leave the house for 14 days, even if they remain well. The 14-day period starts from the day when the first person in the house became ill.

Further advice is available here: Self-isolation: stay at home guidance for households with possible coronavirus and Protect yourself and others from coronavirus.

Settings will need to have a clear, written procedure in place for the protection of staff and children if a child develops symptoms while at the setting. Their parent/carer 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.

In an emergency, call 999 if the child is seriously ill or injured or their life is at risk. Settings should follow their emergency procedures policies, but should not visit the GP, pharmacy, urgent care centre or a hospital where a child is displaying symptoms consistent with COVID-19.

If a member of staff has helped someone who was taken unwell, they do not need to go home unless they develop symptoms (new continuous cough, high temperature, loss of smell or taste) 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.

The new Test, Trace, Protect strategy published on 13 May was implemented across Wales from 1 June.

This strategy sets out the next phase of our approach to tackling coronavirus: testing people with symptoms in the community, tracing those who have come into close contact with people who have tested positive for coronavirus, and protecting family, friends and our community by self-isolating.

Test, Trace, Protect works by:

• Testing those people who have coronavirus symptoms, asking them to isolate from family, friends and their community whilst taking a test and waiting for a result. You can apply for a test for yourself or someone in your household with symptoms. This includes adults and children, including under 5s. If you are displaying symptoms, you can apply for a coronavirus test.
• Tracing those who have been in close contact with people that have tested positive for the virus, requiring them to take precautions through self-isolation. Further information on contact tracing and how it will work.
• Providing advice and guidance, particularly if the person who has symptoms or their contacts are in shielding or other groups at greater risk.
• Ensuring that if the symptoms are not due to coronavirus, individuals and their contacts can get back to their normal routines as soon as possible.

Further information and Q&A about Test, Trace, Protect.

If a child or staff member receives a test and that test is positive, they should self-isolate and report their symptoms. The setting will then be contacted by the Contact Tracing Team and advice will be given on isolation measures to be taken by individuals.

Advice on returning to work following a test.

Where children under 16 are contacted, their parental or guardian consent will be required to proceed with gathering information. Alternatively their parent or guardian would be able to provide contact tracers with the information on behalf of their child.

People are considered as potential contacts if they were in contact with the person who has tested positive during a period beginning up to two days before symptom onset and ending when the case entered home isolation. This is based on current understanding of the main period of infectivity.

A contact is defined as someone who has had close contact during this period, specifically:

• within 1 metre of the index case and has been coughed on, had a face-to-face conversation, had skin-to-skin physical contact, or been in other forms of contact within 1 metre for 1 minute or longer
• within 2 metres of the person tasting positive for more than 15 minutes
• have travelled in a vehicle with the person who has tested positive

This is likely to mean that the small group within which the child has been receiving care or for which the staff member has been providing care will have to self-isolate for 14 days.

Further information can be found here: Contact tracing: your questions

In the case of a childminder who shows symptoms of COVID-19 or whose household member(s) show symptoms of COVID-19, the childminder and their household members would need to follow self-isolation guidance.

This would mean the setting would need to close until the childminder and their household members are able to end their isolation in accordance with the self-isolation and testing guidance: 

• Information for Individuals Tested for COVID-19 Infection
• Self-isolation: stay at home guidance for households with possible coronavirus

Shielding and clinically vulnerable children

For the vast majority of children coronavirus (COVID-19) is a mild illness. Children who have been classed as shielding due to pre-existing medical conditions have been advised to undertake specific ‘shielding’ measures. These children have serious underlying health conditions which put them at very high risk of severe illness from COVID-19 and are advised to rigorously follow shielding measures in order to keep themselves safe. We do not expect these children to attend settings at this time.

Other clinically vulnerable children (who are not shielding) will need to be considered case by case, but of course we would only expect these to attend where parents/carers are satisfied that this is safe for them.

Shielding and clinically vulnerable adults

Shielding adults including staff from childcare settings should also follow the shielding guidance and therefore should not attend work. Clinically vulnerable adults are also advised to be very stringent in following social distancing and hand hygiene advice, and may need to work from home, following individual risk assessment.

Living with a shielding or clinically vulnerable person

If a child or member of staff lives with someone who is clinically vulnerable or shielding they should only attend a childcare setting if stringent social distancing can be adhered to, and the child is able to understand and follow those instructions. This may not be possible for very young children and older children without the capacity to adhere to the instructions on social distancing. In those instances, we do not expect those children to attend a setting. Likewise, we would not expect any staff who are vulnerable to be placed with children who cannot reasonably adhere to social distancing.

More advice can be found in the guidance on shielding.

Cleaning of the setting must take place as set out in Infection Prevention and Control Guidance for Childcare Settings. Additional cleaning and disinfecting must be undertaken of areas that a symptomatic individual has come into contact with. 

Except for public areas where a symptomatic individual has passed through and spent minimal time and 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 Guidance for Childcare Settings 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 should be washed on a hot wash in accordance with the guidance on contaminated laundry in Infection Prevention and Control Guidance for Childcare Settings. 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 coronavirus (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/remove PPE (as required by Health and Safety Regulations) and 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.

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.