Preventing E.coli

The recent E.coli outbreak at a Walkerton, Ontario home daycare that affected four children should have both parents and child care providers doing a thorough assessment of their handwashing, sanitizing and diaper changing techniques and practices.

Children are susceptible to five different classes of E. coli that cause diarrhea infection. The bacteria either directly attacks the intestinal wall or produces a toxin that irritates the intestines. One of the most dangerous E. coli infections is E. coli O157:H7, which produces a toxin that can lead to hemolytic uremic syndrome - a severe illness that can seriously damage many organs, including the kidneys, and cause intestinal bleeding.

Daycares large and small are, unfortunately, potential breeding grounds for all sorts of infections and viruses. Children are in constant contact with each other and with providers. Toys, hands, feet, and just about anything else goes into unassuming mouths of infants and toddlers. Unclean hands rub eyes, and noses. Once an infection takes hold, it's not long after that the entire cew becomes ill.

What Can Parents and Providers Do?

Good hand washing can stop the spread of many illnesses and infection in a matter of minutes. Children should be taught how to, and how often to wash their hands.

A frequent hand washing practice or rule for everyone, including caregivers as children mimic what they see, is vital. No exceptions, excuses or tantrums accepted. The Canadian Paediatric Society, in their handbook, Little Well Beings: A Handbook on Health in Family Day Care, offers these suggestions on when hands should be washed:


    * Cooking or eating
    * Feeding a baby or child
    * Giving a child medication


    * Changing a Diaper
    * Helping a child use the toilet
    * Using the toilet yourself
    * Taking care of a sick child
    * Handling pets or animals
    * Cleaning pet cages or litter boxes
    * Wiping noses

Handwashing Techniques

Here are some simple steps for scrubbing those germs away.

Show children "how" to wash their hands, such as getting the hands completely wet under running warm water, scrubbing with soap for a minimum count of five, (making sure to get "in-between" places like between the fingers and under the nails where germs like to hang out), rinsing under running water for an additional count of five, then drying with a clean towel (preferably disposable towels in a child care setting).

It's a good idea to wash your hands together with the children several times a day so they see you do it and learn how important this good habit is.

If your looking for ways to entice the little tykes to actually practice and make habits of handwashing routines, try using colourful soap or soaps with different shapes. Or sing while your wash, making it a rule that hands aren't washed completely until the song is done.

Sanitary Diapering

Sanitary diapering also plays a key role in the fight against germ contamination. Best practices include:

    * Having a diaper changing area away from any surfaces used for food preparation or child's play. Having the area close to running water is best.
    * Wear disposable gloves for each diaper change ensuring the gloves, along with the diaper, are properly disposed of in a sealed plastic bag, the placed in a covered garbage container.
    * Wash hands directly after each diaper change.
    * Wash the infants hands directly after the diaper change.
    * Spray the diapering area immediately after with a solution of one part bleach to nine parts water. Dry with a clean towel before making another diaper change.

Other Great Tips

Make handwashing a fun and easy routine for kids and you'll have success with your germ fighting efforts. Try these suggestions from the :

    * Install safe stepping stools so that children can reach sinks and taps comfortably.
    * Post handwashing posters at each sink. (Talk to your local Public Health Department, most will be happy to send you what they can...or, make one up with the children.)
    * Sing handwashing songs like this one to the tune of Row your Boat):
      Wash, wash, wash your hands.
      Play our handy game.
      Rub and scrub and scrub and rub.
      Germs go down the drain.
    * Kids can learn about the importance of handwashing by visiting this fun Web site: The Importance of Handwashing Are Microbes Friend or Foe?

Sick Child Policy

Most daycare centres and professional family daycare operators discuss their sick child policy with parents prior to admitting a child into care. In most instances, parents are required to sign that they have read and understood the terms under of the policy, and that they agree with and accept the terms. These guidelines are for the protection of everyone involved in the care. It is vitally important that, when it comes to a sick child, particularly a child with a fever, diarrhea, or vomiting, caregivers steadfastly refuse taking the child into care and that parents respect the caregiver's decision. Moreover, parents should have a backup child care plan in place and never insist on taking a child to the facility when he or she is not well enough, by policy guidelines, to attend the care.

It would be advisable for caregivers to take a course either through their Public Health Department, hospital, or the local college, on how to recognize when a child is ill, how to care for a sick child, when a child is too sick to be in care, and more importantly, when to call for emergency assistance. Most PHDs have a Health Nurse who will be happy to talk with you. Your own peadiatrician or family physician may also offer some guidance. Caregivers should also document a suspected illness by using an Accident/ Injury/illness form. A copy should go into the child's file, and a copy given to parents when they pick their child up. Any child who left the facility even mildly ill should be screened by the caregiver before entering care again.