Infection Control Recommendations for Childcare Centres when Reopening

• Where possible, daily screening should be started electronically (e.g. online form, survey or email) prior to arrival.
• Post signage (i.e. passive screening) at public and staff entrances to prompt anyone to not enter if they feel unwell, have symptoms of COVID-19, have travelled outside of Canada in the past 14 days, or been in close contact with a confirmed case of COVID-19.
• Post signage at public entrances advising visitors not to enter business.
• All individuals, including children, parents/guardians and staff must be screened each day upon arrival before entering the building. This should include daily temperature checks. Deny entry to any person including the child of a parent/guardian who has any of the symptoms outlined in the ‘COVID-19 Reference Document for Symptoms’ on the Ministry of Health’s COVID-19 website.
  • Screeners should take appropriate precautions when screening, including maintaining a distance of at least 2 metres (6 feet) from those being screened, or being separated by a physical barrier (such as a plexiglass barrier), and wearing personal protective equipment (PPE) (i.e., surgical/procedure mask and eye protection (goggles or face shield)
• As much as possible, parents should not go past the screening area.
• Children should be escorted to their program after screening.
• Where reservations or other appointments are made, advise or screen callers indicating to not attend premise if they feel unwell, have symptoms of COVID-19, have travelled outside of Canada in the past 14 days, or been in close contact with a confirmed case of COVID-19.

All cohorting/group sizes and staff to child ratios are to meet provincial requirements as outlined in the Ministry of Education’s Operational Guidance During COVID-19 Outbreak – Child Care Re-Opening

• Childcare programs should operate in cohorts with no more than 15 children. Staff are not included in this number but should still be considered part of the cohort that stays together and should avoid as much as possible interacting with other cohorts.  
• Children attending on a part-time basis (e.g. half days, only Mondays and Wednesdays) should be counted in the total number of individuals in the cohort, even on the days when they are not attending the program.  
• Staff should work at only one location. Supply/replacement staff should be assigned to specific cohorts and supervisors (or designates) should limit movement between rooms only doing so when absolutely necessary.  
• Staff members assigned to a group of children should not work or interact with other staff or children during the work day. If there is need to speak with other staff, they should maintain a distance of 2 metres (6 feet) and wear and mask.  
• If staff are required to change to other duties involving potential interaction with another cohort, they must wear a mask when entering the space of the other cohort. The staff member should practice hand hygiene when entering and leaving the space.  
• Cohorts should not use the same room/space at the same time. This includes, use of washroom and outdoor spaces.  
• It is recommended that each cohort have scheduled drop off, pick up, meal times, and play times in a manner such that the groups are not using the same space at the same time.  
• Each cohort should have designated equipment. If you are unable to do so, ensure that equipment is cleaned and disinfected before and after each cohort use.  
• Sleeping should take place in a designated room that is only occupied by the same cohort.  

• Each cohort must have their own assigned indoor space separated from all other cohorts by a physical barrier. The physical barrier must begin at the floor and reach a minimum height of 8 feet to ensure that it will always be taller than the tallest person in the facility.  It must be as wide as the space/room will allow.
• Maintain physical distancing of at least 2 metres at all times. Considerations should be made for occupancy and layout of both indoor and outdoor areas to address this (e.g. play areas).
• Limit the total number of people at the workplace and where they are assigned to work. Have staff work from home whenever possible (i.e. administrative staff). Restrict visitors and limit workplace entry to only essential personnel.
  • For any play activity room that is currently licensed for a maximum group size of less than 15 children due to square footage requirements (e.g., infant room 1 is licensed for 6 children), licensees can only have the number of children listed on the licence.
  • Infant groups can have a maximum group size of 10 children as this age group has never been permitted to include more than 10 children in a group.
  • There are no changes to the maximum group size for home child care which allows for a maximum of 6 children, not including the providers own children who are 4 years or older.
• Pick-up and drop-off of children should happen outside the childcare setting unless there is a determined need for the parent/guardian to enter the sitting.
• Place signage and markers to notify children, staff and others attending of physical distancing requirements. Consider using signage/markings on the ground to direct families through the entry steps.
• Encourage physical space between children by spreading children out into different areas; staggering or alternating lunchtime and outdoor playtime and incorporating more individual activities or activities that encourage more space between children.
• Personal belongings (e.g., backpack, clothing, etc.) should be minimized. Keep personal items brought into the childcare separate and spread out (e.g. jackets, shoes, bags).
• Limit the amount of face-to-face contact during activities (for children and staff).
• Arrange furniture (e.g. cribs) and other items used by children and staff more than 6 feet apart. Increase distance between nap mats or if space is tight place children head to toe or toe to toe.
• Do not use community playgrounds; however outdoor play at licensed childcare sites is encouraged in small groups which facilitate physical distancing.
• Set and post occupancy limits for indoor areas. Smaller public areas within the premise (e.g. washrooms) should also have occupancy limits that are posted.
• Continue to limit or reduce workspace occupancy through work from home, work schedules and break schedule adjustments where possible.
• Where two cohorts are using the same indoor space (e.g. gym), ensure that a floor to ceiling temporary physical barrier is in place to ensure that physical distancing of at least 2 meters between cohorts is maintained. The physical barrier must begin at the floor and reach a minimum of 8 feet to ensure that is always 12 inches taller than the tallest person in the facility. It must be as wide as the space/room will allow.
• Avoid carpooling. Where sharing vehicles is required, passengers should sit in back seats (if available).  Commuters should wear masks and open windows if possible.

