Infection Control for Daycares: Protecting Staff and Children

Children are naturally curious, physically affectionate, and developmentally incapable of consistently practising the hygiene behaviours that slow infection transmission. This makes child care centres among the highest-risk environments for the rapid spread of communicable diseases.

For daycare operators, educators, and parents, this is not a reason for alarm. It is a reason for a well-designed, consistently applied infection prevention and control (IPAC) program that protects every child and staff member in the centre.

In Canada, Public Health Ontario has developed practical tools, checklists, and evidence-based guidance specifically designed for child care providers. This article draws on those resources and current best practices to give you a comprehensive, actionable infection control framework for your daycare setting.

Why Daycares Are High-Risk Environments for Infection

Several structural features of daycare environments create elevated infection risk compared to most other community settings.

Young children have immune systems that are still developing, making them both more susceptible to infection and more likely to shed pathogens for longer periods after becoming ill. Children under five years old are particularly vulnerable to severe outcomes from common childhood illnesses.

The physical realities of child care — shared toys and surfaces, close physical contact during play and caregiving, limited ability to cover coughs or wash hands independently, and frequent diaper changes — create multiple daily opportunities for pathogen transmission.

Staff ratios mean that one educator may interact with eight to twelve children throughout the day, serving as a potential transmission bridge across the group. A staff member who comes to work while symptomatic can expose every child and colleague in their care within hours.

Manitoba’s Routine Practices Guide for Child Care Facilities notes that while public health measures can significantly reduce the risk of spreading communicable diseases including influenza, gastroenteritis, and respiratory illnesses, the risk is never zero and requires consistent daily practice.

The Foundation: Hand Hygiene in Child Care Settings

Hand hygiene is the single most effective infection prevention intervention in any setting. In daycares, it requires both adult practice and age-appropriate child education.

When Staff Must Perform Hand Hygiene

Staff must clean their hands:

• Before and after every diaper change or toileting assistance
• Before and after handling food or feeding children
• After contact with any body fluids including saliva, mucus, vomit, or stool
• After touching potentially contaminated surfaces or toys
• Before and after administering medication
• After removing gloves
• After removing outdoor clothing or shoes

Soap and water is the preferred method, particularly after diaper changes and contact with gastrointestinal illness. Alcohol-based hand rub (ABHR) is appropriate for many other moments but does not replace soap and water when hands are visibly soiled or after contact with norovirus or C. difficile.

Teaching Children Hand Hygiene

Children aged three and above can learn effective handwashing with adult supervision and positive reinforcement. Post visual handwashing guides at child height at every sink. Supervise handwashing before meals, after outdoor play, and after toileting.

Make hand hygiene an engaging, routine part of the day rather than a reactive response to visible dirt. Children who develop handwashing habits early carry those habits into later life — a long-term public health benefit that begins in your centre.

Environmental Cleaning and Disinfection Schedule

A structured cleaning and disinfection schedule is non-negotiable in any child care setting. The schedule must address three categories of items: toys, surfaces, and diaper change areas.

Toys and Shared Equipment

Toys that children mouth, share during play, or handle frequently require regular cleaning and disinfection.

• Wash toys with soap and water and rinse thoroughly before disinfecting.
• Use a Health Canada-registered disinfectant appropriate for the surface material and safe for use around children.
• Hard plastic toys can typically tolerate more frequent disinfection cycles. Soft toys should be laundered regularly.
• Remove any toy that cannot be adequately cleaned and disinfected from general use.

High-Touch Surfaces

Door handles, light switches, tap handles, countertops, railings, and shared furniture should be cleaned and disinfected at minimum once daily, and more frequently during illness outbreaks.

The City of Toronto’s Infection Prevention and Control Measures for Child Care Centres emphasizes that comprehensive IPAC programs for child care must include immunization support, hand hygiene, respiratory etiquette, and structured cleaning and disinfection practices working together as an integrated system.

Diaper Change Stations

Diaper change areas require meticulous attention because they represent the highest-risk contamination zone in the centre.

• Clean and disinfect the change surface after every single diaper change.
• Use a disposable cover on the change surface and discard it after each use.
• Never leave a child unattended on a change surface.
• Store diapers, wipes, gloves, and waste receptacle within arm’s reach to prevent cross-contamination through reaching over the child or touching surfaces between steps.
• Wash hands with soap and water immediately after each diaper change, even if gloves were worn.

For detailed guidance on cleaning procedures and the difference between cleaning and disinfecting, the cleaning, disinfecting, and sterilizing guide provides a clear framework that applies directly to child care settings.

Illness Exclusion Policies: When to Send Children Home

A well-defined illness exclusion policy is one of the most powerful infection control tools available to a daycare. It must be communicated clearly to all families before enrolment and applied consistently.

