Proper Procedures: Preventing the Spread of Disease in Infant and Toddler Classrooms
By Terri Jo Swim Ph.D.

Teachers of infants and toddlers come in contact with a variety of bodily fluids on a daily basis. Therefore, it is of the utmost importance that they be trained in ways to protect their own health and the health of the children in their care. The Occupational Safety and Health Administration (OSHA; Bloodborne Pathogens, 1992) has published guidelines for preventing the spread of bloodborne pathogens, such as AIDS and hepatitis. These guidelines define universal infection control precautions to be used in all child care programs to break the chain of transmission for bloodborne pathogens. Following these regulations has also been proven to prevent the spread of other communicable diseases. The guidelines include the following:
  • complying with proper handwashing procedures,
  • wearing disposable latex gloves whenever contact with body fluids (e.g., blood, vomitus, urine, feces, saliva) is likely,
  • cleaning all surfaces with a disinfectant (one tablespoon of bleach to one quart of water; Kendrick, Kaufmann, & Messenger, 1995),
  • disposing of infectious materials (e.g., contaminated clothing, diapers) in the proper manner, and
  • subsidizing the cost of Hepatitis B immunizations for all employees (Aronson, 1992).
Handwashing as a Control Measure
Because the best way to protect both teachers' and children's health is to follow these guidelines, the standard procedures for handwashing and diapering will be examined further.
Following the proper procedures for washing hands is critical to the prevention of disease in early childhood classrooms. In fact, "Handwashing is perhaps the single most effective control measure against the spread of communicable and infectious illness in child care environments" (Marotz et al., 1997, p. 112). There are specific times of the day when teachers should wash their hands:
  • before working with the children at the beginning of the day,
  • before diapering,
  • before preparing and serving bottles or other food,
  • after wiping a nose,
  • after administering first aid,
  • after diapering or helping a child use the toilet, and
  • before leaving the classroom for a break or at the end of the day.
Like teachers, children should wash their hands throughout the day. A sink should be placed inside the classroom so that constant supervision of the children can be maintained while they wash their hands. Children's hands should be washed as often as teachers. Some additional times to wash include before and after a cooking activity and before and after playing in the sensory table, especially when the activity involves water. Bacteria can quickly grow at room temperature in a water table (Kendrick et al., 1995). Washing one's hands seems like a simple task, but it is easy to forget one or two of the steps that could lead to hands not being germ-free. Posting the procedures with accompanying pictures helps everyone to remember how to wash their hands properly. The steps included in properly washing one's hands (Kendrick et al., 1995) are listed below.
Proper Handwashing Procedures

Turn water on. Check to make sure that the water is at a comfortable temperature and that disposable paper towels are available.

Moisten hands under water and apply a heavy lather of liquid soap.

Wash hands for 15 to 20 seconds. Scrub the front and back of your hands up to your wrists, between your fingers, and under your nails.

Rinse your hands under the running water. Allow the water to run from your wrist to your fingertips.

Dry your hands with disposable paper towels.

Turn water off by grasping faucet handles with the paper towel you used to dry your hands. Dispose of paper towel in trash can.

Apply hand lotion to prevent cracking and chapping of hands. Dry, cracked hands allow a port of entry for germs and diseases.

Safe Diapering Procedures
Many communicable diseases such as E. coli; Hepatitis A; and hand, foot, and mouth syndrome can be spread through improper diapering (Wisconsin Department of Health and Social Services, 1990). As with washing hands, the procedures for diapering should be clearly posted with accompanying pictures for all teachers to see. Given the number of steps, it would be easy for a teacher to forget one or two. But for the health and safety of everyone involved, it is very important that all of the steps be followed. The recommended steps for diapering a child (Kendrick et al., 1995) are below.
Proper Diapering Procedures

Get all of the supplies that you need (diaper, wipes, latex gloves, clothes, etc.).

Wash your hands, following the recommended procedures, and put on latex gloves.

Pick the child up, holding him or her away from your clothing if you know he or she is soiled. Place the child on a table and buckle the strap to assist holding him or her in place. Never leave a child unattended, even if he or she is buckled in.

Remove clothing. Bag soiled clothes and securely tie the plastic bag to send home. Open diaper and fold over the tabs so they do not stick to the child's skin. Leave the soiled diaper under the child.

Clean the child with baby wipes from front to back using a fresh wipe each time. Use as many wipes as necessary. Pay close attention to cleaning the folds of skin (e.g., around the legs). Place the wipes inside the dirty diaper.

Remove the dirty diaper from underneath the child. Re-secure diaper with tabs.

Remove latex gloves by holding diaper in left hand and using the right hand to pull the left glove off your hand and over the diaper. Repeat with the right hand. This procedure helps to secure the germs inside the diaper and gloves.

Dispose of the diaper in a covered, lined step can if it is possible to do so without leaving the child. If you cannot, place the diaper on the corner of the changing table out of the child's reach.

Wash your hands with a disposable wipe. Dispose of wipe as you did the diaper in Step 8.

Put the clean diaper on and redress the child.

Assist the child in washing his or her hands. If the child is too young to wash his or her hands at the sink, you can wash the hands with either a baby wipe or wet, soapy paper towels. (Be sure to follow your state's regulations if they specify one method over the other.) If you use soap, be sure to remove all soap from the child's hands. Return the child to the play area.

Dispose of all materials, if it wasn't possible to do so before now.

Sanitize the changing table using a bleach and water solution and disposable paper towels.

Wash your own hands according to the procedures mentioned above. Record the diaper change on the child's chart.

Conclusion
The health and well-being of young children can be enhanced by providing a safe classroom environment that includes, but is not limited to, teachers who follow universal infection control precautions. Following universal infection control precautions can greatly reduce the chances of children and teachers in early childhood classrooms contracting communicable diseases. Once the basic health and safety needs of the children are met in the classroom, work can begin on meeting higher-order needs such as building trust and developing positive self-esteem (Greenberg, 1991; Maslow, 1970).

Resources
Kaiser, B. & Rasminsky, J.S. (1995).HIV/AIDS and child care: Fact book and facilitator's guide.Ottawa, Ontario, Canada: Canadian Child Care Federation. Building quality child care: Health and safety.(1990) Washington, DC: NAEYC. Preventing employee exposure to bloodborne and other pathogens.(1993). Minneapolis, MN: University of Minnesota.

References
Aronson, S.S. (1992, November/December). OSHA requires employers to give Hepatitis B immunization and protection to first aiders.Child Care Information Exchange, 88, 55-56.
Bloodborne Pathogens.(1992). Occupational Safety and Health Administration (OSHA). U.S. Department of Labor, Occupational Safety and Health Administration. Washington, DC: OSHA.

Greenberg, P. (1991).Character development: Encouraging self-esteem and self-discipline in infants, toddlers, and two-year-olds.Washington, DC: NAEYC.

Kendrick, A.S., Kaufmann, R., & Messenger, K.P. (Eds.). (1995).Healthy young children: A manual for programs.Washington, DC: NAEYC.

Marotz, L.R., Cross, M.Z., & Rush, J.M. (1997). Health, safety, and nutrition for the young child (4th ed.).Albany, NY: Delmar Publishers.

Maslow, A.H., (1970).Motivation and personality.New York, NY: Harper & Row. Wisconsin Department of Health and Social Services. (1990). Wisconsin communicable disease chart. Madison, WI: Author.