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Procedures for good hygiene in childcare settings

For everyone to ensure that children are kept safe and free from harm the manager will need to be certain that all staff maintain good hygiene to provide a hygienic environment and that all the procedures and practices are followed in order prevent the spread of infection.

Hand Washing 

Hand washing is probably one of the simplest and most effective ways of preventing the spread of infection providing it is done correctly.  Holding hands under running water for a few seconds does not constitute washing them and children need to be taught the importance of this routine procedure.  Set good examples for staff and children at all times and let them see you wash your hands frequently and correctly.

Hands should be washed:

  • After visiting the toilet.
  • Before and after dealing with cuts and grazes.
  • After coughing and sneezing.
  • After blowing noses.
  • After changing nappies.
  • After wiping bottoms.
  • Before preparing food.
  • Before eating.
  • Before feeding children or babies.
  • After handling money.
  • After handling pets.
  • After cleaning up after pets.
  • After cleaning up vomit or other bodily fluids (gloves should be worn when carrying out this activity but hands must also be washed afterwards).
  • Before sitting down to eat or drink.
  • After playing outside.
  • When they appear dirty!

Although long, this list is not exhaustive, and you may be able to think of other times when hands need to be washed.  It is very important that you discuss with staff and children when and why they need to wash their hands and that you encourage them to practise hygienic and healthy procedures at all times. When teaching anyone how to wash their hands thoroughly, follow these steps:

  • Wet hands thoroughly.
  • Add soap. Ideally you should use liquid soap as bars of soap can attract bacteria particularly if they are left to sit in water.
  • Vigorously massage both hands with the lather. Start by rubbing palm to palm, then rub right palm over back of left hand and vice versa. Interlace fingers, massage the back of the fingers and between each finger and thumb, paying particular attention if you wear any rings. Either remove these and wash them separately or wash underneath them whilst they remain on your finger.
  • Rinse hands well, removing all soap.
  • Dry hands thoroughly, preferably using a paper towel.

Food Safety

As a manager of a nursery part of your job will be to oversee other staff preparing, cooking and serving food and drinks for the children in the setting.  The way that these procedures are carried out is very important as it will not only contribute to the health of the children, it will also teach them sensible eating habits.  When possible always use fresh produce and encourage children to try a variety of foods. Remember, children’s preferences change constantly and whilst they may not like a particular food one week this may well change if you re-introduce the same food a couple of weeks later.  Managers may need to monitor food waste and set budgets therefore it is essential that you know what children like and what is healthy to avoid over spending.

It is essential that you think carefully about how food is prepared, stored and handled in order to prevent passing on food-borne illnesses such as Salmonella and Listeria to the children.  Young children, in particular, are very vulnerable to such illnesses, and it is therefore important that staff are aware of good practice at all times and a good manager will ensure that procedures are being adhered to.

Storing food

It is essential that the nursery cook understands the importance of storing food correctly in order to avoid cross-contamination.  For example, you should never store raw meat next to other foods in the fridge.  Make sure that raw meat is placed at the bottom of the fridge, in a leak proof container, to avoid blood and other juices which may contain harmful bacteria, dripping onto other foods. The list below gives guidance of how food should be stored:

Packets/cans/jars

Always store these in a cool, dry place. Check the ‘sell by’ and ‘use by’ dates and make sure that the food is consumed accordingly.  Many people wrongly assume that dried or canned foods have an indefinite shelf life; however, this is simply not true and food in cans should be eaten within twelve months of purchase or by their expiry date.  If you are unsure of the ‘use by’ date, throw the food away. Never give food to babies or young children which may be out of date.

Canned foods and juices

Once opened, must be transferred to a leak proof container before covering and storing in the fridge.  Once a can has been opened, the quality of the contents will be affected, and it is not good practice to store cans, which have been opened, in the fridge.

Salad

Always store salad ingredients at the bottom of the fridge.

Vegetables

Once again, these should be stored at the bottom of the fridge.

Fruit

Although many people understand the importance of storing salad and vegetables in the fridge, often fruit is forgotten and is placed in a bowl left on the table/kitchen counter. However, it is important to remember that by leaving fruit out in this way makes it vulnerable to contamination.  It is a health risk to leave food out which can be touched by anything or anyone including pets and flies.  Think carefully about how you store fruit and always wash it before use.

