1304.22

 

 

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1304.22

Child Health and Safety

(a) Health Emergency Procedures

(b) Conditions of Short-Term Exclusion and Admittance

(c) Medication Administration

(d) Injury Prevention

(e) Hygiene

(f) First Aid Kits

INTRODUCTION TO 1304.22

Head Start’s commitment to wellness embraces a comprehensive vision of health for children, families, and staff. The objective of 45 CFR 1304.22 is to support healthy physical development by encouraging practices that prevent illness or injury, and by promoting positive, culturally relevant health behaviors that enhance life-long well-being.

The standards in this section include health emergency procedures, conditions of short-term exclusion, medication administration, injury prevention, hygiene, and first aid kits.
Performance Standard

1304.22(a)

(a) Health emergency procedures.

Grantee and delegate agencies operating center-based programs must establish and implement policies and procedures to respond to medical and dental health emergencies with which all staff are familiar and trained. At a minimum, these policies and procedures must include:

  

Rationale: In emergency situations, staff members are prepared to act quickly to ensure the health and well-being of each child. Staff who are knowledgeable and well-trained in their agency’s health emergency procedures are prepared to protect the children in their care. This rationale serves 45 CFR 1304.22(a)(1)-(4).

Related Information: See 45 CFR 1304.40(f)(2)(iii) for information on providing parents with the opportunity to learn the principles of emergency first aid, and 45 CFR 1304.22(d)(1) and (2) for information on safety and injury prevention.

Guidance: Emergency policies and procedures clearly stating the responsibilities of each staff member are written in the language of staff members and the population being served, as well as in English. The Health Services Advisory Committee can be instrumental in developing these policies. It also is helpful for emergency providers, such as firemen, policemen, and emergency medical technicians, to participate in developing such policies, particularly after visiting the program, so that staff, children and emergency providers can get to know each other.

Staff training includes techniques for reacting quickly and calmly in implementing emergency procedures; and the training is geared to the age of the children being served.

Home visitors, family child care providers, and other staff work with families to develop plans of action for dealing with emergencies in the home, including conducting periodic emergency practice drills and procedures for families without telephones.
 

Performance Standard

1304.22(a)(1)

(1) Posted policies and plans of action for emergencies that require rapid response on the part of staff (e.g., a child choking) or immediate medical or dental attention;

 Guidance: With consultation from their Health Services Advisory Committee, agencies provide training and post concise directions to staff on administering first aid, contacting emergency care providers, seeing to emergency transportation, and contacting parents.
Performance Standard

1304.22(a)(2)

(2) Posted locations and telephone numbers of emergency response systems. Up-to-date family contact information and authorization for emergency care for each child must be readily available;

  

Guidance: So that staff can quickly access emergency contact information, a list of emergency care facilities and provider telephone numbers is posted at recognized locations, such as at each telephone station in the program site. When calling about an emergency, helpful information includes the following: name of caller, agency, nature of emergency, telephone number, address, easy directions, exact location of injured person(s), number and age(s) of person(s) involved, condition(s) of person(s) involved, and help already given.

Emergency contact information for each child includes:

names and telephone numbers (both at home and at work) of the parents or legal guardians,
names and telephone numbers (both home and work) of parent or contact persons to whom the child may be released, if the parent or guardian is unavailable,
name, address, and telephone number of the child’s usual source of medical and dental care,
information on the child’s health insurance, including the name, identification number, and the subscriber’s name,
special conditions, disabilities, allergies, or medical and dental information, such as the date of the latest DPT immunization, and
parent’s or guardian’s written consent, in case emergency care is needed.

Updated information is kept in a file easily accessible to appropriate staff. Copies of this information accompany staff and children on outings away from the facility.