• Have all staff, parents, children, volunteers and contractors wash their hands thoroughly with soap and water before entering the workplace and after contact with surfaces others have touched. Hand washing is required where hands are visibly dirty whereas hand sanitizer can be used if hands are not visibly dirty.
• Incorporate additional hand hygiene opportunities into the daily schedule.
• Where possible, supervise hand washing. Children should always be supervised if using hand sanitizer.
• Position hand sanitizer stations in accessible but safe locations. Dispensers should not be in locations that can be accessed by young children.
• Post signage to encourage proper hand washing in washrooms and food handling areas.
• Ensure hand wash stations are adequately supplied at all times.

• Develop a schedule for increased, routine cleaning and disinfection as well as daily ‘complete’ cleaning before and during operation.
• Cots and cribs should be disinfected after each use.
• Ensure all toys used at the centre are made of material that can be cleaned and disinfected.
• Toys and equipment should be cleaned and disinfected at a minimum between cohorts.
• Mouthed toys should be cleaned and disinfected immediately after the child is finished using it.
• Washrooms are to be cleaned and disinfected at least twice per day and when visibly soiled.
• Ensure staff are trained in proper use of cleaning and disinfection products (e.g. contact times, if PPE needs to be worn)
• Clean and disinfect high touch surfaces such as door knobs/handles, phones, railings, faucets, toilets, and other shared items frequently. Clean and disinfect shared objects (e.g., tables, counter tops, toys) between each use.  Surfaces should be immediately cleaned following spills or where someone displays respiratory symptoms (e.g. cough or sneeze) in the area.  Remove items that cannot be properly cleaned or disinfected (e.g. stuffed animals) after becoming contaminated.
• Change stations should be cleaned and disinfected between each use.
• Disinfectants used should have a DIN and virucidal claim.
• Wash, rinse, disinfect, and then sanitize food contact surfaces, food preparation surfaces, and food preparation equipment.
• Ensure that cleaning or disinfecting product residues are not left on table surfaces. Residues could cause allergic reactions or cause someone to ingest the chemicals.
• Ensure safe and correct use and storage of disinfectants to avoid food contamination and harm to employees, children and other individuals. This includes storing products securely away from children.
• Use gloves when removing garbage bags or handling and disposing of trash. Wash hands after removing gloves.

