Gloving

The following information is provided as general recommendations. Always follow the glove use policies established by your facility.

General Information

• Gloves are NOT a substitute for handwashing.
• Throw away single-use gloves after each use.
• Hands must be washed after removing gloves.
• Use non-latex gloves when touching people or food whenever possible.
• Gloves should fit well.
• Gloves should be durable, so they do not rip or tear during use.

Types and Use of Gloves

Medical Glove (e.g., surgical glove, examination glove)

• Used for exposure-related tasks where there is contact with blood and body fluids. For example, when handling blood (e.g., nosebleeds, cuts) or items, surfaces, or clothing soiled by blood or bloody body fluids. Follow procedures outlined in the child care or school’s Blood borne Pathogen Exposure Plan.
• Used when changing the diaper of a child with diarrhea or with an infection that is spread through stool, or if the child has open areas on the skin.
• Worn by staff if they have open cuts, sores, or cracked skin.
• Must be approved by the FDA.

Utility Gloves

• Used for cleaning and disinfecting bathrooms, diapering areas, or any areas contaminated with stool, vomit, or urine.
• After use, follow cleaning and disinfecting procedures.

Food Handling Gloves

• May be recommended for handling ready-to-eat foods in some jurisdictions. Check with your local agency’s environmental health agency staff.

Handwashing

General Information

Hands are warm, moist parts of the body that come into frequent contact with germs that cause communicable illnesses. Young children have not yet learned healthy personal habits. They suck their fingers and/or thumbs, put things in their mouths, and rub their eyes. These habits can spread disease, but good handwashing can help reduce infection due to these habits. Caregivers who teach and model good handwashing techniques can reduce illness in child care settings and schools. Gloves are not a substitute for handwashing.

Handwashing is the single most effective way to prevent the spread of infections.
Included in this section are instructions on WHEN TO wash hands and pictures to demonstrate HOW TO do the correct handwashing procedure.

Child Care and School Staff Information

• Learn why, how, and when to correctly wash hands and children's hands.
• Follow a procedure that ensures safety for the infant or child.
• Teach young children to wash hands and supervise them as they do.
• Encourage children to wash hands.

Recommendations for Hand Hygiene Products

Liquid Soap

• Recommended in child care and schools since used bar soap can harbor bacteria. Regular liquid soap is effective in removing soil and germs.
• Soap and water are necessary if hands are visibly soiled.
• When using liquid soap dispensers, avoid touching the tip of the squirt spout with hands.
• If the liquid soap container is refillable, the container and pump should be emptied, cleaned, and dried completely before being refilled.

Antimicrobial Soaps

• Are not recommended by the American Medical Association and the CDC.
• Many scientists are concerned that use of these soaps could lead to strains of resistant bacteria. There is no need to use these soaps, which may actually do more harm than good.
• Must be left on hands for about two minutes in order to have any effect on bacteria.

Alcohol-Based Hand Rubs

• 60% to 90% alcohol (usually 70%). Read the label and follow manufacturer’s instructions.
• Advantages of alcohol-based hand rubs are:
  • Requires less time.
  • Act quickly to kill germs on hands.
  • More accessible than sinks.
  • Reduce bacterial counts on hands.
  • Do not promote bacterial resistance.
  • Less irritating to skin than soap and water (product contains moisturizers).
• Disadvantages of alcohol-based hand rubs are:
  • Should not be used on visibly soiled hands since they are ineffective in the presence of dirt, soil, or food.

Any product should be safely stored out of reach of children.

Procedure for Using Alcohol-Based Hand Rubs

Use enough alcohol-based hand rub to cover all surfaces of the hands and fingers.

1. Apply alcohol-based hand rub to palm of one hand.
2. Rub hands together covering all surfaces of hands and fingers.
3. Rub until hand rub is absorbed.

When Soap and Running Water Are Not Available

• When soap and running water are not readily available, for example, on a field trip, an alcohol- based hand rub can be used. The alcohol-based hand rub must be applied vigorously over all hand surfaces. If hands were visibly soiled, hands must be washed with soap and warm running water as soon as it is available, because the alcohol-based hand rubs are not effective in the presence of dirt and soil.
• DO NOT use a common water basin. The water can become contaminated very quickly.

Towels

• Use single-use paper towels to dry hands or use hand dryers.
• DO NOT use multi-use towels such as hand towels, kitchen towels, or dish cloths.

