Who should use this guidance
- 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).
This guidance sets out the public health advice for childcare settings to minimise the risks of COVID-19 transmission. It also includes the process to follow if anyone develops COVID-19 symptoms while in a setting. It provides a set of principles to help settings do this, and in turn minimise risks.
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 Welsh Government’s Technical Advisory Group continue to review the evidence around the susceptibility of children to the coronavirus, symptomatic and asymptomatic cases among children, and children’s role in transmission.
With our Test, Trace, Protect system in place 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 and will evolve to reflect the latest scientific advice as well as the latest Welsh Government policies.
The Coronavirus Control Plan: Alert Levels in Wales makes clear that childcare settings are able to operate across all four levels. This guidance is therefore relevant at all points, and not subject to change as we move between alert levels. But all settings will need to be prepared for the possibility of outbreaks and ensure they have plans in place.
Childcare in Wales
Childcare is provided in a wide range of settings and caters for children between the ages of 0-12. 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).
- Take all reasonable measures to minimise the risk of coronavirus in workplace;
- 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.
Prevention and mitigation
- 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.
Test, Trace, Protect
- Understand the role of Test, Trace, Protect and how this affects childcare settings.
- Actively engage with Test, Trace, Protect requirements.
- 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 (their household will also need to self-isolate).
- 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.
- If someone from the household of either a staff member or a child attending the setting has symptoms of COVID 19 the whole household must self-isolate.
- If a child or staff member is identified as a contact of someone who has received a positive test, they must self-isolate.
- All settings should 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.
- Plan how to tell parents or carers about the new arrangements for implementing protective measures and how children will be involved in this. Settings should ensure, where possible, children 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.
 Department for Education: Managing school premises during the coronavirus outbreak
 Health and Safety Executive: Legionella risks during the coronavirus outbreak
 Drinking Water Inspectorate: Advice Letter on maintaining drinking water quality when reinstating water supplies after temporary closure due to the COVID-19 outbreak
 Drinking Water Inspectorate. Guidance on Drinking Water Supply Operations in Response to Coronavirus (COVID-19)
Covid secure workplaces
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 well-being comes first
- Comply: The laws which keep us safe must be obeye
- 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
All workplaces have the duty to take reasonable measures to minimise the risk of exposure to coronavirus in the workplace. Reasonable measures guidance is available and a key element of the duty to take reasonable measures and to maintain a Covid secure workplace is the undertaking of risk assessments.
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.
All Wales COVID-19 workforce risk assessment tool
The All Wales COVID-19 workforce risk assessment tool was developed for use in health and social care workplaces and has been adapted for use in education, youth work, childcare and playwork settings. It is intended to be used to assess if staff are at higher risk of developing more serious symptoms if they come into contact with the COVID-19 virus. Your employer and or voluntary organisation has a duty of care to protect the health and safety at work of employees and this includes understanding if they are in a higher risk category from COVID-19.
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.
Childcare and playwork 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.
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.
Prevention: minimising contacts
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.
- Take all reasonable measures to minimise the risk of exposure to coronavirus, as legally required in all premises and workplaces open to the public;
- 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;
- 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;
- 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;
- Make as much use as possible of the available outdoor space for activities.
- 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;
- Ensure that staff adhere to social distancing requirements when interacting with other staff at the setting
- 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;
- Consider how your emergency evacuation procedures might need to change to accommodate child or staff groupings;
- 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;
- Inform parents about the measures you are taking and seek their help to implement them;
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.
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.
The group size should be determined by the number of children a setting is registered to care for, the 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 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.
Attending more than one setting
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. Children over the age of 11 should wear face coverings while being transported by 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. If a child tests positive, has symptoms of Covid 19 or has been identified as a contact of an individual who has received a positive test, they must self-isolate at home and not attend any childcare settings.
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. 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.
Where settings transport children, the following mitigating actions should be considered 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
- Group learners by school/setting if transporting children from more than one school/setting
- Allocate seats so that children can keep the same seats each day
- Children aged over 11 should wear face coverings while being transported.
Prevention: infection control measures
Covid-19 guidance on cleaning regimes that support infection prevention is available. This should be considered in conjunction with the sector specific advice contained within Infection Prevention and Control for Childcare Settings Guidance.
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. Staff should of course be vigilant for symptoms of Covid-19. 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 and follow self-isolation advice.
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, 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
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.
Childcare settings should 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. Ventilation systems should be checked or adjusted to ensure they do not automatically adjust ventilation levels due to differing occupancy levels. 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. If at all possible, 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.
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.
The First Minister announced on 11 September that the use of face coverings would be mandatory in indoor public spaces in Wales from Monday 14 September. Childcare settings are not considered to be public spaces and therefore the wearing of face coverings is not mandatory in a childcare setting. The Face Coverings Guidance for Premises
also makes clear that childcare settings are not required to compel the use of face coverings in all parts of the premises in which social distancing cannot be maintained.
As part of their risk assessment to support their COVID-secure operations childcare settings should consider a range of interventions, which could include the use of face coverings. 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.
Face coverings are not a replacement for far more effective measures such as social distancing and hand hygiene. Where a decision is made to use a face covering we would encourage that individuals use recyclable/multi use face coverings and use them correctly, covering the mouth and nose, ensuring hand hygiene before putting on and following removal. Face coverings should be made up of three layers as set out by the World Health Organisation but do not need to be medical-grade face masks. 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.
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.
Children under the age of 11 do not have to wear face coverings.
Where a setting cares for a mixed age range (i.e. primary and secondary school children) careful consideration should be given to the needs of all the children involved.
