Coronavirus: Wales launches further childcare guidance ahead of reopening

EThe Welsh Government released ‘Protective measures in childcare settings: Keep Childcare Safe on 10 June to support providers to allow more children to attend and protect them and staff from the coronavirus. Guidance for schools on Keep Education Safe: Guidance on learning over the summer term was published at the same time.

The guidance for childcare providers, which is separated into 14 sections, includes social distancing measures, cleaning, use of outdoor space and hand washing. The recommendations are aimed at registered settings and environments primarily caring for pre-school aged children, however, many of the same principles apply to childcare provision for older age groups of children, including after-school and holiday schemes.

Settings providing childcare for older children are also advised to refer to the guidance for schools and to form a judgment on which measures are most appropriate to their operating model during the Covid-19 outbreak.

The main points from the guidance are summarised below:

Social distancing

Social distancing measures should be employed ‘so far as is reasonably practical’ but it is accepted that this will be harder to maintain in a childcare setting where babies and pre-school aged children are being cared for than in other settings. Therefore, infection prevention and control measures must be increased.

Settings should:

• risk assess appropriately to evidence their approach to social distancing which may mean limiting the number of children they can safely care for
• ensure that children and staff where possible only mix in a small, consistent group
• children should be cared for in consistent groups of no more than 8, while adhering to National Minimum Standards ratios
• sessional nurseries that have different cohorts of children at different times of the day may wish to consider having smaller group sizes to limit the number of children staff are in contact with
• as far as possible, the same members of staff should be assigned to each group and these should stay the same during the day and on subsequent days
• keep groups of children separate from other groups where possible
• stagger interaction between different groups of children and consider the movement of children around the childcare setting, including one way route systems where possible to reduce large groups of children gathering
• consider staggering children arriving and leaving the childcare setting to avoid parents gathering during drop off and pick up points
• prevent the sharing of food, drink, utensils, and where possible equipment and toys
• make as much use as possible of the available outdoor space for activities

Use of outdoor space

Settings are advised to allow children to spend as much time outdoors as possible as this can limit transmission and more easily allow for distance between the groups. Outdoor equipment should not be used unless the setting is able to ensure it is appropriately cleaned between groups of children using it, and that multiple groups don't use it simultaneously.

Infection prevention and control measures

Screening of children’s temperatures is not necessary because asymptomatic screening will not identify all cases of COVID-19, the guidance states. However, this will be kept under review and parents should check their child’s temperature before bringing them to the setting if they suspect the child is unwell.

Hand hygiene

Hand hygiene is essential before and after all direct contact with a child and after cleaning equipment and the environment. Hands should be washed thoroughly for 20 seconds with soap and water. An alcohol-based hand rub can be used if hands are not visibly dirty or soiled and if soap and water are unavailable. However, thorough handwashing with soap and water is more effective than the use of hand sanitisers.

Hand washing/sanitising should be done for example:

• on arrival at the setting
• after use of the toilet
• before and after eating
• after returning indoors from outdoor play
• after being in physical contact with other children
• after sneezing or coughing

Resources

• Play with sand, water, plasticine/play dough and cookery and other messy play activities should be restricted and only participated in if the relevant guidance around hygiene and cleaning in the Infection Prevention and Control for Childcare Settings Guidance can be adhered to.
• Equipment, toys and surfaces, including those across all areas of the setting such as toilets, sinks, taps and changing areas, tables and handles should be cleaned and disinfected frequently in line with Infection Prevention and Control for Childcare Settings Guidance.
• Providers should consider removing soft toys and toys that are hard to clean (such as those with intricate parts). Outdoor equipment and entrance gates should also be cleaned and disinfected frequently.
• Settings should ensure all indoor spaces are as well ventilated as possible, by opening windows or use of ventilation units.

Face coverings

The Chief Medical Officer for Wales has been clear that there is no evidence to support the widespread wearing of non-medical face coverings in the community. Non-medical face coverings are only recommended where social distancing cannot be maintained. They are not a replacement for far more effective measures such as social distancing and hand hygiene.
The impact of wearing a face mask when caring for a deaf child should be carefully considered, as communication for many deaf people relies in part on being able to see someone’s face clearly. The National Deaf Children’s Societyhas provided the following communication tips, which childcare staff may find useful in this regard.

Personal Protective Equipment (PPE) in childcare settings

• Gloves and aprons should be used when providing intimate care to a child, including hands-on care such as washing, toileting, or first aid and certain clinical procedures such as assisted feeding.
• Fluid-resistant surgical mask and eye protection should also be worn if a risk assessment determines that there is a risk of splashing to the eyes such as from coughing, spitting, or vomiting.
• Gloves and aprons should be used when cleaning equipment or surfaces that might be contaminated with body fluids such as saliva or respiratory secretions.
• Handwashing should always be practised before putting on and after removing PPE.
• In cases where aerosol generating procedures such as suction are undertaken, gloves, fluid repellent gown, FFP3 mask and eye protection are required.

Where there is suspected coronavirus (COVID-19) in a childcare setting

• Gloves, aprons and a fluid-resistant surgical mask should be worn if a child becomes unwell with symptoms of COVID-19 and needs direct personal care.
• Eye protection should also be worn if a risk assessment determines that there is a risk of splashing to the eyes such as from coughing, spitting, or vomiting.
• Gloves and aprons should be used when cleaning the areas where a person suspected of having COVID-19 has been.
• If a child shows symptoms of COVID-19 while in a childcare setting
  Settings will need to have a clear, written procedure in place for the protection of staff and children if a child develops symptoms while at the setting.
• Their parent/carer should be called immediately and the child collected and taken home. Young sick children will need to be cared for until they are collected.
• The child should be moved away from other children and cared for separately with appropriate adult supervision. If it is not possible to isolate the child, move them to an area which is at least 2 metres away from other children.
• Ideally, a window should be opened for ventilation. Disposable gloves, apron and a fluid-resistant surgical mask should be worn if the child requires personal care or close contact.
• If a risk assessment determines that there is a risk of splashing to the eyes, for example from coughing, spitting, or vomiting, then eye protection should also be worn. 

Test, Trace, Protect

The new Test, Trace, Protect strategy published on 13 May was implemented across Wales from 1 June.
If a child or staff member receives a test and that test is positive, they should self-isolate and report their symptoms. The setting will then be contacted by the Contact Tracing Team and advice will be given on isolation measures to be taken by individuals.