Protective measures in childcare settings: Keep Childcare Safe

• Providers of childcare and play services (including child minding and day care).
• Childcare and play provision registered with the Care Inspectorate Wales.
• Childcare and play unregistered providers (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).

Separate guidance is available for Nannies and will be available shortly for those providing Open Access Play work.

Since 22 June, childcare settings in Wales have been able to extend their operations, providing care for all children, not just those of key workers or vulnerable children. In many cases, this has been on a reduced basis taking account of the protective measures put in place to help reduce the rate of COVID-19 transmission. 

The position concerning the virus and our understanding of both the susceptibility of children and their role in transmission have since moved on. There is now more information available to inform our decisions for the measures to be taken in childcare settings. As a consequence, we have updated our guidance on the protective measures to be taken in childcare settings, enabling providers to further increase their operations. 

Coronavirus and children

The latest scientific advice is that the risk to children of becoming severely ill from COVID-19 is very low. The Welsh Technical Advisory Group, which provides scientific and technical advice to Government during emergencies, has reviewed the current evidence that suggests that where children are infected with the virus, it takes a milder course than in adults. Children generally present with mild symptoms or are asymptomatic. Very few develop severe symptoms or life threatening levels of infection. 

Furthermore, the Technical Advisory Group report that transmissibility in children under the age of 12 seems to be particularly low with emerging evidence showing limited child to child transmission. It is for these reasons that the Technical Advisory Group has concluded children can be ‘COVID secure’ using a broad range of measures. This evidence supports the return of schools to full operation from September, but it also assesses the evidence on children in general. Therefore this information is also relevant to the childcare sector.

Alongside the updated evidence, our Test, Trace, Protect system is operational, and we are clear about the measures that need to be in place to create safer environments within settings. However, there cannot be a one size fits all approach. We recognise that each childcare setting will have individual challenges to address. 

This guidance is designed to support childcare settings as they expand operations over the summer and into the autumn. Guidance will evolve to reflect the latest scientific advice as well as the latest Welsh Government policies, particularly around face coverings and Black, Asian and Minority Ethnic (BAME) communities.

All settings will also need to be prepared for the possibility of localised outbreaks and lockdowns, as has been experienced in Anglesey and Leicester amongst others. Settings will need to consider how they will ensure continuity of provision within the framework of local restrictions. 

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 settings and environments primarily caring for pre-school aged children, many of the same principles apply to childcare provision for school aged children, including after school and holiday schemes, both registered and unregistered. 

Settings providing childcare for school aged 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. Current evidence suggests that the risks of infection are higher for children over the age of 12 than those under 12.

The measures set out in this guidance should be considered alongside the requirements contained within the National Minimum Standards for Regulated Childcare. 

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. 

• Aim to be “COVID Secure”, by carrying out an assessment of the risks and mitigating them with a combination of controls such as limiting contacts and frequent and thorough hand hygiene, decontamination and cleaning. Please refer to the Hierarchy of Risk Controls (Annex A). 
• Consider this guidance and undertake risk assessments before either reopening or expanding provision.
• Where mains water has been turned off since the close of the premises at lockdown, when it is reconnected it will need running through to flush away any microbiological or chemical residues built up while the water supply was disconnected. (1)
• 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. Local authorities and the Cwlwm partners can help provide advice and best practice to support childcare settings in complying with their legal responsibilities.
• Childcare settings will need to ensure physical distancing in the work place for their employees or put in place mitigations following a risk assessment.
• Parents and carers (and visitors to settings) will also need to ensure physical distancing.
• Implement measures that limit the number of contacts that children and adults have.
• Actively engage with Test, Trace, Protect requirements.
• Understand the role of Test, Trace, Protect and how this affects childcare settings.
• Be clear with staff and parents that anyone with symptoms of COVID-19 should not come into work or attend the childcare setting but will need to start a period of self-isolation and arrange a test.
• If a child receiving childcare becomes symptomatic whilst at the setting, the child should be cared for away from other children and a parent or carer should be called for immediately and the child collected and taken home.
• Maintain accurate contact details for and keep a record of all those accessing the premises to enable tracing in the event of an outbreak.
• In accordance with GDPR rules ensure those individuals are aware of the need to record their details and what they may be used for. Employees should also be aware that their personal contact information will need to be provided to a Test Trace Protect enquiry in the event of a suspected or confirmed COVID case associated with the setting.
• Follow Infection Prevention and Control Guidance for Childcare Settings including thorough and regular cleaning and disinfecting of the environment, and effective personal hygiene procedures, especially frequent handwashing by staff and children.
• Follow advice if a child or staff member or a member of child or staff member’s family is showing symptoms of COVID-19.
• Plan how you are going to tell parents or carers about your new arrangements for implementing protective measures and how you are going to involve the children and ensure, where possible, they understand the plans.
• The needs, rights and experiences of all children at the setting should remain a key consideration when planning and operating protective measures.

