Last reviewed 4 January 2022
Nurseries and other childcare provisions are often seen as breeding grounds for infection and children can seem to suffer an endless cycle of minor illnesses. With the peak winter infection period approaching, all early years providers need to ensure they have up-to-date infection control policies and procedures in place. Staff, parents and children should all be aware of the role they can play in preventing infection outbreaks during the winter and this good practice should be maintained throughout the year, says Elizabeth Walker.
Types of illness
Colds and coughs are usually more apparent in the winter season, although they can occur at any time of year. These ailments are not usually serious enough to prevent attendance at a childcare provision, as long as the child feels happy to do so. However, some infections such as coronavirus, and norovirus (also known as the winter vomiting bug), can pose more risk. Children with the following symptoms should be excluded from the provision.
Diarrhoea and/or vomiting.
Fever or temperature (above 38°C).
A new continuous cough.
Loss of sense of smell or taste.
Infectious illness, eg chickenpox, mumps or measles.
Childcare providers must inform Ofsted and the Health Protection Agency (HPA) of any notifiable disease, such as measles, meningitis, mumps, etc, if a child in their care becomes infected. Provisions should act on any advice given by the HPA and inform Ofsted of any action taken.
Procedures to prevent the spread of infection
Effective infection control measures are essential to protect both children and adults. Childcare providers need to be aware of the following good practice.
Immunisation is the most effective preventive measure for the more serious infectious illnesses. For the most up-to-date immunisation advice see the NHS Choices website. Staff should also be up to date with their immunisations, including Coronavirus vaccines.
Childcare providers have recently been called upon to help raise awareness of the childhood flu immunisation programme. Under this programme, all children aged two, three and four years old on 31 August (2021) are eligible for a free annual flu vaccination in the form of a nasal spray. Children under the age of five have the highest hospital admission rates for flu compared to other age groups, but not all parents are aware of the vaccination. Further information on the flu immunisation programme can be found in the guidance Immunising preschool children against flu (July 2021).
Handwashing is one of the simplest and most important ways of preventing the spread of infections, especially those that cause diarrhoea and vomiting or respiratory disease.
Infections can be spread through hands touching other people or surfaces such as door handles, taps, toilet flush handles, toys, tables, etc. It is recommended that:
there is an adequate supply of wash basins that are easily accessible for staff and children
warm water, liquid soap and paper towels are used
hands are washed after using the toilet, and before eating or handling food
hands are washed after handling animals
cuts and abrasions are covered with waterproof dressings.
Coughs and sneezes
Coughs and sneezes quickly spread infections. Children and adults should be encouraged to:
wipe their noses thoroughly with a tissue when runny
cover their mouth and nose with a tissue when sneezing or sneeze into the bend of their elbow
dispose of tissues in the bin
wash their hands after using or disposing of tissues.
A clean environment is essential to prevent the spread of infection, as germs cannot grow on a clean dry surface. It is important to make sure any damaged surfaces are replaced, since germs can accumulate and survive in rough areas and scratches. Childcare provisions should ensure that:
the environment is visibly clean and free from dust and soilage
toys are cleaned and dried after use
when an outbreak of diarrhoea or vomiting occurs, play with sand, water and plasticine/play dough is suspended until the outbreak is over.
Food and water can act as vehicles for the spread of infections. Childcare providers should ensure that:
the provision has a designated space for the preparation of food which is clean and inaccessible to children
staff wash their hands before they prepare, serve or eat food
there is an adequate supply of washbasins placed in food preparation areas
staff who show signs of illness are not involved in food preparation.
Blood and bodily fluids
All spillages of blood and bodily fluids should be cleaned up immediately using disposable gloves and aprons. Always segregate domestic and clinical waste in accordance with local policy. Soiled children’s clothing should be sealed in a plastic bag to go home and not washed or rinsed on site.
Some medical conditions make children vulnerable to infections that would rarely be serious in most children, such as leukaemia or other cancers, or conditions that seriously reduce immunity. Early years provisions need to be made aware of any long-term medical conditions on admission as these children are particularly vulnerable to chickenpox, measles or parvovirus B19. If exposed to such infections, staff must inform the child’s parents as soon as possible and further medical advice should be sought.
With the peak winter infection period approaching, early years providers should ensure that they have reviewed all their policies and procedures relating to illness and infection control. Key points to consider include the following.
Children and staff who are unwell, have a temperature, or sickness and diarrhoea, or who have an infectious disease will be excluded from the provision.
Children should not return to the provision until 48 hours after they have been symptom free.
Provision will be made to accommodate children with long-term illnesses or ailments wherever possible and, if appropriate, a care plan will be drawn up.
If a child becomes ill at the provision the first aider will be asked to see the child immediately and the child’s parents/guardians will be called and asked to collect them.
If the child’s condition worsens such that it causes concern to the first aider and staff then suitable medical treatment should be arranged in the form of a GP, an ambulance or transport to Accident and Emergency as appropriate and the parents/guardians informed.
Children prescribed antibiotics to treat an infection should remain at home for at least 48 hours to support them with their recovery, returning only when they are well enough to participate in a normal childcare session.
Parents/carers need to make arrangements for emergency care to be available should their child become unwell during the day and leave adequate contact numbers. The childcare provider must have a protocol in place for contacting parents/carers.
Where a number of cases of an infection occur, such as an outbreak of Covid-19, diarrhoea or vomiting, the provision should report the outbreak and obtain expert advice from local infection control teams.
Staff should be trained in hygiene methods, infection control, and supporting children in their own personal hygiene.
An effective policy on administering medicines must be in place.
Child Flu Vaccine (August 2021)
Coronavirus (COVID-19) symptoms in children (December 2021)
NHS Immunisation Information (July 2022)
Norovirus Schools Guide for Early Years Professionals, NHS Choices, in collaboration with the Food Standards Agency