Measures to control the spread of infection have become second nature to many settings since the onset of Covid. While handwashing has always played an important role in preventing the spread of tummy bugs and respiratory infections, the pandemic highlighted the need to do it properly. However, the cost of personal protective equipment (PPE) and the need for it to be single use has been a challenge for some settings, particularly those who want to reduce their carbon footprint.
Melanie Pilcher, quality and standards manager at the Early Years Alliance, says the hygiene measures that ‘should always have been in place’ prior to Covid are ‘generally well embedded’ in settings. However, she adds, ‘Practitioners are certainly more aware of the need for good infection control, and not just with regards to minimising the spread of Covid.’
Handwashing
The EYFS states that providers must ‘promote the good health of children’ and take the ‘necessary steps’ to prevent the spread of infection. Good practice in infection control and hygiene in nurseries involves effective handwashing and the use of gloves and aprons when dealing with soiled nappies or bodily fluids.
The NHS advises children and staff to wash their hands after:
- using the toilet or changing a nappy
- before eating or handling raw food such as meat and vegetables
- blowing their nose, sneezing or coughing
- (and before) treating a cut or wound
- touching animals, including pets and their food.
It also advises washing hands for 40 seconds, the amount of time it takes to sing Happy Birthday twice, a method which many settings adopted during coronavirus. Early years providers should offer liquid soap, warm water and paper towels to dry hands, according to guidance from the UK Health Security Agency. Alcohol hand gel can be used if hands are not visibly dirty, but it is not effective against organisms that cause gastroenteritis, such as norovirus.
At Bright Beginnings Childcare Centre in Leeds, the NHS handwashing poster is up on the wall in the toilet and nappy-changing areas.
‘The staff induction covers the correct way to wash hands and when to wash them,’ explains general manager Angela Hynes. ‘We provide standard handwashing soap and Carex Sensitive for those with sensitive skin. Hand sanitiser is still doing the rounds heavily since Covid, although we don’t insist on staff using it,’ she adds.
Tina Maltman, executive director at Childminding UK, says that since Covid, many childminders still wash their hands after coming home from outings and school runs. She says, ‘Before the pandemic, some adults and children may not have washed their hands for 40 seconds, but it is an effective length of time to prevent the spread of infection, and there has not been any relaxation on this.’
Staying protected
Gloves, aprons and masks can protect staff from contamination with bodily fluids or blood, which may contain germs that spread disease. Single-use gloves and aprons are used routinely in nurseries for dealing with soiled nappies or bodily fluids.
‘Urine is considered to be sterile, therefore, in normal circumstances, clearing up toileting accidents or changing wet nappies can be down to personal choice over whether gloves are worn, as long as hands are washed thoroughly before and after,’ Pilcher says.
Although there is no requirement to wear gloves when changing nappies or helping toilet a child, it is ‘always recommended’ when dealing with soiled nappies or if there is an infection outbreak, she adds.
‘Nobody should have to change nappies without wearing gloves if they do not want to,’ Pilcher says.
Pacey advisor Zara Smith, who also manages three early years settings for YMCA Lincolnshire, says some settings have concerns about the over-use of single-use disposable gloves and plastic aprons. ‘Some choose to use organic, biodegradable versions and some have chosen to stop using them altogether, as the most effective way to prevent cross-contamination is through regular and effective handwashing,’ she adds.
Maltman says many childminders and early years staff do not like wearing gloves because of the ‘message that gives to young children that the adult does not want to touch them because they are not clean’.
She adds, ‘An example of when a childminder may choose to wear gloves is after a baby receives a live polio vaccine and the infection can be present in their nappy as the virus could get into minute cuts on hands and infect that way.’
Smith points out that settings should undertake their own risk assessments. ‘Where a risk is identified, the setting can decide the measures they wish to take to minimise that impact, whether that is wearing gloves, or providing staff with more comprehensive training,’ she adds.
Sensitive issues
When it comes to sensitive personal hygiene matters, such as dirty clothes and body odour, Smith says it is best dealt with ‘carefully and privately, with warmth and respect’.
‘Language is important,’ she explains. ‘Better a manager say, “I have noticed…” rather than “Your colleagues have noticed…”. It’s likely to be an embarrassing situation for the staff member, and if they think the team has been discussing it, it only amplifies the embarrassment.’
Smith also says it is important to understand why the issues are occurring, particularly given the cost-of-living crisis. ‘Many nursery workers are only on National Living Wage and maybe they are struggling to buy shampoo or washing powder. If the difficulty can be identified, perhaps the setting can provide the necessary items to allow the uniform to be washed on-site, for example. Or provide deodorant or sanitary products in staff toilets or staff rooms as part of staff wellbeing in the workplace.
‘It’s also best to explain the impact of overly strong perfume or deodorant to staff, ensuring that they understand the potential risk of asthma, explaining that as a setting we wish to reduce the number of chemical particles in the air that we are exposing the little ones to.’
When it comes to hair styles, Smith advises her staff to keep their hair tied back to prevent hair being pulled or the spread of head lice. If they are involved in food preparation, it is a requirement.
Expectations around uniform and cleanliness should be covered in the staff induction and included in the staff handbook and, if necessary, recapped during appraisal meetings.
CASE STUDY: Bright Beginnings, Leeds
‘Our personal hygiene policy has been reviewed and adapted over the years to reflect the changing needs of our staff,’ explains Angela Hynes, general manager of the 168-place childcare centre on the campus of the University of Leeds.
‘Staff are expected to maintain and manage a high standard of personal hygiene and it’s important they always appear clean and smart when at work. We still offer “hygiene boxes” with sanitary items, deodorant, shower gel and towels, if staff need to use the shower facilities. But they are now referred to as “self care boxes” and are placed in the female, male and gender-neutral toilets.
‘We take a holistic approach to our staff and their needs. The emphasis is on the support we provide, detailed in our staff handbook, and we trust them to meet our expectations over hygiene and appropriate dress.
‘We have a large staff team of 38, and if there are any concerns about personal hygiene, we expect our colleagues to share them with us. Support will be offered with “tact and sensitivity”, as stated in our staff handbook, and because we’re part of the university, we have the health and safety team on-site who do our audits and can refer people to occupational health if needed.
‘All members of staff have a locker and are asked to bring in a change of clothes. A shower is available if a child has an accident and a member of staff needs it. All staff receive a welcome pack with a personal alarm, sanitiser, book, pen and a keyring for the locker.
‘Disposable gloves and aprons are readily available in the nappy-changing areas. It’s personal preference to use them, but we advise them to if it’s a soiled nappy or a child has had an accident. Staff wash their hands before and after each nappy change and they spray the mats down each time. We also ensure that potties are emptied straight away.’
MORE INFORMATION
- ‘How to wash your hands’ – NHS (www.nhs.uk)
- Early years foundation stage (EYFS) statutory framework – GOV.UK (www.gov.uk)
- Preventing and controlling infections – GOV.UK (www.gov.uk)