Fingernail Care for Staff and Children

• Keep fingernails short and clean.
• Staff should moisten cuticles to avoid hangnails.
• Clear fingernail polish that is well maintained may be worn; avoid colored nail polish since it is difficult to see dirt under nails.
• Use fingernail brushes to remove dirt and stool from under nails. Use the nailbrush after diapering or assisting with the toilet activities, before and after food preparation, and whenever nails are soiled.
• Artificial nails are highly discouraged from use since they are known to harbor germs even with good handwashing techniques. They can break off into food and have been implicated in disease outbreaks in hospital nurseries. Check with the local licensing agency regarding any food codes that may restrict staff from wearing artificial nails when handling and preparing food.

Ways for Staff to Keep Hands Healthy

• Cover open cuts and abrasions less than 24 hours old with a dressing (e.g., bandage).
• Use warm water, not extremely hot or cold and just enough soap to get a good lather.
• Rinse and dry hands completely.
• Use the soap product that is least drying to hands.
• Use hand lotion regularly to keep skin moist. Use products with a squirt spout so hands do not have contact with the container.
• Wear gloves outside in the cold weather.
• Wear utility gloves for direct hand contact with harsh cleaners or chemicals.
• Wear work gloves when doing yard work, gardening, etc.

Handwashing

The single most effective thing that can be done to prevent the spread of disease is to correctly wash your hands thoroughly and often.

Both STAFF and CHILDREN WASH:

• When arriving.
• Before and after eating, before preparing or serving food, or setting the table.
• Before and after preparing or giving medication.
• After using the toilet, before and after diaper change, or after assisting a child with toilet use.
• After handling items soiled with body fluids or wastes (blood, vomit, stool, urine, drool, or eye drainage).
• After coughing, sneezing, or blowing your nose.
• After playing with or caring for pets or other animals.
• After playing outside.
• Before and after using water tables or moist items such as clay.
• Whenever hands look, feel, or smell unclean. 
• Before going home.

Why, How, When: A Handwashing Curriculum, 1193
Nov 2023

Infection Control Guidelines

Section 1 through 3 of this manual contains information on ways to reduce the spread of germs in child care settings and schools. Key concepts of prevention and control:

• Handwashing (see Section 3) – the single most effective way to prevent the spread of germs.
• Covering your cough (see Section 3) – an effective way to reduce the spread of germs when coughing and sneezing.
• Appropriate gloving (see Section 3) – an effective way to help prevent the spread of germs. Gloves are not a substitute for handwashing. See standard precautions below.
• Proper diapering procedures (see Section 2) – to reduce the spread of germs found in stool to hands, objects, and the environment.
• Cleaning, sanitizing, and disinfection (see Section 2) – to reduce the presence of germs in the environment.
• Food safety (see Section 2) – to reduce the spread of germs from improperly cooked and handled food.
• Exclusion guidelines (see Section 1) – to reduce the chance of spreading germs from ill people to others.
• Immunizations (see Section 7) – for a list of resources for age-appropriate immunizations and child care, and school requirements.
• Avoid sharing personal items – encourage children, students, and staff to NOT share items such as water bottles, food, utensils, beverages, straws, toothbrushes, lip gloss, lip balm, lipstick, towels, headgear, combs, brushes, etc. to prevent the spread of germs to others.
• Promote self-care – encourage staff and children to perform their own first aid, when age appropriate.
• Standard Precautions are used in many settings where there is a possibility of exposure to blood and body fluids (e.g., urine, stool, secretions from the nose and mouth, drainage from sores or eyes). One aspect of standard precautions is the use of barriers. The purpose of using barriers is to reduce the spread of germs to staff and children from known/unknown sources of infections and prevent a person with open cuts, sores, or cracked skin (non-intact skin) and their eyes, nose, or mouth (mucous membranes) from having contact with another person’s blood or body fluids.
  
  Examples of barriers that might be used for child care and school settings include:
  • Gloves (preferably non-latex) when hands are likely to be soiled with blood or body fluids.
  • CPR (cardiopulmonary resuscitation) barriers – CPR mask or shield.
  • A bandage to cover a wound on a child or staff member to absorb or contain drainage from their wound. This prevents the escape of bodily fluids rather than protecting from fluids that have escaped.
  • Other examples that most likely would not be needed in the child care or school setting are:
    • Eye protection and face mask when the face is likely to be splattered with another’s blood or body fluid.
    • Gowns when clothing is likely to be splattered with another’s blood or body fluid.

Proper use of safety needle/sharp devices and proper disposal of used needles and sharps are also part of standard precautions.