 [1] Department for Education: Managing school premises during the coronavirus outbreak
[2] Health and Safety Executive: Legionella risks during the coronavirus outbreak
[3] Drinking Water Inspectorate: Advice Letter on maintaining drinking water quality when reinstating water supplies after temporary closure due to the COVID-19 outbreak
[4] Drinking Water Inspectorate. Guidance on Drinking Water Supply Operations in Response to Coronavirus (COVID-19)

The Health and Safety at Work Act 1974 is the legislation that sets out employers’ duties to staff and to the public, as well as the duties of employees towards themselves and others.

The Act sets out the duties of employers to keep people safe while at work. It states that all work settings that have five or more employees must have a written Health and Safety Policy. It also tells employees about their responsibility to follow safe working practices, to co-operate with their employers and to ensure the safety of others, including children, staff and visitors.

Every setting must carry out a risk assessment prior to reopening or expanding their provision and repeat these on a weekly basis thereafter. The assessment should directly address risks associated with coronavirus (COVID-19), to enable sensible measures to be put in place to control those risks. The Hierarchy of Risk Controls (Annex A) may help settings with this. 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. 

Settings should work with staff, parents and other partners so that everyone is clear how the new arrangements will work in practice and why they are needed.

Providers should use their Care Inspectorate Wales (CIW) online account to notify CIW when they reopen 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.
 

There is general advice available on ensuring workplaces are COVID secure.

The Key principles for workplaces in Wales are identified as:

• care: our health and wellbeing comes first
• comply: the laws which keep us safe must be obeyed
• involve: we all share the responsibility for safe work
• adapt: we will all need to change how we work
• communicate: we must all understand what to do

The All Wales COVID-19 workforce risk assessment tool has been developed to help staff consider their own health and wellbeing status to see if they are at higher risk of developing more serious symptoms if they come into contact with the COVID-19 virus. The Tool uses government guidelines, and the most up to date research, evidence and data available to identify known risk factors, including age, sex, ethnicity, underlying health conditions, Body Mass Index (BMI) and any relevant family history in relation to COVID-19. It is a combination of these various factors coming together which contribute to the severity of infection.

The approach of the COVID-19 Workforce Risk Assessment is a self assessment in the first instance. This supports and empowers staff to consider their health and wellbeing, and understand their personal risk of developing more serious symptoms (if they come into contact with the COVID-19 virus) as either low, high or very high.

Following their self assessment staff should have confidence to discuss their safety at work and any concerns they may have with their manager to consider the right actions to mitigate and manage that risk and ensure staff are as protected as much as possible. 

The Tool includes signposts to health and wellbeing resources to help individuals to manage their health and wellbeing as well as the important and continuing messages of:

• good and frequent hand hygiene
• social distancing in informal workplace activity.

Social distancing is harder for children, and the evidence suggests other measures should also be used when working with children including frequent and thorough handwashing. However, social distancing between adults working in a setting should be in place where possible. 

The Tool was designed for those working in the NHS and Social Care in Wales, however childcare staff are encouraged to use the Risk Assessment, and to complete this online through the national e-learning platform: Learning@Wales.

Where this is completed online a copy will need to be shared with the employer for staff records and to enable them to action. 

Work is ongoing to develop sector specific tools specifically for the education, childcare and playwork sector. 

