EMERGENCY PROCEDURES

We will obtain emergency health care via a 911 call made by the director (or designated staff member in her absence) in cases where a child is severely ill or injured and in need immediate assistance.  In such cases transportation will be provided by emergency service personnel such as EMT’s, fire department, or other emergency responder. A staff member will accompany the child.  The director will supervise the remaining children in the staff member’s absence.   Family members will be notified immediately of the situation in order to be available upon arrival at the emergency medical facility. 

In cases where a child is moderately ill, a family member will be called to pick him/her up and take him/her home or to a medical provider.  The child will be isolated and supervised at the main office or staff room until someone arrives to transport them.

STAFF HEALTH POLICIES

All staff will provide immunization records and results of a current physical and tuberculin test prior to working with the children, and every two years thereafter.  Staff will not attend work if they are presenting with any of the exclusion criteria for mildly ill children.  Staff will bring a health care provider’s clearance upon return to work after any illness of a contagious nature.  Staff will be provided a written copy of the health and safety policies and exclusion criteria at new hire orientation and an initialed copy will be kept on file in the personnel files. If I (or my staff) will be unable to provide care to children due to illness and unable to obtain an appropriate substitute caregiver, the program will notify parents promptly by phone.   Staff will be provided a written copy of the health and safety policies and exclusion criteria at new hire orientation and an initialed copy will be kept on file in the personnel files.

CHILD HEALTH POLICIES

All children must provide proof of proper immunization (or a religious or medical exemption), lead screening (or be supplied with information on how to obtain such) and a current physical form signed by a health care provider before attending.  Consent for center staff to seek emergency medical treatment in the parent or guardian’s absence will be obtained and maintained in the child’s confidential medical file.   All illnesses resulting in an absence will be followed with a note from the parent or guardian or health care provider, which will remain in the child’s medical file.  All injuries or accidents, and signs of abuse or maltreatment will be recorded on an incident form and filed in the medical file.

Upon enrollment immunizations will be entered into a database and reminders will be generated to ensure the child remains current.  A written reminder from the school nurse or other designated staff will be sent home to the parent or guardian to alert of upcoming immunization requirements.

If a child becomes ill while at the center, the director or other designated staff member (who has attended training in recognizing illness and first aid) will assess the level of illness (mild, moderate or severe) and if any exclusion criteria are present.  If the child is mildly ill, the child will remain in the classroom and the director or designated trained staff member will monitor the child periodically.   If the child is moderately ill, the child will be isolated and supervised by the director or designated trained staff member until a family member arrives to remove the child.  If a child is severely ill, emergency procedures will be followed.

Parent or guardians will be provided with a handbook outlining the center’s policies and procedures, including the exclusion criteria for sick children.  A signed acknowledgement of having been provided such will be kept in the child’s medical file.  Exclusion criteria will be posted at the nurse’s station for staff reference.

In the event of a pandemic in the area, the center will follow the guidelines provided by Ulster County Department of Health.  If directed by the Department of Health, the center may close down until redirected to open by the Ulster County Department of Health.

During times of heightened concern over the possibility of a pandemic, the center will provide parents and staff with information to keep them well informed of how to prevent infection and reminders of when to keep sick children home and when staff are too ill to work. 

ADMINISTRATION OF MEDICATION

 The school nurse or center staff designated and trained pursuant to the OCFS guidelines, will administer prescription and non-prescription (over-the-counter) medications for eyes or ears, oral medications, topical ointments and medications, and inhaled medications in accordance with written note from either the parent or guardian or a health care provider.  Prescription medication must be in the original container with the prescribed dosage and child’s name clearly labeled by a pharmacy.   Over-the-counter medications must be in the original container with dosing label intact and legible.  The center staff will administer medications unless they observe the circumstances specified by the health care provider, if any, under which the medication must not be administered. In such instances, the staff will contact the parent or guardian immediately.

Exceptions will be made for children with exceptional needs for medications administered by injection such as an epipen, with the explicit instructions of a health care professional and consent from the parent or guardian.

Administration of all medications and training of all staff responsible for such will be pursuant to the guidelines and regulations set forth in NYS Childcare Regulations 418-1.11 @   http://www.ocfs.state.ny.us/main/becs/regs/418-1_CDCC_regs.asp#s11

INFECTION CONTROL PROCEDURES

General training will be provided to all staff on procedures to minimize infections and, if applicable, advanced training will be provided to staff caring for mildly ill children.

Specific procedures which the center will use to prevent the spread of infections are as follows:

PROPER HANDWASHING TECHNIQUES:

1. Hands should be washed using soap and warm, running water
2. Hands should be rubbed vigorously during washing for at least 30 seconds with special attention paid to the backs of the hands, wrists, between the fingers and under the fingernails
3. Hands should be rinsed well while leaving the water running
4. With the water running, hands should be dried with a single-use towel
5. Turn off the water using a paper towel, covering washed hands to prevent re-contamination.

