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Child Care

Outbreaks

Outbreaks can occur at child care centres due to infectious agents being brought into the centre and then transmission occurring. The goal of outbreak management is to break the train of transmission and prevent further spread of illness. When notified of the cluster of illness, the assigned public health inspector will determine if the cluster is an outbreak or not. If it is an outbreak, the inspector will require control measures be started and provide the centre with an outbreak number. The outbreak number should be referenced on all communications regarding the outbreak especially any samples/swabs that are submitted too the lab for testing. If determined to not be an outbreak, the inspector may still recommend outbreak precautions to prevent an outbreak from being declared in the future.

There are two classifications of outbreaks:

  • Enteric (Gastrointestinal) which usually involves symptoms of nausea, vomiting and diarrhea
  • Respiratory which usually involves symptoms of fever, cough, runny nose, sore throat etc. 

Many precautions are the same or similar regardless of classification though some may vary.

The Simcoe Muskoka District Health Unit (SMDHU) provides a checklist for respiratory outbreaks  and enteric outbreaks to assist the centre in implementing the following outbreak measures.

 

  • When ratios allow, children should be removed from the classroom when it is identified that they are ill. Ill children should be kept away from other children until parents/guardians can come and pick them up. 
  • Ill staff/children are to be excluded from the centre as per the Common Childhood Illnesses brochure or centre policy. 
  • Respiratory outbreaks - ill staff/children are to be excluded from the centre until fever-free and symptoms have been resolving for at least 24 hours AND the staff/child is well enough to participate in programming.  If influenza is the cause of the outbreak, the exclusion period will increase to a minimum of 5 days from he onset of symptoms unless all symptoms have been completely resolved for at least 48 hours.
  • Enteric outbreaks - ill staff/children are to be excluded from the centre until  symptoms have been completely resolved for at least 48 hours. 
  • Effective hand hygiene is an excellent way to reduce transmission of illness.
  • Hand hygiene education should be built into programming to help children to remember to wash their hands more regularly and effectively. 
  • Follow hand hygiene directions when washing hands with soap and water or alcohol-based hand rub. 
  • Help children to remember respiratory etiquette for coughs and sneezes which includes using disposable tissues, coughing/sneezing into elbow and practicing hand hygiene after coughing or sneezing. 
  • The centre must switch to their outbreak disinfectant. This disinfectant must be effective against Norovirus to be considered an outbreak disinfectant. 
  • Be sure to review the manufactures directions for the outbreak disinfection with staff for safe use. 
  • Recommendations for routine cleaning can be found under the Infection, Prevention & Control tab.  During an outbreak or increased illnesses period, the cleaning and then disinfection in the centre should be increased to daily for all affected classrooms and increased from weekly for any unaffected classrooms.  Additional staff may be necessary to assist with the increased cleaning then disinfection demands.
  • Follow the directions for How to Clean Up Body Fluids if there is vomit, diarrhea or a large blood spill requiring cleanup. 
  • Any toys that cannot be easily cleaned and then disinfected should be removed from play for the course of the outbreak.  This will not only help with decreasing transmission but will alleviate some of the work your staff are required to complete during the outbreak. This includes plush toys and dress-up as well as soft furnishings that require laundering. 
  • Sensory and natural play items are often composed of things that cannot be cleaned and disinfected. Shared sensory bins are an ideal location for germs to spread from child to child. 
  • Water is an excellent habitat for germs to thrive. During an outbreak, waterplay should be discontinued. 
  • Group sensory play should be suspended for the duration of the outbreak. 
  • If your centre has questions or concerns about specific sensory play activities during an outbreak, please contact your Public Health Inspector. 
  • Sensory and Natural Play Resource
  • During the course of an outbreak, classrooms (including staff) should cohort (group together and not mix with other classrooms) and be kept separate to prevent transmission between classrooms.
  • Staff should not provide coverage in multiple rooms to prevent further spread of illness. 
  • Children should not visit other rooms for the purposes of transitions.
  • Off-site field trips and centre tours should be rescheduled until the outbreak is declared over. 
  • Supervisors should consider canceling in-person staff meetings during an outbreak.
  • During enteric outbreaks, cloth diapers should not be used and staff may want to consider the use of gloves when diapering and/or toileting.
  • Gloves do not replace good hand hygiene, hands must be washed before gloves are put on and after gloves are taken off. 
  • Diapering Resource
  • Toileting Resource
  • Ensure parents and families are kept up to date on the outbreak and its progress.
  • Outbreak signs are to be posted at entrances to notify parents, families and visitors upon entry.

 
  • The Supervisor (or designate) is required to provide the public health Inspector with regular updates regarding the progress of the outbreak.
  • Updates on ill staff and/or children must be recorded on the line list and submitted daily.
  • A second staff member should be familiar with outbreaks in order to provide updates to the inspector in the absence of the supervisor or designate. 

Each line list is available for download as an Excel document. When using this version, the first page in the document provides you with some reminders for line list completion.  Complete the secton page, enter the name of your centre, the date the outbreak was declared by SMDHU, the outbreak number provided by SMDHU (will start with 2260) and the case definition provided by SMDHU.

The case definition is a sentence that describes who you should be adding to the line list, your inspector can assist you with this.  Page 3 and 4 are the actual line lists, complete all columns possible. 

Ensure the line list is updated whenever new information is made available (new persion is sick, line listed person has recovered and/or returned)

When you submit the line list, DO NOT email the inspector. Instead, send via our new "Electronic Line List Submission" option. 
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