The latest published evidence in relation to the transmissibility in children under the age of 12 seems to be particularly low. Children under the age of 18 make up 22 to 25 per cent of the population, but consistently make up less than 2 per cent of the total COVID-19 caseload in every country.

Limiting social contacts is an important part of reducing the likelihood of seeing large outbreaks of the virus.

The lower the number of contacts a person has, the easier it is for them to manage their overall risk of infection through interactions with others. However, the overall number of contacts an individual, or a family has, are something they will need to manage. Settings cannot manage interactions beyond those that take place on their premises. 

For settings, keeping children and staff in consistent groups that remain the same throughout the week, and separate from other groups will help in limiting contacts within the setting and avoids creating chains of transmission. It is accepted that young children cannot socially distance from staff or from each other and so consistent groups provide an additional protective measure. Maintaining these groups also makes it quicker and easier, in the event of a positive case, to identify those children and staff who may need to self-isolate and to keep that number as low as possible.

Given the updated evidence on the susceptibility and transmissibility of COVID-19 in children, settings can increase the number of children in the small group from 8 specified in previous guidance. 

The group size should be determined by the number of children a setting is registered to care for, the current NMS ratios and the risk assessments undertaken by each setting (which will take into account children’s ages, size of setting, staff safety and so on).

Groups should remain as consistent as possible and staff within that group should endeavour to socially and physically distance from one another.

Staff should remain with the same group at all times. Where it is necessary for a staff member to move between groups (for example, to cover another staff member’s absence), they should maintain the 2 metres from other adults as much as possible. We recognise distancing is not likely to be possible with younger children, and the staff member will need to ensure they follow the necessary hygiene measures rigorously.
It is important that settings have the flexibility to manage and respond to risks in an appropriate way. 

We know that for some families limiting a child to attending one setting will not always be possible due to family or work commitments. 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, consistent group across both settings wherever possible. 

Where that is not possible, they should remain in consistent groups within both settings, and the school, provider and parents work together to manage the overall risks. For example, possible ways of grouping children in wrap around and out of school provision such as breakfast and after school clubs includes:

• by class
• by year group
• by school

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.

Where travel is necessary providers should do all that they can to ensure that children travel as part of the same consistent group they will be in within the setting. Every effort should be made not to mix children from multiple settings in any vehicles used as this would undermine maintaining distinct groups within the setting. 
Where children need to attend more than one setting, parents, schools 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 in close partnership to consider fully how they can make provision work alongside their wider protective measures. Settings are reminded that discussions with parents on health matters are to remain confidential and information only shared if the parent or carer has agreed.

It is important settings have the flexibility to manage and respond to risks in an appropriate way. As settings seek to minimise the risks of transmission, they should consider the Hierarchy of Risk Controls detailed at Annex A.

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 minimising contacts
• ensure that children and staff where possible only mix in consistent groups while adhering to NMS ratios
• cleaning should take place between sessions of different groups (i.e. between the morning and afternoon sessions where the morning and afternoon groups differ)
• 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. Those on work placements or students in regular attendance can be included as ‘staff’. 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 minimise contact
• ensure that only essential visitors attend the setting and adhere to the social distancing requirements whilst there, and encourage children and staff to walk or cycle where possible, and avoid public transport at peak times. Essential visitors could include inspectors, learning support assistants, healthcare workers and so on. It does not include parents who are considering using a setting for the care of their child
• consider staggering children arriving and leaving the childcare setting to avoid parents or carers gathering during drop off and pick up points
• consider putting markers in outside spaces for parents or carers to keep to the 2 metre social distancing rule 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 or individuals apart as per requirements for minimising contacts
• 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 child or 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. From 30 July young children (those of primary school age or younger) will be able to interact outside without social distancing. However, adults will need to continue to distance from one another. 

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 or 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 or carers are encouraged to act accordingly.

Children who present with behaviours which may increase the risk of droplet transmission (such as biting, licking, kissing or spitting) or require a level of care that cannot be provided without close contact, should continue to receive care in the same way, including any existing routine use of PPE.