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.
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.
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.
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.
Personal Protective Equipment (PPE) in childcare settings
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 here in appendix 6 of the Infection Prevention and Control for Childcare Settings Guidance
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 that a symptomatic individual (or those with a positive test result) has come into contact with.
Except for public areas where those with symptoms or a positive test result have 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 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 (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 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.
Responding to infection
Engage with the Test, Trace, Protect Strategy
Under no circumstances should children or staff attend childcare settings if they:
- feel unwell with any of the identified COVID-19 symptoms. They should remain at home and self-isolate and arrange a COVID-19 test
- have tested positive for COVID-19
- live in a household with someone who has symptoms of, or has tested positive for COVID-19.
Parents/carers of children should be advised in advance that a child displaying symptoms or part of a household where someone is displaying symptoms should not be brought to the setting and that the child’s whole household should self isolate as set out in the guidance.
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. From September 2020 the Test, Trace, Protect strategy is supported by the NHS COVID-19 app.
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.
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. 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.
Anyone displaying symptoms of COVID-19 must not attend the setting and should stay at home and begin to self-isolate while making arrangements to be tested. The childcare setting should be informed of the test result immediately. If the test result is negative the child/staff member can return to the setting when they are well enough to do so.
Similarly, if someone in a child/staff member’s household is displaying COVID-19 symptoms, the child/staff member as part of that household will also have to self-isolate. If the household member subsequently receives a negative test result the child/staff member can return to childcare setting and the household no longer needs to self-isolate.
Individuals receiving a positive test result
If a child or staff member receives positive test result, they (and their household) must self-isolate according to the guidance and report the outcome of the test to the childcare setting.
If someone in a child/staff member’s household tests positive for Covid-19, parents/carers/staff should inform the childcare setting immediately. The household must self-isolate. If the child/staff member develops symptoms during the self-isolation period, they will need to get a test. If they complete the self-isolation period without developing symptoms, they can return to the setting.
If a child or 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 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.
Notify Care Inspectorate Wales (CIW)
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.
If a setting is made aware of a positive test result of a member of staff or a child who attends the setting, before official notification from Test, Trace, Protect (TTP) Contact Tracers, they may wish to take precautionary actions. This would involve identifying potential contacts of the positive case (using the definitions of a contact) and advising the staff and parents affected that there is a positive case in their/their child’s group. Parents should be advised that TTP Contact Tracers will provide the official confirmation of the positive test result and will determine who are considered to be contacts (and will need to self-isolate).
Settings may need to share contact details of staff and children with the TTP Contact Tracers and must ensure they have the consent of all individuals accessing the setting to do this.
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:
- Someone you have had face to face contact with at a distance of less than 1 metre of the index case, had skin-to-skin physical contact with, or that you have been coughed on, or been in other forms of contact within 1 metre for 1 minute or longer;
- Someone that you have spent more than 15 minutes within 2 metres of the person testing positive for more than;
- Someone that you have have travelled in a care or other small vehicle with the person who has tested positive or someone that has been in close proximity to you on public transport.
This is likely to mean that the small group within which the child/staff member with a positive test result has been receiving care or for which the staff member has been providing care will have to self-isolate.
If a child or staff member has been contacted by Contact Tracers and identified as a confirmed contact of a positive case, they will need to self-isolate (although the rest of their household does not). Settings should be informed where a child or staff member has been notified to self-isolate.
If the child/staff member notified to self-isolate does not develop symptoms they can return to the setting once their self-isolation period has ended. If they develop symptoms during their self-isolation period they should get a test.
The advice above on Responses to Infection applies to childminders as well as all other childcare settings.
However, if a childminder or one of their household members has symptoms of COVID-19 or a positive test result, the childminder and their household would need to follow self-isolation guidance. This would mean the childminder setting would need to close until the childminder and their household members are able to end their self-isolation in accordance with the self-isolation guidance.
If a member of a childminder’s household is notified to self-isolate due to being identified as a contact of a positive case, childminders are advised to contact their local Environmental Health Teams or PHW Health Protection Teams (0300 00 300 32) for advice. This supports the provision of advice specific to a childminder’s individual circumstances.
PHW Management of confirmed cases of COVID-19 in a childcare setting
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:
- Identification of cases in possible cluster
- Gathering of minimum information
- Initial cluster management and risk assessment
- Declaration of outbreak and management
Identifying clusters and outbreaks
A potential cluster is defined as two or more confirmed 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.
Gathering of minimum information and managing a cluster
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.
When an outbreak is declared
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:
- adjustments to how the setting is operating to facilitate Infection Prevention and Control measures and social distancing
- if further groups need to be notified 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.
Rapid deployment of antigen testing
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.
Prioritisation of childcare staff for testing
The Minister for Health and Social Services has set out a prioritisation for testing in Wales as part of the testing strategy to ensure that in Wales, we are making our testing capacity available where it is most needed. The first priority must be to support NHS clinical care. The prioritisation approach recognises that testing for symptomatic staff working in education and childcare settings where it is needed to keep the setting open is a priority above symptomatic individuals irrespective of local prevalence. This will mean those who test negative can return to work if they feel well enough, ensuring our education and childcare settings can remain open.
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.
There are no plans to undertake Antibody testing of childcare practitioners.
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. As already set out in this Guidance, staff can undertake a self-assessment via the All Wales COVID-19 workforce risk assessment tool. The Tool will help to identify actions that can be taken. 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.
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 extremely vulnerable to developing serious illness if they are exposed to coronavirus because they have a particular serious underlying health condition is available.
Annex A: Approach to risk estimation and management
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.