Children should be excluded from the centre when they have:

• Fever above 38°C (100.4°F), regardless of cause
• Vomiting more than twice in a 24-hour period
• Diarrhea that is watery, bloody, or frequent enough to cause soiling of clothing
• Undiagnosed rash with or without fever
• Conjunctivitis (pink eye) until diagnosed and treated
• Any illness that prevents the child from participating comfortably in activities
• Any illness requiring a higher level of care than the daycare can provide

Children should not return to the centre until they have been fever-free for 24 hours without fever-reducing medication, or as directed by a healthcare provider or public health authority.

Exclusion policies only work if families trust that they are applied fairly and that there will be no penalization for keeping a sick child home. Build that trust explicitly during onboarding and reinforce it every time you communicate about illness.

Staff Wellness and Sick Day Policy

Staff illness is just as significant an infection risk as child illness — arguably more so, because one sick staff member interacts with the entire group throughout the day.

Every child care centre must have a written sick day policy that clearly states staff should not come to work when symptomatic. This policy must be actively supported by management, with adequate backup staffing plans to prevent the pressure of short-staffing from pushing symptomatic staff into the centre.

Staff must also understand that they can transmit illness during the incubation period — before symptoms fully develop. Educate staff on the importance of monitoring their own health and reporting early symptoms promptly.

For staff who care for children during diaper changes or toileting, immunization against hepatitis A and other vaccine-preventable diseases relevant to child care settings is strongly encouraged and may be required by certain provincial guidelines.

Diaper Changing and Toileting: Preventing Fecal-Oral Transmission

Fecal-oral transmission is the dominant route for the most common daycare-associated illnesses including rotavirus, norovirus, and E. coli. Rigorous diaper changing and toileting practices disrupt this transmission pathway at its source.

Beyond the surface cleaning steps described above, a few additional practices are critical:

• Never handle a soiled diaper or clothing without gloves.
• Bag and seal soiled clothing immediately and send it home the same day.
• Maintain a dedicated waste bin with a tight-fitting lid in the diaper change area.
• Ensure the waste bin is emptied and disinfected daily.

Children who are toilet training may experience frequent accidents. Ensure that any clothing soiled with stool is handled with gloves, bagged, and stored away from the child’s general belongings until pickup.

Outbreak Recognition and Reporting in Child Care Settings

Illness clustering in a daycare setting — two or more children or staff with similar symptoms linked to a common exposure — represents a potential outbreak and must be reported to your local public health unit.

Maintain a confidential daily illness log that records symptoms, times of onset, and whether the child or staff member was excluded. This log becomes critical for public health investigation if an outbreak is suspected.

Common daycare-associated outbreaks include:

• Gastroenteritis (norovirus, rotavirus, E. coli)
• Hand, foot, and mouth disease (enterovirus)
• Conjunctivitis
• Respiratory illness clusters (RSV, influenza, COVID-19)
• Measles or varicella in under-vaccinated groups

The measles resurgence and infection control resource provides current guidance on responding to measles exposures in community settings, which is particularly relevant for child care operators given ongoing immunization gaps in some communities.

Immunization Records and Vaccination Requirements

Immunization is the most powerful long-term infection prevention tool in the child care toolbox. A well-vaccinated group of children dramatically reduces outbreak risk for the entire centre.

Maintain up-to-date immunization records for every enrolled child. Know which vaccines are required under your provincial public health legislation and which are recommended. Follow up with families when records are incomplete or when children are due for scheduled doses.

Staff immunization matters too. Ensure all staff are current on their own vaccinations, including annual influenza immunization, and that their records are documented.

For children who are not immunized due to medical contraindication or parental choice, document this clearly and have a plan for exclusion during outbreak situations as directed by public health authorities.

Staff Training and IPAC Policy Development

A written IPAC policy for your centre is not optional. It is the foundation on which every other infection prevention practice rests.

Administrative health policies and procedures help child care centres ensure staff are trained and aware of IPAC measures specific to the centre and how they apply to daily activities. A policy sets out general directions on a specific matter, describing who, what, and why, but does not replace specific operational procedures.

Your IPAC policy should cover hand hygiene, cleaning and disinfection, illness exclusion, outbreak response, immunization requirements, personal protective equipment, and safe food handling. Review and update it at minimum annually.

All staff should receive IPAC orientation training before beginning work and refresher training at regular intervals. Training records must be maintained and available for public health inspection.

For a model approach to developing centre-specific IPAC policies, the how to write an effective IPAC manual guide provides a structured template and content guidance directly applicable to non-healthcare settings including child care.

Protecting children and staff from infection is not just a regulatory requirement. It is the clearest possible expression of your commitment to the children in your care and the families who trust you with them every day.

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