In these circumstances which require provision of the same level of care that has always been required for those children then no additional PPE is necessary as the risk of viral transmission is very low. However, additional space and frequent cleaning of surfaces, objects and toys will be required.

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. Hands should be dried thoroughly after hand washing using disposable hand towels. 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’ 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 or 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.

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.

There is no specific reason why different groups of children cannot share toilets. However where possible, settings might want to provide separate toilet facilities to reduce the risks of cross group contacts. Where this is not possible, using hand sanitiser before entering the toilet and ensuring toilets are cleaned regularly will help. Where settings operate from multi use buildings such as community centres or share toilet facilities with schools, cleaning and hygiene measures will be even more important.

The guidance on Linen and Laundry in Infection Prevention and Control for Childcare Settings Guidance should be followed. Those who travel to work should change into their uniform or 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 or 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.

The Chief Medical Officer for Wales has been clear that there is minimal 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, and since 27 July are mandatory on public transport in Wales. 

They are not a replacement for far more effective measures such as social distancing and frequent and thorough hand hygiene practice.

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. 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. 

There is no specific requirement for staff in childcare settings wear face coverings, but they may wish to do so out of personal choice, or because they are in the “increased risk” group or perhaps the Shielding group (who will no longer be required to shield after 16 August) and therefore they may wish to ensure they take all necessary precautions to protect themselves. 

The Minister for Health and Social Services 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, 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 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. However if children or the parents or carers of that child choose or wish for the child to wear a face covering to the setting there should be a clear process in place for removal on arrival at the setting. Children must be told not to touch the front of their face covering during use or when removing them. They must wash their hands immediately on arrival dispose of temporary face coverings in a covered bin or place reusable face coverings in a plastic bag they can take home with them, and then wash their hands again.

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.

If a child or a member of their family is showing symptoms of COVID-19 (a new, continuous cough, high temperature, loss of or change to sense of smell or taste), they must not attend the childcare setting and must book a test. This also applies to staff working in the setting.

If a child or staff member has symptoms of COVID-19, however mild, the clear medical advice is to immediately self-isolate at home and book a test. All other household members, including any members of an extended household, must stay at home and self-isolate 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 on protecting yourself and others. 

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 or 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 meters 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 they need clinical advice, they (or a member of staff or their parent or carer) should go online to 111 Wales (or call 111 if they don’t have internet access). 

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 (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. Children or staff members who are symptomatic should be tested. 

If any child or staff member tests positive for COVID-19, settings must notify Care Inspectorate Wales of positive test results.

The Test, Trace, Protect strategy published on 13 May was implemented across Wales from 1 June. 
This strategy sets out the 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.

The Welsh Government COVID-19 Testing Strategy was published on the 15th July. The strategy outlines how Wales’ testing capacity will be used to support contact tracing by controlling and preventing transmission of the virus, protecting our NHS services, protecting the most vulnerable groups and utilises developments in future technology to better understand the virus. 

An overview of the Test, Trace, Protect process for childcare settings is available.

In summary this process 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. Information and guidance for staff is also available
• 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
• providing advice and guidance, particularly if the person who has symptoms or their contacts are in groups at increased risk of Covid-19
• ensuring that if the symptoms are not due to coronavirus, individuals and their contacts can end their self-isolation period and get back to their normal routines as soon as possible.

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

If a child or staff member receives a test and that test is positive, they should self-isolate and report their symptoms to the childcare setting or their employer. In the event of a positive test, a contact tracer will contact the person tested to help identify potential contacts. A second contact tracer will then get in touch with those contacts and advise them to self-isolate for 14 days from their last contact with the individual who tested positive. These people will only be required to take a test if they develop symptoms.

It will be important that settings have a clear policy in place for the advent of a positive test for a child in their care or an adult working in the setting. They should require that the setting is informed, and enable them to follow up with all people who came into contact with that person during their time in the setting. They may need to share contact details of staff and children with the NHS Contact Tracers and must ensure they have the consent of all individuals accessing the setting to do this. 

Advice on returning to work following a test is available. 

Where children under 16 are contacted, consent of a parent, carer or guardian will be required to proceed with gathering information. Alternatively, a 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 testing positive for more than 15 minutes
• have travelled in a vehicle with the person who has tested positive or seated near in public transport.

