Communicable Disease Prevention, Sanitation, and Mandatory Reporting

Why Prevention Matters in Group Child Care

Children in group care share toys, surfaces, and air. Their immune systems are still developing, which makes them more vulnerable to communicable illness than adults. A provider who practices consistent sanitation and hand hygiene is the single most effective barrier between a pathogen and the children in their care. The same attentiveness that prevents the spread of hand-foot-mouth disease also positions you to notice when a child may be experiencing abuse or neglect — both are mandatory professional responsibilities.

The Six-Step CDC Hand-Washing Procedure

Hand washing is the foundation of infection control in any child care setting. The Centers for Disease Control and Prevention (CDC) recommend the following six steps, performed with plain liquid soap and running water:

1. Wet your hands with clean, running water (warm or cold) and apply soap.

2. Lather by rubbing your hands together with the soap — include the backs of your hands, between your fingers, and under your nails.

3. Scrub for at least 20 seconds. A useful timer is humming "Happy Birthday" twice through.

4. Rinse your hands well under clean, running water.

5. Dry your hands using a clean paper towel or a certified air dryer.

6. Turn off the faucet using the paper towel, not your bare hand, to avoid re-contamination.

Providers must wash hands upon arrival, before and after food handling, before and after diapering or toileting, after contact with body fluids, after handling animals, and before leaving the facility. In today's GloGerm activity you will see exactly which surfaces most people miss — typically the thumbs, fingertips, and spaces between fingers.

Diapering Sanitation: The Nine-Step Procedure

Caring for Our Children: National Health and Safety Performance Standards (CFOC) provides the nationally recognized diapering sequence. Following every step in order protects the child, protects you, and prevents fecal pathogens from spreading to surfaces throughout the room.

1. Gather supplies before bringing the child to the table: fresh diaper, wipes, gloves, a plastic bag for soiled items, and clean clothing if needed.

2. Cover the diapering surface with a disposable liner.

3. Put on disposable gloves.

4. Carry or walk the child to the table — keep soiled clothing away from your body.

5. Remove the soiled diaper and clothing. Place soiled items in the plastic bag.

6. Clean the child's skin with wipes, wiping front to back.

7. Remove your gloves by turning them inside out; place them in the bag.

8. Wash the child's hands, then your own hands (or use a disposable wipe on infant hands before your own full hand wash).

9. Diaper and dress the child, then sanitize the diapering surface with an approved disinfectant solution.

Document each diaper change on the diaper log: time, diaper contents noted, any skin concerns, and your initials.

Preparing a Bleach Sanitation Solution

An unscented household bleach solution is the standard disinfectant for diapering tables and other high-contact surfaces. A common approved concentration for general surface sanitation in child care is approximately one tablespoon of bleach per one quart of water (check your state licensing requirements for any locally mandated ratios). Mix fresh solution daily — bleach degrades quickly, especially in sunlight. Label the spray bottle with the date, time of preparation, and the word "BLEACH SOLUTION." Allow the solution to remain wet on the surface for the contact time specified on the bleach label before wiping or air-drying. Never mix bleach with ammonia or other cleaners.

PPE reminder: Wear gloves when mixing or applying bleach solution. Work in a ventilated area to avoid inhaling fumes. Store out of children's reach.

Common Communicable Illnesses: Exclusion and Return-to-Care

Group care settings are frequent sites of transmission for several illnesses. Key exclusion principles from CFOC:

• Hand-foot-mouth disease (enterovirus): Exclude if the child cannot participate comfortably or has open, weeping sores. Children may return when fever-free and sores are healed or dried.
• Conjunctivitis (pink eye): Exclude if bacterial (purulent discharge); return after 24 hours of appropriate treatment and symptom improvement.
• Head lice: Many programs allow return after first treatment; follow your facility's current policy and your state health department guidance.
• RSV (respiratory syncytial virus): Exclude if the child has fever or cannot participate normally; return when fever-free for 24 hours without fever-reducing medication.
• Gastrointestinal illness: Exclude for vomiting or diarrhea; return when symptom-free for at least 24 hours.

Always notify parents promptly and notify your licensor or local health department when a reportable illness is identified.

Mandatory Reporting of Child Abuse and Neglect

Every person working in a licensed child care facility is a mandated reporter. This is a legal obligation, not a choice. You do not need proof — suspicion based on observable signs is enough to trigger a report.

At least three core obligations you must fulfill:

1. Report promptly. A report must be made to the appropriate child protective services (CPS) agency or law enforcement as soon as you have reasonable suspicion. Do not wait for confirmation, and do not conduct your own investigation.

2. Document what you observed. Record the child's exact words, the physical signs you noticed, the date and time, and who was present. Use objective, factual language — describe, do not interpret.

3. Maintain confidentiality. The report and all related information must be kept confidential. Do not discuss the case with other parents, staff members who are not directly involved, or anyone outside the required reporting chain.

Additional obligations in most states include cooperating with investigators, not alerting the alleged abuser that a report has been made, and retaining documentation on file per your state's record-keeping rules. Your CDA Functional Area 8 (Safe) materials provide detailed guidance on recognizing signs of abuse and neglect.

Safety Summary

• Always wear gloves for diapering and surface disinfection.
• Never use bleach solution near children without ensuring ventilation.
• Wash hands at every transition point — no exceptions.
• Report suspected abuse or neglect immediately; your role is to report, not to investigate.