Refrigeration safety

As previously it is important that food is stored in the fridge correctly.  All food should be stored in a suitable, leak-proof container, and it should be covered.  Fridges should be set no higher than 5° C; freezers should be set at -18° C.  Avoid over-filling the fridge as it is essential that air can circulate in order for it to stay cool.  Food should be stored in the fridge as follows:

  • Bottom- this area should be for fruit and vegetables. Most fridges will have a specially designed box for these food items.
  • First shelf from the bottom- use this shelf for raw meat and fish
  • Next shelf up use for yogurts, condiments, eggs etc.
  • Top shelf use for storing butter, jars etc which pose no threat of leakage.
  • Milk, juices, soups etc. should be stored in the door of the fridge.

Food should never be allowed to thaw out on a kitchen work surface.  Place the food in a leak-proof container and allow it to thaw out in the fridge.  Make sure that it is completely thawed through before cooking. Once food has been defrosted you must never re-freeze it.

A good manager should be actively seen to check all aspects of the workplace, including the kitchen.  Ask to look at completed temperature records and open the fridge and cupboards on a regular basis to see if food is being stored correctly.  If in any doubt, ask questions and make sure that you are happy with the response given by the staff.

Food preparation safety

It is essential that, in addition to storing food safely, staff also need to understand the necessity for safe and hygienic food preparation in order to avoid infection. By taking note of the following points you will be able to ensure that all potential problems caused by harmful bacteria are eliminated:

  • Always wash hands before preparing or cooking food.
  • Never use the same board for cutting and preparing raw meat, vegetables and bread. Always use a separate board for each food. Plastic chopping boards are preferable as these are much easier to keep clean than wooden ones. It is good practice, when preparing food to use different coloured plastic boards for different types of food to eliminate any chances of cross contamination.
  • As with boards, it is essential that the same knives, plates or other utensils are not used for cutting or preparing different foods.

The kitchen is often overlooked when it comes to managers overseeing the day to day running of the setting and this is something which should be addressed. Managers often spend time in the rooms observing how staff work with children and carrying out risk assessments of the toys and play areas however few think about including the kitchen and it is worth spending an hour or two observing the cook carrying out his/her duties and making sure that standards are not being compromised particularly if they are working along and therefore have no one to answer to.

Women cutting food with gloves

Risk assessments for storing, preparing and cooking food

When spending time in the kitchen make a few notes of potential hazards and discuss these with the cook.  It is important that you ensure that you are not trying to pick fault in the way the cook goes about their duties but often a fresh pair of eyes will notice things that are taken for granted on a routine basis.

 

HAZARD

 

RISK

 

RISK RATING

 

ACTION TAKEN

Wooden chopping board

 

Cross contamination of bacteria from raw and cooked foods.  High risk Confirm order of new boards
Fruit left in fruit bowl on work surface

 

Contamination from coughs and sneezes, risk of germs from flies etc. Medium risk Keep covered or preferably store in the fridge.  Wash all fruit before consumption.

Food provides an ideal way of transmitting bacteria and infection to humans, and it is therefore essential that managers assess the way food is stored, prepared, cooked and served.  Food poisoning is classed as a ‘notifiable disease’, and it is possible, in extreme cases, usually in the very young and the very old, for death to occur as a result of severe food poisoning.

We are surrounded by bacteria and, indeed we actually need bacteria for our bodies to remain healthy; however, if certain forms of bacteria were allowed access to our food they would multiply quickly resulting in food poisoning.  The chart below gives examples of some of the main types of bacteria, their source, the symptoms they cause and how an outbreak can be prevented.

