Current through Register Vol. 50, No. 3, March 20, 2024
A. Written policies and procedures regarding
infection control practices and disease prevention shall be developed by each
center which include the following.
1.
[Formerly paragraph 21:010-1] Staff and children shall wash their hands at
least at the following times: upon entering the center, before preparing or
serving meals, after toileting or changing diapers, before and after eating
meals or snacks, and anytime hands become soiled with body fluids (urine,
stool, saliva, blood, nasal discharge).
2. [Formerly paragraph 21:010-2] Procedures
shall ensure that staff teach use of running water, soap, and single use of
disposable towels. Hands shall be washed and scrubbed for at least 10 seconds
with soap and running water. Warm running water in sinks is required.
3. [Formerly paragraph 21:010-3] Weekly
monitoring by the center director shall ensure that handwashing and cleaning
procedures are followed as specified in the center's plan.
4. [Formerly paragraph 21:010-4] Noses shall
be blown or wiped with disposable, one-use tissues that are discarded in a
plastic-lined and covered garbage container.
5. [Formerly paragraph 21:010-5] Draining or
oozing cuts or sores shall be covered.
6. [Formerly paragraph 21:010-6] Child care
personnel shall adopt routine procedures for handling blood and
blood-containing fluids and wound exudates of all children in the center.
a. For spills of vomitus, urine, and feces,
floors, walls, bathrooms, table tops, toys, kitchen counter tops, and
diaper-changing tables shall be cleaned and disinfected.
b. For spills of blood or blood-containing
body fluids and injury and tissue discharges, the area shall be cleaned and
disinfected. Gloves shall be used in these situations unless the amount of
blood or body fluid is so small that it can easily be contained by the material
used for cleaning.
c. Persons
involved in cleaning contaminated surfaces avoid exposure of open skin sores or
mucous membranes to blood or blood-containing body fluids and injury or tissue
discharges by using gloves to protect hands when cleaning contaminated
surfaces.
d. Mops shall be cleaned,
rinsed in sanitizing solution and then wrung as dry as possible and hung to
dry.
e. Blood-contaminated material
and diapers shall be disposed of in a plastic bag with a secure tie.
7. [Formerly paragraph 21:010-7]
The day care center director shall exclude from care any child with the
following illnesses or symptoms based on potential contagiousness of the
disease. Periods may be extended beyond this depending upon individual
conditions.
|
Illness/Symptom
|
Exclude Until
|
|
Meningococcal disease (Neisseria
meningitis)
|
Well and proof of
non-carriage1
|
|
Hib disease (Haemophilus influenza)
|
Well and proof of
non-carriage1
|
|
Diarrhea (two or more loose stool, or over and above
what is normal for that child)
|
Diarrhea resolved or is controlled (contained in
diaper or toilet)
|
|
Fever of unknown origin (100°F oral or 101 rectal or
higher) and some behavioral signs of illness
|
Fever resolved or cleared by child's
physician/health department
|
|
Chicken pox
|
Skin lesions (blisters) all scabbed over
|
|
Hepatitis A
|
One week after illness started and fever resolved
|
|
AIDS (or HIV infection)
|
Until child's health, neurologic development,
behavior, and immune status is deemed appropriate (on a case-by-case basis) by
qualified persons, including the child's physician2
chosen by the child's parent, guardian and the center director
|
|
Undiagnosed generalized rash
|
Well or cleared by child's physician as
non-contagious
|
|
Any child with a sudden onset of vomiting,
irritability or excessive sleepiness
|
Evaluated and cleared by child's physician
|
a.
1Proof of non-carriage: Either by completion of
appropriate drug regimen of Rifampin (two-day course for Meningococcal disease
or four-day course for Hib disease) or by a negative throat culture obtained
after completion of treatment for meningitis.
b.
2These persons
should include the child's physician and other qualified individuals such as
the center director, a representative from the Office of Public Health, and a
child development specialist, and should be able to evaluate whether the child
will receive optimal care in the specific program being considered and whether
an HIV-infected child poses a potential threat to others.
c. With most other illnesses, children have
either already exposed others before becoming obviously ill (e.g., colds) or
are not contagious one day after beginning treatment (e.g., strep throat,
conjunctivitis, impetigo, ringworm, parasites, head lice, and scabies). The
waiting periods required after the onset of treatment vary with the disease.
Check with your local health department for information on specific diseases.
Children who are chronic carriers of viral illnesses such as cytomegalovirus
(CMV) and Herpes simplex can and should be admitted to day care
centers.
d. The parent or
designated person shall be notified as soon as possible if a child develops
symptoms of illness or suffers an accident while in care.
8. [Formerly paragraph 21:010-8] Guidelines
shall be developed regarding biting behavior, treatment of bites, and
notification to parents of the children (if injury requires first aid or
medical attention).
9. [Formerly
paragraph 21:010-9] Each child care employee shall receive a total of three
hours of training per year on infectious diseases, health and safety, and/or
food service preparation. Whenever possible, this training should be provided
during regular working hours.
