Sanitation

1. Sanitation Lindsey Allen, B.S.,CHES Child Care Health Consultant Cherokee Co. Health Department

2. Layout of Training • Pre-test • Objectives • Training • Post-test • Evaluation

3. Objectives • Participants will be able to define sanitation and sanitation classification. • Participants will be able to describe proper hand washing procedure and the importance of it. • Participants will be able to describe proper diapering procedure and the importance of it.

4. Objectives Continued • Will be able to describe basic food preparation and storage rules and regulations. • Will be able to describe sanitizing of equipment and utensils. • Will be able to describe proper sanitizing and storage of cots, mats, etc. • Will be able to describe proper sanitizing of toys

5. Sanitation Defined Sanitation refers to the development and application of sanitary measures for the sake of cleanliness, protecting health, etc.

6. Sanitation Classification • Inspections are required twice per year in accordance with the NC General Statute 15A NCAC 18A.2800. • Classifications: • Superior: 0-15 demerits (no 6 point) • Approved: 16-30 demerits (no 6 point) • Provisional: 31-45 demerits (or any 6 point) • Disapproved: 46 or more demerits, or failure to improve a Provisional classification.

7. Definitions • Cleaning-removing visible soil and debris. Includes scrubbing, washing with detergent and water, and rinsing. Always clean before sanitizing or disinfecting. • Sanitizing-kills nearly 99.9% of germs. Includes covering cleaned area with solution (concentration dependent upon surface area). • Disinfecting-kills nearly 100% of germs and is used in same manner as sanitizer.

8. Handwashing-Why? • Single most important step in the prevention and spread of diseases (especially with diarrheal and respiratory illnesses). • Total of 10 demerits may be deducted for handwashing during inspection. • Saves time and money

9. Modes of Transmission • Respiratory or airborne (like coughing or sneezing). • Fecal-oral contact (hands contaminated with human waste). • Contact (touching). • Contact with infected blood and secretions (like urine or saliva).

10. The Child Care Setting The most common form of transmission in a child care setting is by fecal-oral contact. This means human waste is on your hands and they are not washed properly. Then, in turn, is passed onto someone else.

11. Common Pathogens-Shigella • Symptoms can occur within one day to one week of exposure. • Symptoms include: stomach cramps, diarrhea, vomiting, fever, and headache. • Transmitted strictly by human feces. • 14,000 confirmed cases every year in US. • Last between 5 to 7 days.

12. Common Pathogens-Rotavirus • Wheel-like appearance • Almost all children infected • 20-70 deaths per year • Symptoms-severe fever, diarrhea, and vomiting all leading to severe dehydration. • Spread through fecal-oral contact • Cannot be treated with antibiotics. • Outbreaks from November to May.

13. Steps for Proper Handwashing Use liquid soap and tempered water (80 to 110 degrees). Rub hands vigorously for 15 seconds. Wash all surfaces (back of hands, palms, wrists, under fingernails, and between fingers). Rinse well for 10 seconds. Dry hands with a paper towel Turn off faucet with paper towel.

14. Employees-When? • Upon reporting for work • Before and after handling food • Before bottle feeding or serving food • Before handling utensils • After bathroom or handling body fluids • After diaper changing • After handling soiled items • After being outdoors • After handling animals or animal cages • After removing gloves

15. Children-When? • Upon arrival at the center • After diaper changing or visit to the toilet • Before eating meals or snacks • Before and after water play • After outdoor activity • After handling animals or animal cages

16. Hand Sanitizers • To be used only when outdoors • Never to be used after diapering • Potential for alcohol poisoning • Drug resistant bacteria • Hormone disruption • Potential for weakened immune system

17. Handwashing Activity Glo-germ activity

18. Diaper Changing Diaper changing surfaces are some of the most contaminated surfaces in a classroom and could contain all the pathogens we mentioned earlier.

19. What is required? • Designated area with hand sink nearby • Diapering surface must be smooth, intact, and a non-absorbent surface • 4 demerits will be taken if anything is stored on diapering surface or if the pad/surface is in disrepair

20. How should it be cleaned? • With soapy water, wiped dry, and then a disinfecting solution applied • Solution should be between 500 to 800 parts per million (ppm) of chlorine bleach (1/4 cup bleach per gallon of water) • Bottle labeled and stored out of reach (5ft or higher) • 6 demerits may be taken if not properly cleaned and disinfected or if disinfectant does not meet the required strength of 500-800ppm

21. So much more than an inspection… • Each individual should be able to prepare solution • Kills germs-reduces sickness among children • Weakens if not prepared daily • Protect yourself!