Type of bacteria Source Symptoms Prevention
Salmonella Found in raw eggs and chicken and the intestines of animals and birds. Diarrhoea, vomiting, fever, severe abdominal cramps lasting from 1-7 days. Never store raw and cooked foods near one another in the fridge.  Never give raw eggs to children in any form.  Ensure that all meat is cooked thoroughly in order to ensure that any bacteria is destroyed.
Staphylococcus aureus Found in the nose, throat and mouth of humans.  Also present in skin, hair, cuts and open sores. Vomiting and severe abdominal pain which can last up to 24 hours. Wash hands frequently when preparing and cooking food particularly if you have a cold.  Tie hair back and cover any cuts or open sores with an appropriate dressing.  Avoid touching the nose and mouth.
Clostridium perfringens Found in the soil, it is transmitted via dust, insects and faeces. Diarrhoea and severe abdominal pain which can last up to 48 hours. Thorough washing of hands before handling food stuffs.  Make sure that raw and cooked foods are not stored together and ensure that all food is cooked thoroughly, particularly meat based dishes.
E. Coli This is the usual bacterium found in the human digestive tract which is transferred by the failure to wash hands thoroughly. Diarrhoea, vomiting and severe abdominal pain which can last anything from 1 to 5 days. Ensure that you practise good personal hygiene methods and that you wash hands frequently particularly after visiting the toilet, wiping noses etc.
Listeria This is caused by a result of cross contamination from the environment and can be found in prepared, chilled foods. Listeria is very dangerous to young babies and to pregnant women.  Symptoms of Listeria include fever, septicaemia and meningitis. Be careful how you store food and always make sure that your fridge is kept at the correct temperature and that air can circulate.  Vulnerable people such as pregnant women and young children should not be given soft cheeses, pate, or meals which have been re-heated.
Tidy Nursery

Hygienic Work Practices

Child care practitioners must practise hygienic work methods and, more importantly, they must be seen to be doing so. Children learn from the adults around them, and it is therefore paramount that the children witness first-hand how you wash your hands, prepare the food, clean up after accidents etc.

Most large settings will have a policy in place for cleaning equipment and toys, and often they will employ cleaners and caretakers to carry out these tasks. However a good manager will still look at the procedures used and, more importantly, check that they have been done.  Again, ask to look at the cleaning rota which should detail what was cleaned and when.

The chart below sets out some of the common hazards you and your staff should be looking out for everyday when toys and equipment are put away.

Material Signs of wear Examples
Wood Splinters

Cracks

Rough edges

Flaking or peeling paint

Tables, chairs, shelves etc.

Wooden toys such as dolls houses, jigsaws, vehicles etc.

 

Plastic Cracking

Splitting

Fading of colours

Chairs

Toy boxes

Toilet seats/potties

Bicycle/tricycle seats

Tableware, beakers, plates etc.

Plastic toys such as rattles, vehicles, etc.

Metal Rust

Flaking/chipped paint

Highchairs, pushchairs, car seats, outdoor equipment such as climbing frames, slides and swings.

Toys and play equipment will be handled often by lots of children throughout the course of the day.  Remember that babies and young children explore using their mouths, and objects will soon become unhygienic if not cleaned properly on a regular basis.  It is often the job of the manager to arrange cleaning rotas and set out when and how sterilising of toys and equipment should be done.

The main areas which will need particular attention paying to when cleaning are:

  • Toilets and hand basins
  • Work surfaces
  • Feeding equipment
  • Toys and play equipment
  • Tables and highchairs
  • Floors
  • Bins
  • Potties and changing mats

We will now look carefully at each of these areas and how they can be cleaned effectively.

Toilets and hand basins

These must be cleaned as and when necessary.  There is no point instructing staff to clean the toilet at the end of the day when the children have gone home, if someone has had an accident at lunchtime resulting in a wet or soiled floor or dirty toilet seat!  Toilets and hand basins must be monitored throughout the day and cleaned when necessary.  They should, however, also be thoroughly cleaned at the end of each day.  The whole of the toilet, both inside and out should be cleaned using a strong disinfectant or bleach solution in order to kill the bacteria which inevitable lurks here, pay particular attention to the area under the rim and the handle.

Work surfaces

It is absolutely essential that these are kept scrupulously clean at all times to prevent the spread of infection.  Work surfaces should be wiped down regularly with a clean cloth and a suitable disinfectant solution.

Feeding Equipment

Babies and young children are exceptionally vulnerable to infection, and it is therefore paramount that bottles and feeding utensils are sterilised for all babies under 12 months of age.