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 on contact tracing is available. 

Building upon the Disease Outbreak Plan for Wales (2020), Public Health Wales has provided specific advice regarding the investigation and management of clusters and outbreaks of COVID-19 in educational and childcare settings .The advice outlines what steps should be taken to protect individuals and communities where outbreaks are occurring, as well as reducing spread to other communities:

1. identification of cases in possible cluster
2. gathering of minimum information
3. initial cluster management and risk assessment
4. declaration of outbreak and management 

A potential cluster is defined as two or more cases of COVID-19 among children or staff in a childcare setting within 14 days or; an increased rate of absence due to suspected or confirmed cases of COVID 19.

A potential outbreak is defined as two or more confirmed cases of COVID-19 among children or staff who are direct close contacts, proximity contacts or in the same ‘bubble’* in the setting, within 14 days. This may be a class, year group or other defined group. 

It is important to highlight that if only one person has been identified with a case of COIVD-19 in a setting the regular TTP contract tracing process should be followed.

Confirmed cases of COVID-19 in a setting should be flagged by local contact tracing teams and followed up with the childcare settings to establish the potential of clusters or outbreaks. However if a potential cluster or outbreak has been identified by the setting or Local Authority they must contact their Regional multi agency TTP Team as soon as the potential cluster or outbreak has been identified.

Regional TTP teams will work with the head of the setting and relevant Local Authority to gather a range of information related to the unique nature of the setting, the context and situation in which the cases have occurred and to establish if guidance on infection control measures and social distancing measures for children and staff has been followed. A risk assessment will be undertaken and if an outbreak is not declared the Regional TTP team will continue to work with the setting to manage and review the cluster.

An Incident Management Team (IMT) is likely to be put in place to which key individuals who are needed to investigate and manage the situation will be invited.

Based on the individual circumstances of the outbreak and the setting the IMT will consider:

• djustments to how the setting is operating to facilitate Infection Prevention and Control measures and social distancing
• if further groups need to be asked to self-isolate (e.g. class groups, other functional groups
• whether to undertake an enhanced investigation including testing of a wider group

The group for testing may be wider than the group identified for exclusion and could include the whole setting or a distinct section of the setting.

An outbreak will be declared over when there has been 28 days since the onset of the last confirmed case in the setting and the results of any possible cases in children or staff in that time have tested negative.

The rapid deployment of testing will be made available to support outbreaks in childcare settings by the NHS Wales TTP Programme and Local Health Boards.

The method for delivery and sampling of rapid antigen tests can be executed in a range of ways such as the deployment of Mobile Testing Units (MTUs), temporary testing satellites or home tests. The most appropriate testing channel will be discussed and agreed between all stakeholders. 

Antibody testing tests for antibodies produced by the body in response to the coronavirus infection and indicates whether the person being tested has previously had the virus. A positive antibody test result does not mean that a person is immune, or cannot pass on the virus to others. It also does not mean that those who test positive are exempt from and able to ignore the latest Government advice on social distancing and other interventions to control the spread of the virus.

The purpose of antibody testing is to support the gathering of information on the prevalence of the infection in Wales. The provision of antibody tests are for surveillance and monitoring purposes only. 

A small sample of teachers are being asked to undertake antibody testing following a decision made by the Chief Medical Officers of all four nations.

We are working to determine the position of antibody testing for the childcare sector.

In line with Welsh Government Technical Advisory Group advice, when the prevalence of COVID-19 is low, as it is now, care needs to be taken in using RT-PCR (Antigen tests) as a screening tool. Low prevalence of COVID-19 in a particular ‘community’ or cohort is likely to generate a higher rate of false positives and false negatives. False positives could cause more harm arising from unnecessarily isolating cases and their contacts as a result of the broader Test, Trace, Protect system, while a smaller number false positives results may provide false reassurance. Therefore at this time there would be limited benefit in adopting this approach in schools and settings across Wales.

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.
 

On 16 July the Chief Medical Officer confirmed that people in Wales who are shielding will no longer need to do so from 16 August.