Hands should be washed after the following activities:

• At the beginning of the day, upon moving to work with a new group of children and after coming in from outdoors
• After using the toilet, assisting children with toileting or changing diapers
• After coughing, sneezing, using a handkerchief or disposable tissue
• After handling soiled equipment or utensils
• Before and after the administration of medications
• Before and after food handling or eating
• After handling pets or other animals
• After engaging in any other activities that contaminate the hands

PROPER DIAPERING TECHNIQUES

Diapering will be done in a designated diapering area.  DIAPERING WILL ONLY HAPPEN IN THIS AREA, food handling is not permitted in this area.

The surfaces in the designated diapering area will kept clean, waterproof, and free of cracks, tears and crevices.  The containers in the diapering area, including skin creams and cleaning items, will labeled appropriately and stored away from the diapering surface and out of the reach of the children.

DIAPER WILL BE CHANGED USING THE FOLLOWING STEPS:

1. CHECK and collect all necessary supplies – making sure to keep everything off the diapering surface except the items needed during the diapering process. 

·         PLACE roll paper or disposable towel on diapering surface, making sure that it covers the diaper changing area from the child’s chest to the child’s feet.

·         Make sure the following items are among the collected necessary supplies – fresh diaper, as many wipes as needed for this diaper change, non-porous gloves and a plastic bag for any soiled clothes.

       2.  Avoid contact with soiled items, but continue to always keep a hand on the child.  Items that come

            In contact with items soiled with stool or urine will have to be cleaned and sanitized. 

      CARRY the child to the changing table, keeping soiled clothing from touching the caregiver’s 

       clothing.  Bag soiled clothes, and, later, securely tie the plastic bag to send the clothes home.

3. PUT on disposable gloves. Unfasten diaper – leaving the soiled diaper under the child.  Hold the child’s  feet to raise the child out of the soiled diaper and use disposable wipes to clean the diaper area.  Remove stool and urine in a front to back motion, making sure to use a fresh wipe each time.  As the wipes are being used put the used ones directly into the soiled diaper.  NOTE any skin problems for later reporting.

4.  REMOVE the soiled diaper.  Fold diaper over and secure it with the tabs.  Place soiled diaper into a lined, covered or lidded can and then into a receptacle out of the reach of the children.

5.  CHECK for spills under the child.  If there is visible soil, remove any large amount with a wipe, then fold the disposable paper over on itself from the end under the child’s feet so that a clean paper surface is now under the child.

6.  REMOVE your disposable gloves and put them directly into the covered or lidded can.  Wipe your hands with a disposable wipe.

7.  Slide a clean diaper under the child.  If skin products are used, put on disposable gloves and apply the skin product.  Dispose of gloves properly.  Fasten the diaper.

8.  Dress the child before you remove him from the diapering surface.  Clean the child’s hands, using soap and water at a sink.  If the child is too heavy to hold for hand washing and cannot stand at the sink, use disposable wipes or soap and water with disposable  paper towels to clean the child’s hands.  Take the child back to the child care area.

9.  Clean and disinfect the diapering area.  This should include:

·         Dispose of the table liner into the covered or lidded can.

·         Clean any visible soil from the changing table.

·         Spray the table so the entire surface is wet with bleach solution or hospital-grade germicidal solution.

·         Leave the bleach on the surface for 2 minutes, then wipe the surface or allow it to air dry.

      10.  Wash hands thoroughly.

PROPER GLOVING PROCEDURES

Gloves will be available on the play ground, in the first aid kit, at the diaper-changing table, in the car on field trips and with the cleaning materials.

·         Put on a clean, unused pair of gloves.

·         Provide the appropriate care.

·         Remove each glove carefully. Grab the first glove at the palm and strip the glove off. Touch dirty surfaces only to dirty surfaces.

·         Ball up the dirty glove in the palm of the other gloved hand.

·         With the clean hand, strip the glove off from underneath the wrist, turning the glove inside out. Touch clean surface to clean surfaces.

·         Discard the dirty gloves immediately into a step trash can. Failure to discard gloves promptly allows the spread of infection.

·         Caretakers must wash their hands after removing and disposing of gloves. Wearing gloves does not eliminate the need for hand washing. Wash your hands using proper hand washing techniques.

SAFETY PRECAUTIONS RELATING TO BLOOD:

ALL STAFF will follow standard precautions when handling blood or blood contaminated body fluids.  THESE INCLUDE:

·   Use Universal Precautions

·   Wear disposable gloves whenever there is a possibility of coming in contact with blood or other potentially infectious materials (body fluids and tissues)

·   Caregivers are to be careful not to get any of the blood or blood-contaminated body fluids in their eyes, nose, mouth, or any open sores.

·   Wash hands using the proper hand washing procedures before and after each exposure:

  Changing diapers where there is blood in the stool

  touching blood or blood-contaminated body fluids

  treating cuts that bleed

  wiping surfaces stained with blood

·   If blood is touched accidentally, the exposed skin will be thoroughly washed with soap and running water.

·   Clothes contaminated with blood will be placed in a securely tied plastic bag and returned to the parent at the end of the day.

·   Surfaces, including countertops and floors, that have been blood stained will be cleaned and then disinfected with a germicidal solution.