Home visitors and other staff encourage and assist parents to develop a list of names and telephone numbers of individuals to contact in an emergency. Two copies of such lists are made — one copy to post at home and another to give to a responsible person outside the home, such as a neighbor. Parents without telephones develop plans for accessing a neighbor’s telephone or a nearby public telephone, two way radio, or "walkie-talkie," in case of an emergency.
Performance Standard

1304.22(a)(3)

(3) Posted emergency evacuation routes and other safety procedures for emergencies (e.g., fire or weather-related) which are practiced regularly (see 45 CFR 1304.53 for additional information);

  

Guidance: A written plan for evacuating and for responding to a fire, flood, tornado, earthquake, hurricane, blizzard, violence in the community, and power failure saves valuable time in emergency situations. Plans include specifics, such as escape routes, assignments for all staff, and the location of the nearest fire alarm. Home visitors help parents to develop an emergency evacuation plan for their own home, as well as a strategy for how to help all family members above age two to understand and follow such a plan.

The Health Services Advisory Committee, emergency medical system (EMS) staff, the fire inspector, and the local fire department are helpful in developing an emergency plan.

Although it is impossible to anticipate each potential emergency situation, some emergencies are prepared for by taking precautions such as:

Planning two exit routes from every location in the building;
Having unannounced evacuation drills at least once a month, at varying times of the day; and
Maintaining records of evacuation drills for the on-site inspection and review of the building inspector.
 

Performance Standard

1304.22(a)(4)

(4) Methods of notifying parents in the event of an emergency involving their child; and

  

Guidance: When contacting parents or other emergency contact persons, it is important for staff to calmly and succinctly relate all relevant information.

An incident or injury report form is useful in documenting what has happened to a child and what has been done to care for that child, as well as the notification made to parents and the parents’ response to this notification.
Performance Standard

1304.22(a)(5)

(5) Established methods for handling cases of suspected or known child abuse and neglect that are in compliance with applicable Federal, State, or Tribal laws.

  

Rationale: It is essential to intervene in any suspected case of abuse and neglect, both for the safety of the child and for the wellness of the family. Federal, State, and Tribal laws require educators and caretakers to report all suspected cases of abuse and neglect. Establishing these procedures helps staff determine when and to whom such a report needs to be made.

Related Information: See Appendix A to 45 CFR 1301.31, the Identification and Reporting of Child Abuse and Neglect, for a description of Head Start policy governing the prevention, identification, treatment, and reporting of child abuse and neglect; see 45 CFR 1304.41(a)(2)(vi) for information on collaborative relationships with child protective service agencies; and see 45 CFR 1304.52(k)(3)(i) for information on training staff to recognize and report child abuse and neglect.

Guidance: Head Start plays an important role in working with families to prevent child abuse and neglect. Head Start staff help to identify risk factors for abuse, and work with the family to clarify appropriate expectations, enhance parenting skills, and offer the family emotional support and resources. In establishing agency procedures for handling cases of suspected or known child abuse or neglect, agencies:

Assure that agency policies are in compliance with applicable Federal, State, Tribal, or local child abuse and neglect laws regarding the definition of child abuse and neglect and the standards of evidence required for reporters under applicable laws;
Establish a local agency reporting plan, as required by 45 CFR 1301.31(e);
Contact the local, State, or Tribal agency responsible for receiving reports of suspected child abuse and neglect, in order to learn about specific reporting procedures. Agencies may include State and local child protective service (CPS) agencies, Indian child welfare programs, local police departments, or State or local departments of social services. Identify and establish relationships with problem-solving and support groups for abusers and potential abusers (e.g., Parents Anonymous) to provide referrals and training for prevention and intervention;
Train all staff to identify and report child abuse and neglect. Ensure that staff do not, themselves, investigate suspected cases of child abuse and neglect. Their role is to report suspected cases to the appropriate agencies. Ensure that staff report to their supervisor regarding a suspected case of abuse or neglect;
Provide special training and support to home visitors who, because they are in the families’ homes on a regular basis and have an unusually close relationship with the parents, are in a special situation for reporting child abuse and neglect;
Cooperate with enforcement agencies and, when possible, work with abusing or neglecting parents and caretakers to provide them with support, counseling, and other referrals;
Encourage an appointed staff member to approach the individual(s) suspected of abuse or neglect, whenever appropriate, and if doing so will not constitute a danger to reporting staff; convey concerns and inform the individual(s) that a report to the appropriate authorities is being submitted;
Ensure confidentiality of the individual reporting of the suspected abuse and of all reports of suspected abuse (see 45 CFR 1304.52(h)(1)(ii) for information on the program’s confidentiality policy);
Recognize that most States require only suspicion that abuse or neglect has occurred before reporting may take place; incidents must be reported as soon as they are suspected, because waiting for proof may result in serious risks to the child; and
Inform staff members of cultural differences in childrearing practices and direct them to discuss with a designated staff member any concerns regarding differences in child rearing practices.
Performance Standard

