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Child Care

Outbreaks in Child Care Centres

Outbreaks can occur at child care centres because of transmission of illness. The goal of outbreak management is to break the chain of transmission and prevent further spread of illness. The local public health inspector will support the centre to manage an outbreak.

The Outbreak Quick Start Guide for child care operators provides an overview on managing outbreaks.

Completed line lists can be submitted via the online Electronic Line List Submission option or via fax at 705-733-7738. Do not submit line lists via email. 

There are two classifications of outbreaks:

  • Enteric (Gastrointestinal)
  •  Respiratory 
 

Under the Health Protection and Promotion Act, licensed child care centres are required to report all clusters of illness identified at the centre to the health unit. A cluster of illness is when multiple children or staff are ill with similar symptoms. When the number of staff and/or children that are ill at a centre exceeds the normally expected (baseline) illness rate for the centre, the centre must contact SMDHU at (705) 721-7520 ext. 5744 to report the increase in illness.

When notified of the cluster of illness, the assigned public health inspector will help the centre 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. If the situation is not determined to be an outbreak, the inspector may still recommend outbreak precautions to prevent an outbreak from being declared in the future.

Outbreak Resources

The Simcoe Muskoka District Health Unit (SMDHU) provides resources that assist with management of the outbreak including outbreak checklists, line lists and signage. Resources for both respiratory and enteric outbreaks can be found below.

The following resources are intended to support the centre when an increase in respiratory illnesses is noted. 

  • Respiratory Outbreak Checklist – This checklist outlines additional measure that should be implemented during an outbreak. When noting an increase in respiratory illnesses the centre can refer to the respiratory outbreak checklist for recommended measures that can be implemented to prevent the spread.
  • Line Lists – Line lists are used to organize cases of staff and children that meet a case definition during an outbreak. The case definition is a set of criteria which define who should be added to the line list. It will outline location, symptoms, and date of onset. Case definitions may be updated over the duration of an outbreak if further information arises. Complete line lists allow for effective assessment by the health unit during an outbreak. Line lists should be completed and submitted as soon as possible to your local public health inspector. Line lists must be submitted confidentially either via fax - 705-733-7738 or via our Electronic Line List Submission.

The following resources are intended to support the centre when an increase in enteric (gastrointestinal) illnesses is noted. 

  • Enteric Outbreak Checklist – This checklist outlines additional measures that should be implemented during an outbreak. When noting an increase in enteric illnesses the centre can refer to the enteric outbreak checklist regarding recommended measures that can be implemented to prevent the spread.
  • Line Lists – Line lists are used to organize cases of staff and children that meet a case definition during an outbreak. The case definition is a set of criteria which define who should be added to the line list. It will outline location, symptoms, and date of onset. Case definitions may be updated over the duration of an outbreak if further information arises. Complete line lists allow for effective assessment by the health unit during an outbreak. Line lists should be completed and submitted as soon as possible to your local public health inspector. Line lists must be submitted confidentially either via fax - 705-733-7738 or via our Electronic Line List Submission.
  • Enteric Outbreak Sign (Red) – This sign is to be posted at the front door of the centre during an enteric outbreak to communicate to visitors that the center is in outbreak and the expectations for entering the centre. 

Ensure to enter the following information on the line list:

  • The name of the centre.
  • The date the outbreak was declared by SMDHU.
  • The outbreak number provided by SMDHU (will start with 2260).
  • The case definition provided by SMDHU. The case definition is a sentence that describes who you should be adding to the line list. 
  • Complete all columns of the line list with the information you have available.
  • Ensure the line list is updated whenever new information is made available (new person is sick, line listed person has recovered and/or returned). 
  • Ensure to add new cases to the same line list.
  • If a person is already line listed and returns to the centre and is excluded due to symptoms again, update their row on the line list, do not add the same person to the line list twice.
  • The Supervisor (or designate) is required to provide the public health Inspector with regular (daily) updates regarding the outbreak.
  • Updates on ill staff and/or children must be recorded on the line list and submitted via one of the approved, confidential means, 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.
  • When you submit the line list, DO NOT email the line list to the inspector. Instead, send via our new "Electronic Line List Submission" option or via fax - 705-733-7738.