• Avoid using water or sensory tables. If sensory materials (e.g., playdough, water, sand, etc.) are offered, they should be provided for single use (i.e. available to the child for the day) and labelled with child’s name, if applicable.
• Reinforce “no food sharing” policies.  If meals or snacks are provided, ensure each child has their own individual meal or snack. Multi-use utensils must be sanitized.
• Children must not share food, soothers, bottles, sippy cups, toothbrushes, facecloths etc. Label these items with the child’s name to discourage accidental sharing.
• When holding infants and toddlers use blankets or cloths over clothing and change the blankets or cloths between children.
• Thermometers must not be used between children/staff without single-use protective covers or disinfecting between use.
• Children should bring their own sunscreen where possible and it should not be shared. Staff may provide assistance to apply sunscreen to any child requiring it and should exercise proper hand hygiene when doing so (for example washing hands before and after application).
• Play structures can only be used by one cohort at a time.
• Where possible, try to provide personalized kits for children (e.g. craft kit) instead of sharing items.
• Linens must be laundered between children.
• Discourage sharing of items that are difficult to clean, sanitize, or disinfect.  Shared spaces and structures that cannot be cleaned and disinfected between cohorts should not be used.
• Home child care providers are encouraged to have designated toys and equipment (e.g., balls, loose equipment) for each room or cohort. Where toys and equipment are shared, they should be cleaned and disinfected prior to being shared.
• Limit any sharing of food, tools, equipment, or supplies by staff members.
• Ensure adequate supplies to minimize sharing of high-touch materials (e.g., serving spoons) to the extent possible; otherwise, limit use of supplies and equipment by one group of staff at a time and clean and disinfect between use.
• Use touchless payment options as much as possible, if available. Ask customers and employees to exchange cash or card payments by placing on a receipt tray or on the counter rather than by hand to avoid direct hand to hand contact.
• Clean and disinfect frequently touched surfaces such as pens, counters, or hard surfaces between use and encourage patrons to use their own pens.

• Meal practices should ensure there is no self-serve or sharing of food at meal times.
• Meals should be served in individual portions to the children.
• Food service items (e.g. utensils, dishes) should only be provided upon food service.
• Use disposable food service items (e.g., utensils, dishes, napkins, tablecloths). If disposable items are not feasible or desirable, ensure that all non-disposable food service items are handled with gloves and washed with dish soap and hot water, or in a dishwasher. Employees should wash their hands after removing their gloves or after handling used food service items.
• There should be no food provided by the family outside of the regular meal provision of the program (except where required and special precautions for handling and serving the food must be put in place).
• Children should neither prepare nor provide food that will be shared with others.
• Ensure proper hand hygiene is practiced when staff are preparing food and for all individuals before and after eating.
• Where possible, children should practice physical distancing while eating.
• There should be no sharing of utensils.

• Masks must be worn in all enclosed areas that members of the public can access and in all enclosed areas where employees cannot maintain 2 metre physical distance.
• All children in grades 4 and above are required to wear a non-medical or cloth mask while inside in the child care premises, including in hallways.
• All school-aged children are encouraged but not required to wear a mask while inside in the child care premises, including in hallways. Parents/guardians are responsible for providing their school-aged child(ren) with a mask(s).
• The use of masks is not required outdoors for adults or children if physical distancing of a least 2-metres can be maintained between individuals.
• Reasonable exceptions to the requirement to wear masks are expected to be put in place by childcare operators. Exceptions to wearing masks indoors could include circumstances where a physical distance of at least 2 metres can be maintained between individuals, situations where a child cannot tolerate wearing a mask, reasonable exceptions for medical conditions, etc.
• Operators should document their requirements and exceptions related to masks.
• Masks are not recommended for children under the age of two
• Where persons cannot maintain physical distancing, install barriers (e.g. plexiglass) or provide appropriate PPE (e.g. masks for staff who may need to be within 2 metres (6 feet) of customers or other staff members).
• Appropriate PPE should be determined based on the task being completed.
• Ensure staff are trained as to how to don (i.e. put on) and doff (i.e. take off) PPE
• Change out of work clothing at the end of each shift and wash them. Do not store your street clothes and work clothing in the same space unless both are clean

• Avoid offering any self-serve food or drink options.
• Avoid cash transactions. Debit or credit using ‘tap’ option is preferred.
• Consider implementing a system for virtual and/or telephone consultations when and where possible. Non-essential face-to-face appointments should be postponed or converted to virtual appointments.
• Consider extending business hours if it reduces surges in patrons attending workplace.
• Hold meetings so that everyone is 2 m or more apart, online or via teleconference.
• Offer options for vulnerable employees at higher risk for severe illness (including older adults and people of all ages with certain underlying medical conditions) that limits their exposure risk (e.g., modified job responsibilities).