Infection Control Recommendations for School Athletic Programs

General Information

Students participating in school athletic programs may have an increased risk of infection because of skin-to-skin contact or through the sharing of water bottles, athletic equipment, and towels. To minimize the risk of infection:

• Exclude athletes with non-intact skin (e.g., boils, sores, cuts, etc.) from competition or practice until evaluated by a healthcare provider.
• Exclude athletes with head lice from activities where there is head-to-head contact or headgear is used until they are treated.
• Ensure that all athletes have their own water bottles and discourage the sharing of water bottles.
• Provide clean towels for athletes during practice and competition to minimize contact with the saliva and secretions of others.
• Encourage all persons to wear shower shoes, sandals, or flip-flops in the shower or the locker room to prevent the spread of fungal infections (athlete’s foot) and plantar warts.
• Inform athletes that items such as toothbrushes, razors, and nail clippers might be contaminated with blood and should not be shared.
• Cover breaks in skin with a waterproof bandage. Change the bandage if it gets wet.
• Have athletes shower after every practice/game. DO NOT share towels.

Possible Blood Exposure

Participation in sports may result in injuries in which bleeding occurs. The following recommendations have been made for sports in which direct body contact occurs or in which an athlete’s blood or other body fluids visibly tinged with blood may contaminate the skin or mucous membranes of other participants or staff:

• Have athletes cover existing cuts, abrasions, wounds, or other areas of broken skin with an occlusive dressing (one that covers the wound and contains drainage) before and during practice and/or competition. Caregivers should cover their own non-intact skin to prevent the spread of infection to or from an injured athlete.
• Wear disposable gloves to avoid contact with blood or other body fluids visibly tinged with blood and any object such as equipment, bandages, or uniforms contaminated with these fluids. Hands should be thoroughly cleaned with soap and water or an alcohol-based hand rub as soon as possible after gloves are removed.
• Remove athletes with active bleeding from competition as soon as possible and until the bleeding has stopped. Wounds should be cleaned with soap and water. Skin antiseptics may be used if soap and water are not available. Wounds must be covered with an occlusive dressing that remains intact during further play before athletes return to competition.
• Advise athletes to report injuries and wounds as soon as possible, including those that occur before or during competition.
• Clean and cover minor cuts or abrasions that are not bleeding or draining during scheduled breaks; this does not require interruption of play. However, if an athlete's equipment or uniform fabric is wet with blood, the uniform should be removed and replaced, and the equipment should be cleaned and disinfected or replaced.
• Clean equipment and playing areas contaminated with blood until all visible blood is gone. Then disinfect with an EPA-approved disinfectant* (viricidal, bactericidal, fungicidal) OR make a 10% bleach solution (e.g. 1 part bleach (5% chlorine) plus 9 parts water, which is 100 ml bleach plus 900 ml water or ¼ cup of bleach plus 2 ¼ cups of water). Bleach solution deteriorates rapidly and should be made fresh daily. If using the bleach solution, apply it to the surface or area. DO NOT rinse. Air dry. The disinfected area should be in contact with the bleach solution for at least 1 minute. A 10% bleach solution is corrosive to some metals and is caustic to the skin.

  • Note: A 1:10 solution is the OSHA standard for cleaning and disinfecting blood spills. For other disinfection, a more dilute solution (e.g. 1:50 – 1:100 or ½ – ¼ cup per gallon) may be used.

  • * EPA-approved disinfectants must be used according to the manufacturer's recommendations.

• Have access to a well-equipped first aid kit during any adult-supervised athletic event. This includes personal protective equipment for first aid responders.
• DO NOT delay emergency care because gloves or other protective equipment are not available. If the caregiver does not have the appropriate protective equipment, a towel may be used to cover the wound until an off-the-field location is reached, where gloves can be used during the medical examination and treatment.
• Follow current CPR guidelines.
• Train equipment handlers, laundry personnel, and janitorial staff in proper procedures for handling washable or disposable materials contaminated with blood. Staff should always wear gloves when handling items contaminated with blood.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of Communicable Disease Control and Prevention at 573-751- 6113 800-392-0272 (24/7), or your local health department.

Misuse of Antibiotics

Antibiotic misuse has resulted in antibiotic-resistant bacteria that can cause severe infections and even result in death. Everyone (child care staff, teachers, school nurses, parents/guardians, healthcare providers, and the community) has a role in preventing antibiotic misuse.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of Communicable Disease Control and Prevention at 573-751- 6113 or 800-392-0272 (24/7), or your local health department.