1304.22(b)(1)

(b) Conditions of short-term exclusion and admittance.

(1) Grantee and delegate agencies must temporarily exclude a child with a short-term injury or an acute or short-term contagious illness, that cannot be readily accommodated, from program participation in center-based activities or group experiences, but only for that generally short-term period when keeping the child in care poses a significant risk to the health or safety of the child or anyone in contact with the child.

  

Rationale: Temporarily excluding a child from program participation protects the health of the affected child, other children, and staff.

Guidance: Clear policies and procedures, developed by the agency with the involvement of the Health Services Advisory Committee, indicate those instances in which a child should be temporarily excluded from the program. This policy is conveyed to parents at enrollment, so that everyone concerned will understand and follow standard policy, and so that all may function as partners in determining whether the child in question stays home or not, and can plan accordingly.

Current, professionally established guidelines on short-term exclusion and readmittance may be used to develop agency short-term exclusion policies. When determining such policies and procedures, consideration should be given to whatever arrangements working parents make to care for their ill or injured child. When applicable, staff may suggest alternatives for child care, if reasonable modifications cannot be made in the program setting.

A child may be readmitted to the program when he or she meets appropriate criteria. Some conditions, however, may require approval by a local health official, before readmittance is possible or wise. Staff consult with the Health Services Advisory Committee or other local health officials regarding these conditions and readmittance recommendations.
Performance Standard

1304.22(b)(2)

(2) Grantee and delegate agencies must not deny program admission to any child, nor exclude any enrolled child from program participation for a long-term period, solely on the basis of his or her health care needs or medication requirements unless keeping the child in care poses a significant risk to the health or safety of the child or anyone in contact with the child and the risk cannot be eliminated or reduced to an acceptable level through reasonable modifications in the grantee or delegate agency’s policies, practices or procedures or by providing appropriate auxiliary aids which would enable the child to participate without fundamentally altering the nature of the program.

  

Rationale: Provided the program can reasonably accommodate them, all eligible children are afforded an equal opportunity to be included in Head Start, regardless of special health needs or medication requirements, so that they and their families may benefit fully from the experience.

Related Information: See 45 CFR 1308.4(a) and (c) for additional information on meeting the needs of, and including, children with disabilities.

Guidance: Including a child with special health care needs or medication requirements, such as a child with HIV or diabetes, can involve developing policies and strategies, with the assistance of the Health Services Advisory Committee, that include the following:

Making reasonable accommodations for the child. The Health Services Advisory Committee and local agencies or organizations, such as hospitals, schools, and local health departments, can suggest ways to accommodate the child in the program;
Ensuring that parents and health care providers supply clear, thorough instructions on how best to care for the child, in order to protect his or her health, as well as the health of other children and staff;
Ensuring that the program has adequate health policies and protocols, staff training and monitoring, and supplies and equipment to perform necessary health procedures;
Reassuring parents of other children that their children are at no health risk;
Promoting understanding of the child’s special health needs, without embarrassing or drawing attention to the child; and
Protecting the privacy of the affected child and her or his family.

In developing strategies for maintaining optimum health requirements, staff review Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act, which prohibit discrimination against persons with disabilities, including those with chronic health conditions. In addition, programs are familiar with State child care licensing regulations and medical and nursing practices regarding health procedures.