• For those on a municipal or communal water supply, flush your water lines by opening all faucets for 10-15 minutes and the water runs clear.
• For those on a private water supply, ensure equipment is operating properly (e.g. filters, treatment units), flush and consider shock chlorinating system. Only commence use of water system once satisfactory drinking water samples are obtained.  For Small Drinking Water System Operators, follow regulatory requirements (O. Reg. 319/08)

• Where possible, increase the ventilation system’s air intake or open doors and windows. Avoid central re-circulation where possible. Change HVAC system filters regularly.
• Similarly, open windows when in vehicles with others where possible.

• Log all children, volunteers, contractors (e.g. for special needs), and staff attending the daycare on a daily basis. This information is crucial in the event of an outbreak.
• Child care centres must have protocols in place to notify parents/guardians if their child begins to show symptoms of COVID-19 while in child care, including the need for immediate pick up.
• Children in particular should be monitored for atypical symptoms and signs of COVID-19. Click here for more details.
• Do not permit children who are ill to attend the child care centre.
• Symptomatic children should be separated from others in a supervised area until they can go home. If a separate room is not available, the sick person should be kept at a minimum of 2 metres (6 feet) from others.
• Anyone who is providing care to the symptomatic child should maintain a distance of 2 metres (6 feet).
• Have the child (if above the age of 2 and tolerated) wear a surgical/procedure mask. Persons caring for them should also wear a surgical mask, eye protection, any other PPE appropriate for the circumstance and not interact with others.
• The person providing care should also avoid contact with the ill person’s respiratory secretions;
• Hand hygiene and respiratory etiquette should be practiced while the child is waiting to be picked up.
• Tissues should be provided to the child for proper respiratory etiquette, along with proper disposal of the tissues.
• Childcare centres within the meaning of the Child Care and Early Years Act, 2014, have a duty to report suspected or confirmed cases COVID-19 under the Health Protection and Promotion Act. The centre should notify the HNHU by completing and submitting the HNHU’s School and Childcare Centre IIlness Reporting form The HNHU will provide specific advice on what control measures should be implemented to prevent the potential spread and how to monitor for other possible infected staff members and children. The HNHU can also provide the employer guidance on what information should be shared with other parents/guardians of children in the childcare centre.
• Environmental cleaning of the space where the child is separated from others should take place following their pick up. Additionally, all spaces and items attended and handled by the child should be cleaned and disinfected. All items that cannot be cleaned (paper, books, cardboard puzzles) should be removed and stored in a sealed container for a minimum of 7 days.
• Other children and staff (including siblings and other immediate family members of the sick individual) in the centre who were exposed to the ill child or staff member should be identified as a potential contact and further cohorted (i.e., grouped together). The local public health unit will provide any further direction on testing and further actions needed based on the level of exposure for these contacts. For example, those within 2 metres (6 feet) of ill individual for 15 minutes or more may be required to self-isolate while those who simply walked by the ill individual should just monitor themselves for symptoms for 14 days.
• Symptomatic staff and children should be referred for testing. Testing of asymptomatic persons should only be performed as directed by the local public health unit as part of outbreak management.
• The employer should consult with the local public health unit to determine when the staff member can return to work.
• Licensed child care centres must consider a single, symptomatic, laboratory confirmed case of COVID-19 in a staff member or child as a confirmed COVID-19 outbreak in consultation with the local public health unit. Outbreaks should be declared in collaboration between the centre and the local public health unit to ensure an outbreak number is provided.
• For home-based child care: if a person who resides in the home becomes symptomatic and/or tests positive for COVID-19, the home-based child care centre should not operate until clearance is received from the local public health unit.

• Ensure staff know how to report an illness in a timely manner and take action to protect themselves and others when at work
• Review signs, symptoms and methods of transmission of COVID-19
• Consider having a point person for each shift that can address COVID-19 concerns
• Provide staff health and safety training including but not limited to how to properly clean the space and equipment, how to safely conduct daily screening and keep daily attendance records, and what to do in the case that someone becomes sick.
• As with all workplaces, the Occupational Health and Safety Act must be applied.  Safety is everyone’s responsibility under the act and thus all staff should assess and plan to address their tasks with infection control in mind.  Application of R.A.C.E. is recommended:

R – recognize the hazard

A – assess the risk associated with the hazard

C – control the risk associated with the hazard (e.g. Hierarchy of Controls)

E – evaluate the controls