22. Proper Diaper Changing Gather supplies BEFORE placing child on table Put on gloves (if needed or required by center) Remove clothes and soiled diaper, using a moist towelette wipe front to back to clean child Dispose of gloves if used, soiled items in plastic-lined, covered receptacle Wipe hands with disposable towelette or paper towel Slide a clean diaper, fasten, and redress Wash child’s hands or if child is unable to support their head, clean the child’s hands with disposable towelette, and return child to supervised area

23. Steps Continued… 8. Spray entire diapering surface with soapy water and wipe clean, using disposable paper towels 9. Spray entire surface with approved disinfecting solution and allow to remain on surface for minimum of 2 minutes 10. Wash your hands following proper handwashing procedures even if disposable gloves are used *Special Note: Be sure posters are posted in handwashing and diapering areas!*

24. Food Supplies • Free from spoilage, filth, or other contamination (6 demerits) • Safe for human consumption (6 demerits) • Items from home properly labeled and dated • Using outside sources for food supply

25. Food Storage and Protection • Stored in approved, clean, tightly covered, storage containers • Dry foods stored in containers labeled • Stored above the floor • Not be stored under exposed sewer lines • Raw food shall be stored on shelving beneath and separate from other foods • Potentially hazardous food lower than 45, or higher than 140.

26. Food Preparation • Prep can only take place in designated areas • With least possible manual contact, with utensils, and clean and sanitized surfaces • Utensils and surfaces cleaned after raw food preparation • Fruits and vegetables must be washed • Foods being cooked-all parts 165 except in certain instances • Metal stem-type numerically scaled accurate to 2 degrees shall be used

27. Thawing Foods (5 demerits) • In refrigerated units at a temperature not to exceed 45 degrees • Under potable water of a temperature of 70 degrees or below • In a microwave oven only when the food will be immediately transferred to conventional cooking equipment

28. Cleaning & Sanitizing • Each center should have at least a two-compartment sink, drainboards, or countertop space • Separate lavatory for handwashing • Removal of food particles • Sinks cleaned and sanitized prior to use • Equipment and utentils shall be washed in first compartment with hot detergent solution • Tabletops (eating and children’s work tables), food contact surfaces, food prep surfaces, etc should be sanitized with solution 50-200ppm

29. Common Foodborne Illnesses • Botulism • Campylobacter • E.Coli • Listeria • “Mad Cow” disease • Norovirus • Salmonella • Staph • Trichinosis

30. Food Safety Report Card

31. Beds, Cots, Mats, & Linens • Good repair (3 demerits) • Stored to prevent contamination (floor side not to touch sleeping side) • Cleaned and sanitized between users • Easy to clean surfaces • Mattresses and mats waterproof material • Assigned and labeled with individual linens (3 demerits) • Wash cloths, bibs, and burping cloths shall not be used for more than one child and laundered when soiled (3 demerits)

32. Toys, Equipment, & Furniture • Shall be kept clean and in good repair (4 demerits) • Toys and other mouthed surfaces shall be cleaned and sanitized daily in rooms where children aren’t toilet trained (4 demerits) • Shall be free of peeling, flaking, or chalking paint • Water play centers filled just prior to each session and emptied after each sessions • Toys used in water centers shall be cleaned and sanitized after use

33. Resources Child Care Center Handbook. Division of Child Development. Oct 2009. Cleaning, Sanitizing, and Disinfecting-Using Bleach Solutions. NC Child Care Health and Safety Resource Center. 2009. Module 1: Sanitation Classification, Handwashing and Diaper Changing. Guildford County Department of Public Health, Children’s Environmental Health Section. Sept 2008. The Big 9 Foodborne Illnesses and what they do to you. Calorie Lab. 2008. http://calorielab.com/news/2008/06/23/foodborne-illnesses/

34. Questions? Lindsey Allen, B.S., CHES Child Care Health Consultant Cherokee County Health Department Phone: (828) 837-7486 ext. 506 Lindsey.allen@cherokeecounty-nc.gov