SANITATION OF EQUIPMENT AND TOYS:

The following is the cleaning and sanitization procedure to be used for any equipment, toys and objects used or touched by children.

·   Equipment that is frequently used or touched by children on a daily basis will be cleaned and disinfected when soiled and at least once weekly.  The following  cleaning procedure will be implemented for the items touched by children:

o        Use 1 tablespoon of bleach for every 1 quart of water or ¼ cup bleach to every gallon of water.

o        Drain, rinse and allow toys to air dry overnight in the sink

·   Infant toys and equipment will be disinfected daily using the above procedure.

·   Toddler and Preschool toys and equipment will be disinfected weekly or after illness in the group using the above procedure.

·   Each room will maintain a bin where toys that have been contaminated will be stored until properly sanitized.

·   Carpets that are contaminated with body fluids will be spot cleaned.

·   Diapering surfaces will be disinfected after each diapering of a child.

·   Countertops, tables and food preparation areas/surfaces (including cutting boards) will be cleaned and disinfected before and after food preparation and eating.

·   Potty chairs will be emptied and disinfected after each use.   They cannot be washed out in a hand washing sink, unless the sink is washed and disinfected after such use.

·   Toilet facilities will be kept clean at all times, and will be supplied with toilet paper, soap, and disposable towels that are accessible to the children.

·   Any surface that comes in contact with body fluids will be disinfected immediately.

·   Thermometers and toys mouthed by children will be soaked in a disinfectant immediately before use by another child.

STAFF will use the following procedures for cleaning and sanitizing non-porous hard surfaces, this includes tables, countertops and diapering surfaces:

·         Wash the surface with soap and water.

·         Rinse until clear

·         Spray the surface with the bleach solution (1 tablespoon of bleach for every 1 quart of water or ¼ cup bleach to every gallon of water) until it glistens.

·         Let it sit for 2 minutes.

·         Wipe with a disposable paper towel or let air-dry.

DAILY HEALTH CHECKS:

A daily health check of each child will be carried out by the primary caregivers/Teachers or other designated staff member.  Training will be provided to such staff to ensure competency in the recognition of symptoms of illness, communicable diseases and child abuse or maltreatment.  ANY UNUSUAL FINDING IN THE FOLLOWING CHECK SHOULD BE DOCUMENTED.  While doing the daily health check the caregiver will check for the following at the child’s level so the caregiver can interact with the child:

1.        Child’s behavior: is it typical or atypical for time of day or circumstances.

2.       Child’s appearance:

·         Skin:  pale, flushed, rash

·         Eyes, nose, and mouth:  note color, dryness or any discharge, is the child rubbing eyes, nose or mouth excessively

·         Hair:  in case of lice outbreak look for nits

·         Breathing:  normal or different; any coughing

3.        Check with the Parents:

·         How did the child seem to feel or act at home

·         Any sleeping difficulty

·         Are they eating/drinking normally – when was the last time they had anything to eat or drink

·         Any thing unusual happen

·         When was the last time the child used the toilet or was diapered – has their bowel movements and urine output been normal

·         Has the child received any medication or treatment

4.        Any evidence of illness or injury since the child last participated in child care.

5.       Any indications of child abuse or maltreatment

HEALTH CONSULTATION

The center will employ a LPN as health care consultant who will have weekly scheduled visits.  The health care consultant will review the center’s health care policies and procedures annually and review program's ongoing compliance with the health care plan and policies.  The health care consultant will maintain the children’s medical files and ensure immunizations are up to date.  The health care consultant will ensure all administration of medications complies with the regulations. 

STAFF TRAINING

Training in the center’s health and safety policies will be provided to all new hires at staff orientation and reviewed annually.  Specific training in CPR/first aid, recognition and care of illness, signs of abuse or maltreatment, infection control procedures, administration of medication, and developmentally appropriate practices will be provided to staff members respectively according to need.

CARE OF MILDLY ILL CHILDREN

Children who are mildly ill can attend the day care.  The illness must be minor and not represent a significant risk of serious infection to other children.  These illnesses are not communicable and the mildly ill children can participate in regular program activities with minor modifications, such as more quiet or rest time and/or exclusion from active outdoor activities.  When rest is needed, the child will be assigned one staff member.  The director then will help supervise the classroom if needed.

Children who are considered mildly ill have minor colds or are recovering from illness that they have been on medications for and are no longer contagious.  

All other signs and symptoms that a child has of illness will result in the child needing to be excluded from day care.  These include:

• Persistent diarrhea
• Significant fever or 100 or more using an Axillary thermometer within 24 hours
• Undiagnosed rash
• Untreated conjunctivitis
• Untreated infections such as scabies, ring worm or lice
• Vomiting
• Contagious stages of viruses, such as chicken pox

Children with illness that require medical treatment will be excluded until approved to return by their medical professional.  These include:

• Impetigo
• Strep Throat
• Mumps
• Rubella
• Pertussis

Children with the following illness will be excluded until the local health department approves readmission:

• Diphtheria
• Hepatitis B
• Meningitis or meninigococcal disease.

Other illness or symptoms of illness as determined by the program.