Universal (or Standard) Precautions

A few years ago the Centers for Disease Control and Prevention (CDC) established guidelines for the care of patients with communicable diseases. The guidelines were intended to reduce the spread of infection to health care providers and to other patients. The guidelines were termed "universal precautions." They were designed to prevent transmission of blood-borne germs such as the hepatitis B virus and they targeted the proper handling of body fluids such as vomit, urine, feces, blood, and wound drainage.

The recommendations were recently expanded and renamed as "standard precautions." They are still primarily designed to prevent the spread of blood-borne diseases, but they also are an excellent way to reduce the spread of infectious diseases in non-health care settings such as childcare facilities and schools. It is important to recognize that children with infectious diseases are often contagious before they appear to be sick or are aware that they are ill. Therefore, childcare providers should follow this application of the CDC's standard precautions to prevent the spread of infectious diseases.

Steps to Take

First, remember that thorough cleaning with soap and water followed by a disinfecting process should always be the first line of defense against germs. For spills of body fluids like vomit, urine, blood, feces, saliva, nose and eye discharges, drainage from wounds, and human milk, clean all counter tops, changing tables, floors, and other surfaces with soap and water and follow with a disinfecting solution made of hypochlorite solution (liquid chlorine bleach containing 5.25 percent hypochlorite) in tap water. Combine 1/4 cup of liquid bleach that is 5.25 percent hypochlorite with one gallon of tap water or, for a smaller amount, one tablespoon of bleach plus one quart of tap water. The sodium bleach solution must be made fresh every 24 hours. It loses strength quickly upon exposure to light or heat. It must never be mixed with anything but fresh tap water! Combining it with chemicals in other cleaning solutions such as pine oil can cause the release of chlorine gas and other poisons.

Allow the disinfecting solution to air dry on the surface for continued effectiveness. If the surface cannot be air dried, leave the disinfectant for at least three minutes before drying. Use gloves to protect your hands unless the fluid is easily contained by the tissue or cloth being used to wipe it up. Gloves are required for spills containing blood or body fluids that contain blood. Gloves are not required for spills of breast milk.

Avoid spreading any of the contaminated material by splashing. Be careful not to get any of the body fluid in your eyes, nose, mouth, or any open wounds or sores. If this does happen, scrub the affected area liberally with soap and warm water.

When cleaning up small spills, disposable materials such as paper towels may be used. Sponges, cleaning cloths, or towels should be laundered in hot water. Mops should be cleaned, rinsed in disinfecting solution, wrung out as dry as possible, and hung to finish drying.

Dispose of all contaminated material, including diapers, in plastic bags that are sealed and tied securely. Solid stools (as in a soiled diaper) may be emptied into the toilet, but be careful not to splash it or the contaminated toilet water on yourself. Then place soiled clothing in a plastic bag, seal it, and give it to the parents to pick up with their children at the end of the day. Although it may be unpleasant for the parents to be greeted with sealed and soiled clothing, explain that this procedure is for the protection of all children, including their own.

Hand Washing

In addition, pay attention to your own safety. After following the standard precautions, carefully and vigorously wash your hands and any splashed-upon area of your skin with abundant soap and warm running water. The sodium hypochlorite disinfecting solution is usually not necessary, but it is a nontoxic way to spot clean soiled clothing if desired.

Gloves are recommended for certain activities to protect both the adult and the child. When diapering a child, for example, the gloves help protect your hands from contamination, and also help protect the child's diaper area from germs or infection from your hands. Gloves help prevent contamination, but wearing gloves does not eliminate the need to wash hands. It also is recommended that you wash your hands when the gloves are removed. Why? Gloves may have small holes in them and bacteria multiply rapidly in the warm environment of the glove. Also, hands are often contaminated from the outside of the gloves when removing the gloves.

How to wash hands? Soap and running water is the best! Here are some guidelines:

• Specify hand washing areas. If possible, identify a sink for hand washing and do not use it for food preparation or other activities.
• Check the water temperature. Water temperature should be less than 120 degrees F. to prevent burns.
• Rub soap to create a lather over the hands, between fingers, and around nail beds and fingernails for at least 10 seconds. There are many choices in soaps: liquid or bar, fragrances, colors, and antibacterial. Check children's medical information files to be sure they are not allergic to any fragrances, dyes, or other ingredients. It is not necessary to use antibacterial soaps since germs are easily removed by the rubbing action and running water.
• Hold the hands under running water until the soap lather is gone. Hold hands in a downward position so that the water flows from the back of the hands to the fingertips.
• Dry hands thoroughly. To reduce the chance of contamination, use disposable paper towels or an air hand dryer to dry hands.
• Use the paper towel to turn off the faucet. Remember, when you went to wash your hands, the first thing you touched was the faucet, so sinks and faucets become heavily contaminated with germs.

Fact or Fiction

One more note of precaution. Unfortunately, many people believe that if something is written in a book or magazine or other publication it must be true. Nothing could be farther from the truth. In this technology-intensive era, a similar assumption has developed that if something is found on the Internet it too "must be true." Information has circulated on the Internet that vinegar is acceptable as a disinfectant. This is absolutely untrue and dangerous -- vinegar is not a disinfectant.

By Donald Palmer, MD
American Academy of Pediatrics
Committee on Early Childhood, Adoption & Dependent Care

National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, American Academy of Pediatrics; 800-433-9016; www.aap.org. The text of this publication can be found on the National Resource Center for Health and Safety in Child Care's web site, nrc.uchsc.edu.

Hand Washing Poster, www.childhealthonline.org/topics.htm

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