Child Care Centre Health Requirements & Inspections

Public HealthCall 905-546-2063 orEmail [email protected]

Children in child care centres commonly acquire gastrointestinal & respiratory illness.

Hamilton Public Health Services is mandated to ensure all licensed child care centres have infection control programs in place.

Public health requirements for child care centres are in place to protect children and staff from infections and illness.

Hamilton Public Health Services provides consultation for the development of infection prevention and control policies and procedures on topics such as immunization, reporting of diseases of public health significance and outbreak management.

Daycare centres, child care centres, preschools and before and after school programs are important places in our community where care, food and education are provided to babies and children.

Public Health Services provides these services for child care centres:

Public health requirements for child care centres are in place to protect children and staff from infections and illness:

Contagious or communicable infections spread from person to person. Bacteria, viruses, parasites or fungi cause these infections. For illnesses to spread from person to person, all of these conditions must be present:

Hand washing is the most effective way to reduce the spread of infections in a child care centre. It is vital that staff wash their hands properly immediately after changing diapers or helping a child use the toilet.

All outbreaks are reportable to Public Health Services, no matter what the cause. In addition, operators must report specific diseases to Public Health Services.

If you have been told that staff or a child has a reportable disease that can be transmitted in child care centres you must report it by calling Public Health Services at 905-546-2063.

It is not necessary to confirm or get a diagnosis from a doctor before reporting an infectious disease; you can use information from the child's parent or observations from the staff at the child care centre for reporting. We handle all personal information confidentially.

Public Health Services will investigate and provide information and guidance for infection control including letters for parents and recommendations for cleaning.

Consider these signs or symptoms to determine if a child is ill:

A child that is non-responsive, having trouble breathing, is having a convulsion or whose condition is deteriorating rapidly must receive immediate medical attention; call 911.

Contact the child's parent or guardian to pick up the ill child if they are not well enough to be at the child care centre. Until the parent or guardian arrives, ensure that:

Call Public Health Services at 905-546-2063 if you are concerned or a significant number of children are ill at the child care centre.

Do not allow a child with any of these symptoms to stay at the child care centre:

Diseases or illnesses and how long the disease requires a child to stay away from a child care centre.

If a child has an illness but is well enough to be in child care and does not have symptoms or a disease that require exclusion ensure that:

These symptoms or illnesses do not require that a child be excluded from child care centres:

Ill staff should not be at work. Ill staff cannot work in the kitchen. When staff begin working at the child care centre they should get the centre's policy for ill staff, which should include information about when staff are expected to stay home. Record absences and exclusions in staff records.

Do not allow staff with any of these symptoms to stay at the child care centre:

The Child Care & Early Years Act requires operators to track illnesses among children at child care centres.

For each child these must be done every day:

An Illness Surveillance Form or Line List is a record of the history of illnesses among the children and staff, allowing comparisons to be made from day to day and season to season. It provides a baseline of the number or type of illnesses to take action to control or reduce the spread of illnesses later on. Baseline incidence of illnesses allows the operator to notice when there is an increase or change of illness in the child care centre.

Complete the Illness Surveillance Form for Staff and Students(File, 56.5 KB)

An outbreak is when the number of ill children or staff becomes a concern or when they significantly exceed the usual number, and people who are ill have similar symptoms.

When 10% of the children at the child care centre have a similar illness, this is a warning there may be an outbreak. Some diseases such as measles should be treated like an outbreak even if there is only one case.

If you are unsure whether the illness is an outbreak, call Public Health Services at 905-546-2063.

Poster Resources

Signs for your child care centre:

There are 2 types of outbreaks:

Gastroenteritis is upset of the stomach and intestines with one or more of these symptoms:

Germs that cause gastroenteritis are:

Enteric Disease Outbreak Control Checklist for Child Care Centres(File, 74.5 KB)

What to do in a Gastroenteritis Outbreak:

If Public Health Services declares an outbreak:

An outbreak cannot be declared over without consultation and agreement from Public Health Services. Talk with your public health inspector or call 905-546-2063.

Symptoms of respiratory illness include:

Germs that can cause respiratory illness include rhinovirus, or the common cold, influenza, RSV and others.

Respiratory IIlness Outbreak Control Checklist for Child Care Centres(File, 74.5 KB)

What to do in a Respiratory Illness Outbreak:

If Public Health Services declares an outbreak:

An outbreak cannot be declared over without consultation and agreement from Public Health Services. Talk to your public health inspector or call 905-546-2063.

