Know

The Importance of Healthy Environments

Have you ever gone to a restaurant and sat down at a sticky table or found dried food on your fork? Have you ever hesitated about picking up a pen at the bank or grocery store because the person in front of you had a cold? Have you ever put a public toilet seat down with your foot just to avoid touching it? Have you ever stayed in a hotel room that made you want to avoid touching the comforter or the remote control?

Most people have experienced some of these uncomfortable and stressful health-related situations. As adults, we can respond to such situations by visiting a different restaurant or hotel, or by washing our hands as soon as we leave the bank or restroom stall. We want to stay healthy and we want to believe that our environments are reasonably clean. Children and their families have these same desires. Child development programs must provide environments that are clean and that prevent the spread of communicable diseases. It is your responsibility to make sure infants and toddlers have a safe and healthy environment for play and learning.

Germs

Germs are the cause of infectious diseases. Unfortunately, germs cannot be seen by the naked eye and they are generally transmitted without us even knowing it. Germs are transmitted as a result of:

• Direct contact: Touching the fluid from another person's infection (e.g., saliva, nasal mucus), transmitted through environmental objects, such as toys, cabinet handles, equipment, or person to person. It only takes a small drop of fluid for transmission to occur.
• Respiratory: Spread via the mouth and nose through the air when someone sneezes or coughs.
• Blood infections: Spread when blood, and sometimes other bodily fluids, enters the blood stream of another person.
• Fecal-oral transmission: Spread to a person's mouth (oral) via hands soiled with feces that touch food, surfaces or objects. Germs from feces are invisible. Hands and surfaces may appear clean, though feces germs can still be present. Disease from fecal-oral transmission can make adults and children very ill.

There is no way to completely eliminate the transmission of germs, especially with all the mouthing, touching, and picking that happens in infant and toddler programs, but there are ways to decrease the transmission of germs among children, staff and families. In addition to following your program's health related policies, it is essential that you adhere to your program's cleaning and sanitation requirements and follow proper hand washing procedures to minimize the occurrences of spreading germs (see Lesson Two for more on handwashing).

Cleaning, Sanitizing, and Disinfecting: What's the Difference?

Although we often use the words cleaning, sanitizing and disinfecting interchangeably, they each have their own meaning. To provide a safe and healthy environment for children, you need to understand the difference between each term (American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education, 2019). This will help you know which products are designed for each purpose.

1. Cleaning means to remove dirt or debris from a surface and sometimes involves scrubbing or friction in order to remove the debris. For example, you spray a table with a mix of water and detergent to remove food products and debris after a meal.

2. Sanitizing means to reduce germs on a surface. When you sanitize a surface, it meets most health regulations. Sanitizing products usually are not effective unless the surface has been cleaned first. After cleaning the table with detergent and water, you spray an approved mix of water and bleach to sanitize the table and kill germs. A sanitizer may be appropriate to use on food-contact surfaces (dishes, utensils, cutting boards, high chair trays), toys that children may place in their mouths, and pacifiers.

3. Disinfecting means to destroy most germs on a surface. Disinfecting a surface is often necessary when it has made contact with body fluids. Disinfecting usually requires a stronger bleach-water mixture. You disinfect on non-porous surfaces, such as diaper-change tables, countertops, door and cabinet handles, and toilets and other bathroom surfaces.

Keep in mind that infants and toddlers should not be near surfaces, materials, and toys (including meal and snack tables and diapering tables) while the surfaces or items are being sanitized or disinfected. Inhalation of chemicals as they are being applied can be dangerous. All chemicals should be locked and out of reach of children.

Cleaning should be a habit and a priority, however it should never distract you from supervising or engaging with the infants and toddlers in your care. In the Explore activity, you will reflect on how to best share the cleaning tasks in your classroom amongst the caregivers, so that you can help ensure healthy environments and responsive caregiving for the children in your care.

Any products you use to clean, sanitize, or disinfect should be approved by the Environmental Protection Agency (EPA) to ensure they are safe for you to use. When you clean, sanitize, or disinfect, you should follow approved procedures. Typically, this means washing the materials or surface by hand with soap or detergent and water, sanitizing or disinfecting, and allowing the object to air dry. You can also use a dishwasher to sanitize toys or materials if it has a sanitize setting or a high-temperature option.

The U.S. Department of Health and Human Services (DHHS) and the Centers for Disease Control (CDC) recommend that if an EPA approved disinfectant is not available, then you should use a fresh chlorine bleach solution. The DHHS and CDC provide the following guidelines on preparing and using the solution:

• Add 1 tablespoon of bleach to 1 quart (4 cups) of water. For a larger supply of disinfectant, add ¼ cup of bleach to 1 gallon (16 cups) of water.
• Apply the solution to the surface with a cloth.
• Let it stand for 3 to 5 minutes.
• Rinse the surface with clean water.