Toys and play equipment

Toys and play equipment will be handled often and by numerous children throughout the day.  Young children in particular will be prone to putting objects in their mouths and often children taking part in role play activities, for example, will pretend to eat and drink the food using a play kitchen and utensils, often putting them in their mouths therefore it is essential that plastic items are sterilised.  If the setting has a dishwasher, try putting plastic toys in there to be washed; it saves a lot of time and they will be washed at a high temperature.  Other items, such as plastic rattles and soft toys can be washed effectively by placing them in a pillowcase, fastening securely and washing them in the washing machine.   Larger items will need to be wiped down with a clean cloth and suitable disinfectant solution.

Bear in mind that all toys and equipment will need some form of cleaning and it is a good idea to enquire about the maintenance of an item before purchasing it.  If the item appears difficult to clean, avoid it.  Enquire about the possibility of purchasing spare parts, particularly for expensive items which will be prone to a lot of wear and tear.

Tables and highchairs

Should be wiped down carefully each time they have been used.

Floors

Babies and young children will sit or lie on the floor to play, and it is essential therefore that your floor area is kept as clean as possible.  Avoid allowing children and their parents’ access to your play areas whilst wearing their outdoor shoes. Politely request that they remove their shoes at the door and explain that this is for hygiene reasons as there are young children on the floor. Carpets should be vacuumed every day and throughout the day if they become heavily soiled, for example, after a cutting out and gluing activity or following mealtimes.  Hard floors should be mopped with a suitable disinfectant solution and as the manager you may need to arrange for carpets to be professionally cleaned on a regular basis.

Bins

Bins harbour bacteria and germs.  They should be emptied at least once a day and should never be allowed to overflow.  Always wash bins out with a suitable disinfectant solution after emptying and line them with a plastic bag or bin liner. Recycle waste thoughtfully and sensibly.

Potties and changing mats

These must be cleaned thoroughly after every use. Wash potties out with a suitable disinfectant solution. Changing mats should be wiped down with a disinfectant solution after each use.

Disposing of waste materials safely

Although we have looked at how to practise safe and hygienic methods with regard to handling food and cleaning toys and equipment, it is also necessary for managers to understand the importance, not just of keeping the nursery and equipment clean, but also of how to dispose of waste materials safely and effectively in order to avoid an outbreak of illness due to cross contamination from poorly discarded waste products. Waste materials can take the form of:

  • Unused or uneaten food
  • Soiled nappies
  • The contents of potties
  • Blood
  • Vomit

Staff should understand the following important rules:

Unused or uneaten food

Always wrap any waste food securely in a plastic bag which should be tied before placing in an outside dustbin.  Leftover food should never be reheated and served to young children.

Soiled nappies

Always wear plastic gloves and a protective apron when changing nappies.  Soiled nappies should be placed in a plastic bag (specially designed gadgets are now available which wrap nappies individually in anti-bacterial film but these can prove expensive if you are caring for several children in nappies).  Scented nappy sacks with tie handles are inexpensive and highly effective for the disposal of soiled nappies.

Contents of potties

Tip the contents of the potty down the toilet.  Never be tempted to dispose of urine down the sink!  Wash the potty out thoroughly with a disinfectant solution each time it has been used.

Blood

Always wear plastic gloves when treating accidents. Clothing which has been soiled with blood should be either washed immediately or placed in a plastic bag then tied securely for the child’s parent to take home.  Any used bandages, dressings, etc. should be placed in a plastic bag, tied and disposed of in an outside dustbin.  Any floors or carpets soiled with blood should be washed immediately with a suitable disinfectant solution.

Vomit

Once again, wear gloves when cleaning up after a child who has vomited.  Rinse soiled clothes and place in a plastic bag, securely tied for the child’s parent to take home or wash immediately according to the manufacturer’s instructions.  Mop up as much vomit as possible and then thoroughly clean the area with a suitable disinfectant solution.  Carpeted areas should be thoroughly scrubbed or ideally cleaned using a steam cleaner to eliminate any traces of bacteria.

Most local authorities will insist that nurseries pay for specialist firms to collect hazardous waste such as soiled nappies and the nursery will be responsible for arranging and paying for these collections.

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