The two best ways to clean hands are:

Children should only use hand rub when they are supervised. Children or staff should not use hand rub when their hands are visibly dirty or soiled or when hands are wet.

Staff and children should wash their hands:

Children cannot use a large common basin to rinse their hands. Children should wipe their hands with a paper towel, then go to a sink and wash their hands with soap and warm water.

Staff should wear disposable gloves to clean up blood, vomit, urine (pee) or feces (poop).

Cleaning and disinfecting reduce the spread of viruses and bacteria. Some viruses and bacteria can live for weeks on toys and other surfaces like change tables. Cleaning with soap and water reduces the number of bacteria and viruses that may be on surfaces. Disinfecting after cleaning will kill most of the viruses and bacteria that were left after cleaning. A cleaning schedule is necessary to make sure cleaning is done. A good practice is to use a checklist with everything that needs to be cleaned.

Disinfectants work best on pre-washed objects and surfaces.

Acetic acid, also known as vinegar is not a disinfectant. It does not kill bacteria. Disinfectants include:

Chlorine Bleach

Chlorine bleach is also called sodium hypochlorite or chlorine. Some tips for using chlorine bleach:

There are two different mixtures of bleach and water you can use as disinfectants:

Low level disinfectant (1:100) is for all general purpose disinfecting, not for clean-up of body fluids such as vomit, feces (poop) or blood.

Make the low level disinfectant by using one of these methods:

High level disinfectant (1:10) is for surfaces contaminated with feces (poop), vomit, urine (pee) or blood.

Make the high level disinfectant by using one of these methods:

Some commercial products are chemicals that are already mixed at a store or supplier.

You can use dishwashers to clean and disinfect toys. If you use a dishwasher intended for home use, you can only use it two times each day. The dish detergent you use must contain a chlorine compound.

Minimum recommendations for cleaning and disinfecting under normal conditions. During an outbreak of a communicable disease, extra cleaning and disinfecting is necessary.

Immediately remove children from the area and begin clean up for vomit, feces (poop), urine (pee) or blood.

Exposure to blood carries a risk of infection from blood-borne viruses such hepatitis B, hepatitis C or HIV. The risk of getting these viruses in child care centres is low.

Exposure to blood-borne viruses can result from:

Here are some tips for blood exposure:

If you are exposed to blood:

There is a concern about spread of infection from human bites only if the skin is broken. Transmission of HIV is very unlikely through a bite.

If you, a staff member or child is bitten by another person:

Recommendations for how to set up diaper changing areas at a child care centre and how to change diapers.

How to set up the diaper changing area at a child care centre:

Steps to take to change a diaper:

Some requirements for hygiene practices at child care centres:

Label combs for each child or clean, rinse and disinfect combs in between each use.

Food handlers must follow the requirements of the Ontario Food Premises Regulation. Read the Ontario Regulation 493/17 Food Premises

to learn about:

These requirements must be met in child care centres:

Public health requirements are listed below for play areas such as wading pools and sensory play.

Wading pools are shallow pools of water for use by children to have fun, enriching experiences with water, but only if they’re carefully supervised. Because it's so easy for a child to drown in even a small amount of water, you must be absolutely certain that any body of water at or near your facility is completely inaccessible when it's not part of supervised water play. Therefore, Public Health Services recommends that Day Care facilities use a sprinkler instead of a hard plastic or blowup wading pool, as sprinklers help reduce the risk of exposure to potential harmful bacteria, viruses or parasites.

Requirements for wading pools include:

Additional operating instructions and standards for recreational water use at the child care centre could be found in the Operating Procedures for Non-Regulated Recreational Water Facilities and the Ontario Public Pools Regulation 565

Public health requirements for sensory play:

Water Play Tables

Indoor Sandboxes

Outdoor Sandboxes

Other Sensory Play

These guidelines and requirements are in place for pets and animals visiting or living at child care centres:

Steps to take if a child is bitten by an animal while in the care of the child care centre:

Public health inspectors check all licensed daycares, before and after school programs and preschools in Hamilton for safe food handling and infection control. We visit these premises:

Requirements the inspectors check for can be found in the:

These child care nutrition resources were created by Public Health Dietitians in Ontario to help and support providers to:

For support in implementing these nutrition recommendations contact:

Speak to a Registered Dietitian by calling Telehealth Ontario. Toll-free: 1-866-797-0000 Toll-free TTY: 1-866-797-0007

Visit UnlockFood.ca for information about food and nutrition.

Super Tasty Snack Ideas

Download the Super Super Tasty Snack Ideas pamphlet(PDF, 662.24 KB) to help plan your next healthy snack.