B. [Formerly paragraph 21:011] Indoor
environmental surfaces associated with children's activities and objects
handled by children shall be cleaned when soiled and at least on the following
basis.
1. Table tops and objects handled by
children such as washable toys shall be cleaned at least once weekly. Items
that children may place in their mouths shall be washed and sanitized at least
daily. Soft, non-washable toys shall be limited to personal use items brought
from home that are not shared between children.
2. All walls and ceilings shall be of a color
that readily shows soil. Walls, ceilings, and other surfaces shall be
maintained in good repair and in a clean condition; not able to visibly
contaminate cold rinse water.
3.
Floors, except those carpeted, shall be vacuumed or swept, and mopped with a
disinfecting solution at least daily and when soiled. Soiled mop water shall be
disposed of immediately after use. Stored mops shall be hung.
4. Carpeted floors and large throw rugs which
cannot be washed, shall be vacuumed at least daily and shampooed at least every
three months and when soiled.
5.
Toilet rooms and fixtures shall be cleaned and disinfected at least daily and
shall be in good repair. Toilet rooms shall have walls, floors and ceilings of
a smooth, easily cleanable finish, and shall be painted a light color. These
rooms must be ventilated by means of a ventilation system in compliance with
Part XIV.
6. Potty chairs and
diaper changing surfaces shall be cleaned and disinfected after each
use.
7. Any object or surface
contaminated by bodily fluids (e.g., urine, feces, blood, wound or tissue
exudate) shall be cleaned immediately and disinfected with a fresh solution of
household bleach diluted 1/4 cup in 1 gallon of water made fresh every 24
hours.
8. Soap and separate paper
towels will be provided at handwashing sinks.
C. [Formerly paragraph 21:012] Coat hooks
spaced at least 12 inches apart, or individual cubicles or lockers, child's
height shall be provided for storage of clothing and personal possessions of
the children.
D. [Formerly
paragraph 21:013] All areas accessible to children shall be free of toxic or
hazardous materials and conditions.
1.
[Formerly paragraph 21:013-1] Cleaning materials, detergents, aerosol cans,
pesticides, health and beauty aids, poisons, and other toxic materials shall be
stored in their original labeled containers and shall be used only in a manner
that will not contaminate play surfaces, food, food preparation areas, or
constitute a hazard to the children. When not in actual use, such materials
shall be kept in a locked place inaccessible to children and stored separately
from medications and food. Matches and lighters shall be inaccessible to
children.
2. [Formerly paragraph
21:013-2] All medications will be kept in a locked cabinet.
3. [Formerly paragraph 21:013-3] Poisonous or
potentially harmful plants on the premises shall be inaccessible to
children.
4. [Formerly paragraph
21:013-4] No pets shall be maintained on the premises except aquarium fish if
they are kept out of the reach of children, or animals to aid the
disabled.
5. [Formerly paragraph
21:013-5] Electrical outlets accessible to the children shall be covered with
child resistant covers or be of the child-proof type.
6. [Formerly paragraph 21:013-6] All stair
cases must be provided with suitable barriers to prevent access by children.
All porches and decks where children are allowed to play must be provided with
suitable barriers to prevent falls.
7. [Formerly paragraph 21:013-7] Smoking
shall not be permitted in indoor areas of the child care facility.
8. [Formerly paragraph 21:013-8] Premises
shall be maintained free of insect, rodent or other pest infestations or
haborages. Application of any pesticide shall not be done when children are
present. No restricted use pesticides shall be stored or used on the premises
unless by properly licensed persons.
9. [Formerly paragraph 21:013-9] Open
containers such as mop buckets shall not be left unattended.
E. [Formerly paragraph 21:014]
Openings to the outside shall be protected against the entrance of flies or
other flying insects by outward opening, self-closing doors, closed windows,
screening or other effective and approved means.
F. [Formerly paragraph 21:015] Each
foundation, floor, wall, ceiling, roof, window, exterior door, and basement
shall be free from openings which may permit the entry of rodents.
G. [Formerly paragraph 21:016] Each center
shall be provided with a designated area for the care of a child who needs to
be separated from the group due to injury, illness or the need for additional
rest. This area shall be located so the child may be supervised. Toilet and
lavatory facilities shall be readily accessible. If the child under care is
suspected of having a communicable disease, all equipment used by the child
shall be cleaned and sanitized after use. This area may be used for other
purposes when not needed for the separation and care of a child or if the uses
do not conflict.
H. [Formerly
paragraph 21:017] All formula bottles for those children still on bottles must
be properly designated with the particular child's name attached to the bottle.
These formulas are to be brought in bottles with caps and tops and shall
immediately be placed under refrigeration by the operator. When bottles are
emptied, they must be promptly cleaned and any bottles to be reused must be
properly sterilized.
I. [Formerly
paragraph 21:018] In child care centers, infants shall be cared for in an area
separated by a suitable barrier from older children. Activities which bring
infants and older children in contact with each other shall be
limited.
AUTHORITY NOTE:
Promulgated in accordance with the provisions of
R.S.
40:4(A)(10) and
R.S.
40:5.