Resources that are of assistance in preparing staff to care for children with special medical needs include:

the child’s health care provider,
Health Services Advisory Committee members,
local public health department staff,
local medical and nursing society members, and
medical equipment manufacturers.

Providing the support necessary to promote, improve, and deliver the above services means collaborating with agencies such as the Centers for Disease Control and Prevention, the State Children with Special Health Needs (CSHN) agency, and State, Tribal, and local health departments.
Performance Standard

1304.22(b)(3)

(3) Grantee and delegate agencies must request that parents inform them of any health or safety needs of the child that the program may be required to address. Programs must share information, as necessary, with appropriate staff regarding accommodations needed in accordance with the program’s confidentiality policy.

  

Rationale: This requirement will prepare the staff to provide better care for the child and to help protect the health of other children and staff, and it will facilitate the appropriate and prompt reporting of diseases.

Related Information: See 45 CFR 1304.40(f)(2)(iii) for information on providing parents with the opportunity to learn principles of preventive medical and dental health. Also, see 45 CFR 1304.52(h)(1)(ii) for information on following the program’s confidentiality policy.

Guidance: Staff and parents share responsibility for the health of all children. Agencies implement an ongoing process to ensure that parents have opportunities to inform staff of accommodations their child may require, such as those due to a child’s chronic illness or condition. Staff offer such opportunities during enrollment and throughout the year as a child’s health needs arise. Plans to accommodate a child’s health or safety needs are in place before services to a child begin or as soon as possible after the need is identified.

Parents are reassured that disclosing such information is voluntary and that parents only need to share sufficient information to accommodate the child. Agencies ensure that there is a process to share information among staff on a need-to-know basis and that all staff and parents understand the agency’s confidentiality policy.
 

Performance Standard

1304.22(c)

(c) Medication administration.

Grantee and delegate agencies must establish and maintain written procedures regarding the administration, handling, and storage of medication for every child. Grantee and delegate agencies may modify these procedures as necessary to satisfy State or Tribal laws, but only where such laws are consistent with Federal laws. The procedures must include:

 Rationale: The proper storage of medication and its administration by designated staff, following the written authorization of the child’s physician and parents, safeguard the health of children, staff, and families. This rationale serves 45 CFR 1304.22(1)-(3).

Guidance: The Health Services Advisory Committee assists in developing procedures for the administration, handling, and storage of medication. In developing such procedures, it is important to encourage communication with parents, to be aware of any individual or community health considerations, and to be cognizant of State policies. For example, if applicable, medication administration procedures should be outlined in an individualized plan for the child. In the home-based option, parents administer medications to their children.
Performance Standard

1304.22(c)(1)

(1) Labeling and storing, under lock and key, and refrigerating, if necessary, all medications, including those required for staff and volunteers;

  

Related Information: See 45 CFR 1304.53(a)(10)(iii) for additional information on the storage of medications.

Guidance: In developing procedures and techniques for labeling and storing medication, it is important for both agencies and families to keep the following in mind:
Instructions and information. To ensure the safety of children, prescribed medication is labeled by a pharmacist, with the child’s first and last names, the name of the medication, the date the prescription was filled, the name of the health care provider who wrote the prescription, the medication’s expiration date, and administration, storage, and disposal instructions.

For over-the-counter medication with a documented recommendation by a health care provider, parents should provide instructions and information on a label, including: the child’s first and last names; specific, legible instructions for administration and storage supplied by the manufacturer or health care provider; and the name of the health care provider who recommended the medication for the child.