SMDHU has created a new video which outlines the steps in completing a line list. If you have additional questions regarding how to fill out a line list, please refer to the video.

When the centre is not in outbreak and is following routine practices, or the centre has been placed into enhanced surveillance, the following signs are available to communicate to visitors of the centre expectations at the centre at any given time.

  • Routine Surveillance Sign (Green) – This sign is for any time the centre is not in outbreak to communicate general routine infection control practices to visitors.
  • Enhanced Surveillance Sign (Yellow) – This sign is for any time the centre is beginning to note an increase in illness but has not yet reached outbreak status. This sign signals to visitors to use increased vigilance with infection control practices while visiting the centre.

Additional Precautions During an Outbreak

During an outbreak, or while in enhanced surveillance, your local public health inspector will request you put additional measures in place to help prevent the spread of transmission of illness. Click on the below to learn  more regarding measures which may help prevent the spread of illness. 

  • When ratios allow, children should be removed from the classroom when it is identified that they are ill. If ratios do not allow, ill children should be isolated away from other children in the same room. Ill children should be kept away from other children until parents/guardians can come and pick them up. Parents should be called to request pick up as soon as possible. Once an ill person has left the centre the area where they were isolated and any toys or equipment used should be cleaned and disinfected. 

Ill staff/children are to be excluded from the centre as per the Common Childhood Illnesses brochure or centre policy.

During a Respiratory Outbreak - Ill staff/children are to be excluded from the centre until:

  • Fever free
  • Symptoms have been improving 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 the onset of symptoms unless all symptoms have been completely resolved for at least 48 hours.
  • During an Enteric Outbreak - Ill staff/children are to be excluded from the centre until
    • Symptoms have been completely resolved for at least 48 hours

Exclusion criteria should be based on symptomology without the use of medication.

This exclusion criteria is based on minimum expectations. The centre may wish to adhere to stricter measures. Always refer back to the centre’s policy.
  • Effective hand hygiene is the #1 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 during a declared outbreak. This disinfectant must be effective against non-enveloped viruses (ex. norovirus) to be considered an outbreak-level disinfectant. For help in determining if your outbreak disinfectant is appropriate, please contact your public health inspector.
  • Be sure to review the manufacturer’s instructions (directions listed on the bottle) for the outbreak disinfectant with staff for safe and effective use. Of particular importance is to review the contact time needed to kill non-enveloped viruses such as norovirus. Outbreak disinfectants often require additional personal protective equipment.
  • Recommendations for routine cleaning can be found on the Infection, Prevention and Control page of our website. During an outbreak or a period of increased illness, the cleaning and then disinfection in the centre should be increased to daily for all affected classrooms. Additional staff may be necessary to assist with the increased cleaning then disinfection demands.
  • Please reference our How to Clean Up Body Fluids poster if there is vomit, diarrhea or liquids containing blood 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 clothes as well as soft furnishings that require laundering.
    • Sensory and natural play items are often composed of material that cannot be cleaned and disinfected. Shared sensory bins are an ideal location for germs to spread from child to child. Group sensory play should be suspended for the duration of the outbreak.
    • Water is an excellent habitat for germs to thrive. During an outbreak, waterplay should be discontinued.
    • During an outbreak, classrooms (including staff) should cohort (group together and not mix with other classrooms) to prevent transmission between classrooms.
    • Staff should not provide coverage in multiple rooms to prevent further spread of illness. If coverage is required for breaks, this should occur by supervisors.
    • 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.
    • 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.
    • Linked is a template for notification to parents of current outbreak (to be put on the letterhead of the centre). This template can be used when communicating with parents the outbreak status of the centre.
    • Parents can be referred to our Frequently Asked Questions page for clarification on outbreak management.
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