Safe Handling of Breast Milk

Many studies have shown the benefits of breastfeeding, which is generally the preferred method of infant feeding. The AAP recommends exclusive breastfeeding for the first 6 months of an infant’s life and continued breastfeeding after the introduction of solids for at least 12 months and beyond. All child care providers should encourage and support the breastfeeding mother. These guidelines are provided to prevent transmission of infectious organisms that may be contained in breast milk.

General Information

Breast milk is a body fluid. HIV and other serious infectious diseases can be transmitted through breast milk. However, the risk of infection from a single bottle of breast milk, even if the mother is HIV positive, is extremely small. CDC does not list human breast milk as a body fluid for which most healthcare personnel should use special handling precautions. Occupational exposure to human breast milk has not been shown to lead to transmission of HIV or HBV infections. In the United States, women who are HIV-positive are advised not to breastfeed their infants, and therefore, the potential for exposure to milk from an HIV-positive woman is low. Breastfeeding is not contraindicated for infants born to mothers who are infected with hepatitis B virus or mothers who are infected with hepatitis C virus.

Prevention of Exposures

Store each child’s bottled expressed breast milk in a container designated only for that child. Each bottle should be clearly labeled with the child’s first and last name and the date the milk was expressed. Warm each child’s bottle of breast milk in its own separate labeled container.

The mother’s own expressed milk should be used for her own infant. Likewise, infant formula should not be used for a breastfed infant without the mother’s written permission. Confirm each child’s identity before feeding to prevent potential exposure to another mother’s breast milk.

Non-frozen human milk should be transported and stored in the containers to be used to feed the infant, identified by a label that won’t come off in water or handling. Containers with a significant amount of contents remaining (greater than 1 ounce) may be returned to the mother at the end of the day as long as the child has not been fed directly from the bottle. Do not save milk from a used bottle for use at another feeding.

Frozen human milk may be transported and stored in single-use plastic bags and placed in the back of a freezer where the temperature is more constant. Human milk should be defrosted in a refrigerator and then heated under warm running water.

Staff Prevention

• Staff should wash their hands before and after feeding.
• Clean up spilled breast milk and sanitize.

Follow-up of Exposures

• Inform the parents of the child who was given the wrong bottle that:
  • Their child was given another child’s bottle of expressed breast milk.
  • They should notify their child’s healthcare provider and ask about whether their child needs to have an HIV test.
  • The risk of HIV transmission is believed to be low.
• Inform the mother who expressed the breast milk that the bottles were switched and ask:
  • Will she give the other parents information on when the breast milk was expressed and how it was handled prior to being brought to the child care center?
  • If she has been tested previously for HIV, would she be willing to share the results with the parents of the child, given the incorrect milk?
  • If not tested previously for HIV, would she be willing to be tested for HIV and share the results with the other parents?
• The risk of an infant becoming infected with HIV after one feeding of breast milk from an HIV positive mother is thought to be extremely low. Factors relating to the risk of spread are unknown, but may include:
  • repeated or prolonged exposure to breast milk.
  • amount of HIV in the breast milk.
  • infant exposure to blood while breastfeeding (e.g., blood from a mother’s cracked nipples), or the presence of mouth sores in the infant.

These conditions are less likely to occur in the child care setting. Additionally, chemical properties in breast milk act together with time and cold temperatures to destroy HIV that may be present in expressed breast milk.

If a child has been given another child’s bottle of expressed breast milk by mistake, the potential exposure to HIV should be treated the same way as an exposure to any other body fluid.

The risk to staff exposed to HIV from breast milk is very low because the risk of spread from skin/mucous membrane exposures is extremely low.

Modified from What to do if an Infant or Child is Mistakenly Fed Another Woman’s Expressed Breast Milk, Centers for Disease Control and Prevention, 2023.

Breastfeeding Is NOT Advisable if One or More of the Following Conditions Are True:

1. An infant diagnosed with galactosemia, a rare genetic metabolic disorder
2. The infant whose mother:
   • Has been infected with the human immunodeficiency virus (HIV)
   • Is taking antiretroviral medications
   • Has untreated, active tuberculosis
   • Is infected with human T-cell lymphotropic virus type I or type II
   • Is using or is dependent upon an illicit drug
   • Is taking prescribed cancer chemotherapy agents, such as antimetabolites that interfere with DNA replication and cell division
   • Is undergoing radiation therapies; however, such nuclear medicine therapies require only a temporary interruption in breastfeeding

For further information about breast milk storage or safe handling practices, please call your child care health consultant. Additional information can also be found at the American Academy of Pediatrics' Breastfeeding and the Use of Human Milk and The Transfer of Drugs and Therapeutics into Human Breast Milk: An Update on Selected Topics.