Medications administered "as needed" ("PRN" medications) have specific directions for administration, including minimum time between doses, maximum number of doses, and criteria for administration. Medication required for use by staff and volunteers is clearly labeled with their first and last names.
Container. Prescribed medication is provided in an original, child-resistant container labeled by a pharmacist. For over-the-counter medications recommended by a health care provider, parents may be asked to provide the medication in a child-resistant container.
Storage and inaccessibility to children. Medication of any kind needs to be kept away from food, and stored in sturdy, child-resistant, closed containers that are both inaccessible to children and prevent spillage. If medication requires refrigeration, a small lock box designated for storing medication may be kept in the refrigerator.
Expiration dates. Medication should not be used beyond the date of expiration on the container, or beyond the expiration of the instructions provided by the physician or other person legally permitted to prescribe medication. Instructions that state the medication may be used "whenever needed" should be reviewed by the physician at least annually.
Transportation. Efforts should be made to minimize the transportation of medication. If, however, medication does need to be transported, staff ensure that there are measures to keep it temperature-controlled, if necessary, and that there is a responsible adult in charge of the medication (e.g., the bus monitor, if a child requiring medication takes the bus), in accordance with State and Tribal law.
 

Performance Standard

1304.22(c)(2)

(2) Designating a trained staff member(s) or school nurse to administer, handle and store child medications;

  

Related Information: See 45 CFR 1304.22(c)(6) and 1304.52(d)(2) for further information.

Guidance: Child medications are handled by designated staff, selected and trained in accordance with State or Tribal law. The designated individual(s) may be someone who is at the program regularly, so that all children may become comfortable with him or her. In the absence of State law, the most qualified person should administer the medication. A back-up staff member also is designated and kept informed of all current procedures. If State law requires that an individual be licensed to administer medication, a reasonable accommodation may be to obtain the services of a nurse or a nurse practitioner for this purpose.
Performance Standard

1304.22(c)(3)

(3) Obtaining physicians’ instructions and written parent or guardian authorizations for all medications administered by staff;

  

Related Information: See guidance to 45 CFR 1304.22(c)(6) for information on techniques staff should know regarding administering medication.

Guidance: A physician or other person legally authorized to prescribe medication provides instructions for the dose, frequency, method to be used (e.g., before meals, tilting head), and duration of administration in writing by a signed note or a prescription label. These instructions are legible and easily understood. The program provides training for the staff person(s) administering medication.

Signed parent authorization forms are kept in the child’s health record. The Health Services Advisory Committee may assist in the development of these authorization forms.

In cases when medication is needed for emergency treatment, it is administered only if authorized by a local poison control center or a physician.
Performance Standard

1304.22(c)(4)

(4) Maintaining an individual record of all medications dispensed, and reviewing the record regularly with the child's parents;

  

Rationale: Information pertaining to the dispensation of medication should be well-documented, so that administration is accurate and accomplishes its intended purpose. Changes in a child’s behavior, or physical symptoms, may indicate a need to communicate with the physician to alter the dosage or type of medication. This rationale serves 1304.22(c)(4)-(5).

Guidance: Each time medication is dispensed during program hours, the amount of medication given, the time and date of administration, and the name of the person administering each dose is recorded in the child’s record. Special circumstances, such as spills, responses, reactions, and refusals to take medication, also are included in the child’s health record. This information is then reported to and reviewed by the parent and the individual who prescribed the medication. If there are consistent administration problems, an experienced health professional should be consulted.
Performance Standard

1304.22(c)(5)

(5) Recording changes in a child's behavior that have implications for drug dosage or type, and assisting parents in communicating with their physician regarding the effect of the medication on the child; and

  

Related Information: See 1304.20(e)4) for additional information on involving parents as active partners in their child’s health care process.

Guidance: Staff encourage parents to give the first dose of medication at home, so that they can observe whether the child has any type of reaction. In extenuating circumstances where the first dose of medication is given by a staff person, staff members with whom the child has regular contact are instructed to watch for any changes in the child’s normal behavior patterns, such as signs of lethargy, moodiness, aggressiveness, or physical reactions such as rashes. When administering medication to infants and toddlers, staff watch for allergic reactions, such as swelling, rashes, or breathing difficulties.

If changes are noted at any time during medication administration, they are recorded and immediately brought to the attention of the child’s parents. The parents, in turn, contact the physician, who determines whether or not to continue the child’s medication, and at what dosage. A child’s reaction to medication may occasionally be extreme enough to initiate emergency procedures.
Performance Standard

1304.22(c)(6)

(6) Ensuring that appropriate staff members can demonstrate proper techniques for administering, handling, and storing medication, including the use of any necessary equipment to administer medication.