Shielding means protecting those people who are extremely vulnerable to the complications of COVID-19 because they have particular existing health conditions 

For the vast majority of children COVID-19 is a mild illness. Children or adults who have been classed as shielding due to pre existing medical conditions have been advised to undertake specific ‘shielding’ measures. These adults and children have serious underlying health conditions which put them at very high risk of severe illness from COVID-19 and were advised to rigorously follow shielding measures in order to keep themselves safe. They will have received a shielding letter from the Chief Medical Officer. 

From 16 August, however, staff who have been shielding can return to work and if they return to work the workplace must be COVID secure and the individual should follow the social and physical distance measures closely. Additionally from that date children who have been shielding can return to childcare.

The Chief Medical Officers from across the UK accepted the guidance published by Royal College of Paediatrics and Child Health (RCPCH) in relation to children and shielding. According to the RCPCH guidance, the majority of children currently on the Shielding Patients List (SPL) no longer need to shield. Over the summer paediatricians and GPs will be reviewing the records of children who have been shielding to assess whether they need to remain on the SPL. Once a child is removed from the SPL because they do not need to shield, they can behave in the same way as any other child in the setting. Whilst shielding advice is paused, those who remain on the SPL should follow the same advice as those children in the ‘increased risk’ group. 

It is important to keep in mind that for adults and children who have been shielding this will represent a significant change in their circumstances. Some will be nervous about no longer shielding and may require additional reassurance to enable them to return to the setting. There are circumstances where children would be unable to attend settings for health reasons irrespective of COVID-19. 

We do not expect staff or children in this category to attend settings before 16 August, and even then some may not feel safe to return immediately. This should be handled sensitively. 

In the case of children, we would only expect these to attend where parents or carers are satisfied that this is safe for them. Childcare settings may wish to consider undertaking individual risk assessments if necessary and arranging a meeting with the appropriate individual to discuss their concerns.

If in doubt about whether their health condition means they should not be attending their setting, staff, parents and carers should take advice from their GP or hospital doctor.

For staff returning after shielding a risk assessment must be undertaken and the employer should ensure that all reasonable measures are put in place to enable them to return safely. Social distancing for staff should remain in place in line with the current regulations and guidance. It is important to note that staff can remain furloughed at the present time and employers will need to discuss with staff how and when to support their return to work. 

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. Pregnant women are specifically advised to work from home after 28 weeks’ gestation. As the advice to shield is being paused people in this category can go out to work and return to settings. Every setting should continue to carry out risk assessments and put in place controls to minimise those risks, such as the frequent hand washing, surface hygiene and one way systems. 

Cleaning of the setting must take place as set out in Infection Prevention and Control for Childcare Settings Guidance. 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 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 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 (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.

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The hierarchy of risk controls does not replace the importance of following the HSE 5 steps to risk assessment when preparing risk assessments. However the hierarchy will help identify the most appropriate measures to adopt.

This hierarchy of controls is a way to prioritise risk control measures based on how effective different types of control are in reducing risks. Risk reduction measures should be assessed in order of the priority given in the hierarchy; it is not a case of simply jumping to the easiest control measure to implement. Types of control higher up the hierarchy are more effective at reducing risks than those lower down. Controls should be practical to be implemented and, ideally, should be able to be maintained easily over time. 

It is critical to remember that it will only rarely be feasible to eliminate the risk completely. The combination of controls introduced should aim to reduce the risk to as low as reasonably practicable prioritising structural, environmental interventions over individual level ones.

This of course does not simply mean considering risks of transmission, but also balancing these against risks to wider health and wellbeing and learning. Ultimately childcare settings need the flexibility to respond to these risks as they are able to.

When considering contact between contact groups, we would advise settings to consider:

• elimination: Redesign the activity such that the risk is removed or eliminated
• substitution: Replace the activity with an activity that reduces the risk. Care is required to avoid introducing new hazards from the substitution
• engineering controls: Design measures that help control or mitigate risk
• administrative controls: Identifying and implementing the procedures to improve safety

Having gone through this process, PPE should be used where the guidance recommends this.