See

What do clean and healthy environments look like for infants and toddlers? In these environments, cleanliness is a habit. Soiled or mouthed toys go into a labeled "soiled toy" bin for cleaning. Spray bottles are available for cleaning and sanitizing; soap mixtures and bleach mixtures are changed daily. Watch the video below to see ways infant and toddler caregivers maintain a clean and healthy environment.

Standard and Universal Precautions

Another way to reduce the risk of transmission of microorganisms (germs) that can cause infection is to practice standard or universal precautions. Standard precautions cover all situations where you may come into contact with body fluids, but universal precautions apply specifically to contact with blood, and does not apply to contact with feces, nasal secretions, sputum, sweat, tears, urine, saliva, or vomit unless these body fluids also contain blood. In child care settings, standard precautions involve using barriers to prevent contact with body fluids from another person, as well as cleaning and sanitizing contaminated surfaces. You can read more about standard precautions in the Standard and Universal Precautions as they Apply to Child Care Settings fact sheet found in the Learn section below.

Barriers you might use to help prevent bodily fluid contact might include:

• Moisture-resistant disposable diaper table paper
• Disposable towels
• Gloves
• Plastic bags, securely sealed

You should always use disposable non-porous gloves when blood or body fluids containing blood may be involved.

Gloves may be optional for diapering and contact with other bodily fluids described above, but check with your coach, trainer, or administrator for times your program or Service guidelines recommend using gloves. Gloves are not necessary for feeding human breast milk.

Whenever gloves are worn, you should practice good hand hygiene. See Lesson Two for more on handwashing and Lesson Three for more on glove procedures.

Do

Your role is critical in ensuring your classroom is a clean and healthy environment where children learn and thrive. This section describes what you can do to keep your classroom healthy. The Apply section below provides a more detailed schedule to help support healthy practices.

Keeping Your Classroom Healthy

Toys and Classroom Materials

One toy can be used by many children every day. Toys can become a home for germs, especially when infants and toddlers put them in their mouths, cough or sneeze on them, or touch them after toileting. It is very important to regularly clean and sanitize the toys in your room. To do this:

• Keep a box or bin labeled "soiled toys." When a child mouths a toy, coughs, or sneezes on it, place the toy in the bin. According to the American Academy of Pediatrics, you can keep soapy water in the bin or the bin can be a dry spot for storing toys until you can clean them. Make sure you have cleaned and sanitized the toy before returning it to the learning environment.
• Clean activity spaces, dress-up clothes, and machine-washable cloth toys at least weekly.
• Clean hats daily.
• Clean mouthed toys after each use and sanitize them daily.
• You can put plastic toys in the dishwasher to clean and sanitize them.

Classroom Surfaces

Many surfaces in your classroom probably serve multiple purposes. Maybe you serve snacks on a table that is later used for a sensory activity, or children use the same sink to wash their hands after using the restroom or after art. Cleaning, sanitizing, and disinfecting surfaces on a schedule can help you maintain a healthy environment. Cleaning guidelines for surfaces in your room include:

• Clean and disinfect door knobs and handles daily.
• Clean and sanitize food-preparation surfaces before and after each use.
• Clean and sanitize dishes after each use.
• Clean and sanitize food tables and trays before and after each use.
• Clean countertops after each use and sanitize daily.
• Clean the refrigerator monthly if you have one in your classroom.
• Clean the floors daily.
• Clean and disinfect the drinking fountain daily.
• Clean phone receivers daily.
• Vacuum carpets daily.

Toileting and Diaper Changing Areas

The restroom or changing area is the location where germs and bacteria are most likely to spread. It is very important to keep toileting and diapering areas clean. These guidelines will help you limit contamination:

• Clean and disinfect any changing surfaces after each use.
• Clean and disinfect sinks and faucets daily. If the sink is also used for non-toileting routines, disinfect it after toileting use.
• Clean and disinfect countertops daily.
• Clean and disinfect floors daily.

Cribs, Cots and Bedding

In full-day programs, it is important to provide a healthy environment for sleep. Lice and skin infections can be spread through blankets or bedding that are stored and cleaned improperly. Follow these suggestions for healthy sleep environments:

• Store each child's bedding (sheets, blankets, pillows, sleeping bags) separate from the other children's bedding.
• Launder sheets and pillow cases weekly or before being used by another child.
• Clean cribs and cots weekly or before being used by another child.
• Launder blankets monthly. If the blankets touch the child's skin, clean weekly.

Completing this Course

For more information on what to expect in this course, the Healthy Environments Competency Reflection, and a list of the accompanying Learn, Explore and Apply resources and activities offered throughout the lessons, visit the Infant & Toddler Healthy Environments Course Guide. 

Please note the References & Resources section at the end of each lesson outlines reference sources and resources to find additional information on the topics covered. As you complete lessons, you are not expected to review all the online references available. However, you are welcome to explore the resources further if you have interest, or at the request of your trainer, coach, or administrator.