  

Rationale: Staff knowledge of proper techniques for handling medication safeguards the health of all children in the programs.

Related Information: See 45 CFR 1304.52(k) for additional information on staff training and development, and 45 CFR 1304.22(c)(2) for additional information on designating a trained staff member.

Guidance: Some appropriate techniques for medicine administration include:

Reading the label and prescription directions in relation to the required dose, frequency, storage, and other circumstances relative to administration;
Using age-appropriate administration techniques to gain the child’s cooperation; and
Documenting that the medication, in fact, was administered.

According to State child care laws and regulations, including Professional Practice Acts, a health care provider trains staff members to use any equipment needed to administer medication, such as nebulizers, or any instrument specifically used to administer medication to infants and toddlers. Staff administering medication demonstrate their ability to perform those procedures.

All staff who are in contact with the child understand the way the medication works, and are alert to its possible side effects.
Performance Standard

1304.22(d)(1) & (2)

(d) Injury prevention.

Grantee and delegate agencies must:

(1) Ensure that staff and volunteers can demonstrate safety practices; and

(2) Foster safety awareness among children and parents by incorporating it into child and parent activities.

  

Rationale: Injuries often are the result of a mismatch between a child’s abilities and activities, unsafe conditions in the environment, or a lack of adult supervision. Fostering and incorporating safety awareness into a program supports Head Start’s role of protecting each child.

Related Information: See 45 CFR 1304.53(a) for information on keeping the Head Start physical environment and facilities well maintained and hazard free. See 45 CFR 1304.53(b)(3) for information on Sudden Infant Death Syndrome (SIDS).

Guidance: Although injuries are the number one cause of death of young children, they often can be prevented by a practical awareness of potential hazards, and by providing effective supervision, taking action to eliminate or reduce hazards, appropriately responding to an emergency, and teaching children, parents, and staff members about safety.

To prevent injuries and to protect children, the families, staff, and children, themselves, are made aware of critical injury prevention principles, including the importance of:

Using proper restraints in motor vehicles and protective gear, such as bicycle helmets;
Keeping firearms, medication, and other hazardous materials locked and away from children; and
Supervising children at all times.

As part of the ongoing training for staff, parents, and volunteers, agencies focus on safety practices in both home and program settings. Agencies observe staff throughout the year to determine their ability to demonstrate safety practices and serve as a positive role model on health and safety issues. Staff incorporate violence prevention in the day-to-day practice of their jobs. (See 45 CFR 1304.22(a)(5) for additional information on preventing child abuse or neglect.)

Staff and parent attitudes and behavior toward safety are as important as the safety of the physical environment. Different ways for parents and staff to promote safety messages to children include the following:

Involving children in making and enforcing rules of safety in order to increase their safety awareness and help them feel involved;
Using "teachable moments" to discuss safety, such as when a child gets a minor bump or bruise, and to talk to the children about ways to prevent similar injuries, taking care not to make the injured child feel embarrassed; and
Teaching children what to do in an emergency, and where to go for help.

For additional information on injury prevention, agencies contact local organizations, such as SAFE KIDS coalitions, health departments, and American Red Cross chapters. National organizations include the Children’s Safety Network, the U.S. Consumer Product Safety Commission, the American Academy of Pediatrics, and the National Highway Traffic Safety Administration.
 

Performance Standard

1304.22(e)(1) & (2)

(e) Hygiene.

(1) Staff, volunteers, and children must wash their hands with soap and running water at least at the following times:

(i) After diapering or toilet use;

(ii) Before food preparation, handling, consumption, or any other food-related activity (e.g., setting the table);

(iii) Whenever hands are contaminated with blood or other bodily fluids; and

(iv) After handling pets or other animals.

(2) Staff and volunteers must also wash their hands with soap and running water:

(i) Before and after giving medications;

(ii) Before and after treating or bandaging a wound (nonporous gloves should be worn if there is contact with blood or blood-containing body fluids); and

(iii) After assisting a child with toilet use.

 Rationale: Effective implementation of hygiene, sanitation, and disinfection procedures significantly reduces health risks to children and adults by limiting the spread of infectious germs. This rationale serves 45 CFR 1304.22(e)(1)-(6).

Related Information: See 45 CFR 1304.22(e)(3) for information on the use of gloves, and 45 CFR 1304.22(e)(4) for information on universal precautions.

Guidance: Effective handwashing practices include:

Using running water that drains;
Using soap, preferably liquid;
Rubbing hands together for at least 10 seconds; and
Turning off the faucet with a paper towel.
Performance Standard

1304.22(e)(3)

(3) Nonporous (e.g., latex) gloves must be worn by staff when they are in contact with spills of blood or other visibly bloody bodily fluids.

  

Related Information: See 45 CFR 1304.22(e)(4) for information on universal precautions.

Guidance: Gloves are available to all staff, including home visitors and bus drivers, who may come into contact with bodily fluids.

Gloves are not required during routine diapering or when wiping noses. However, some agencies, based upon the advice of the Health Services Advisory Committee, may choose to require the use of gloves in those instances as well. For protection, disposable gloves are worn when changing the diaper of a child with diarrhea or a diagnosed gastrointestinal disease.

Gloves made of disposable latex (or disposable, non-latex/reusable rubber gloves, properly sanitized, for those allergic to latex) are removed and disposed of properly after contact with spills of blood or other bodily fluids.

The use of gloves is not a substitute for handwashing. Staff wash their hands immediately after the gloves are removed.
 

Performance Standard

1304.22(e)(4)

(4) Spills of bodily fluids (e.g., urine, feces, blood, saliva, nasal discharge, eye discharge or any fluid discharge) must be cleaned and disinfected immediately in keeping with professionally established guidelines (e.g., standards of the Occupational Safety Health Administration, U.S. Department of Labor). Any tools and equipment used to clean spills of bodily fluids must be cleaned and disinfected immediately. Other blood-contaminated materials must be disposed of in a plastic bag with a secure tie.

 Related Information: For specific details on universal precautions, refer to "Occupational Exposure to Bloodborne Pathogens," by the Occupational Safety and Health Administration and the ACF Transmittal Notice IM-93.2, "Head Start Occupational Health Standards for Bloodborne Pathogens."

Guidance: Agency guidelines for cleaning and disinfecting areas contaminated by bodily fluids include the following:

Clean the soiled area, then disinfect the area with a solution of ¼ cup household liquid chlorine bleach in one gallon of tap water, made fresh daily;
Dispose of waste and contaminated materials (e.g., diapers, rags) in a plastic bag with a secure tie; and
Use the solution recommended above to rinse and disinfect the materials used for cleaning spills, and then wring materials as dry as possible, before hanging them up to dry further.

To ensure safety, keep cleaning materials away from areas used by children.
Performance Standard

1304.22(e)(5)

(5) Grantee and delegate agencies must adopt sanitation and hygiene procedures for diapering that adequately protect the health and safety of children served by the program and staff. Grantee and delegate agencies must ensure that staff properly conduct these procedures.

  

Related Information: See 45 CFR 1304.53(a)(10)(xvi) on procedures for disposing of soiled diapers, and 45 CFR 1304.53(a)(10)(xiv) on ensuring that adequate toileting, diapering, and handwashing facilities are provided.

Guidance: When diapering a child:

Make certain that the child is safely secured at all times;
Diaper on an elevated, nonporous surface used only for that purpose;
Talk to the infant or toddler while diapering;
Note anything unusual in the child’s diaper;
Situate the diaper changing area as close to a water source as possible;
Change children at regular intervals, or when obviously appropriate; and
Be mindful of contamination risks, taking precautions to minimize those risks. Such precautions include: washing the adult’s and the child’s hands; properly securing soiled diapers or clothing; and cleaning and disinfecting all soiled surfaces.

Diapering procedures are posted in the diaper changing area.
Performance Standard

1304.22(e)(6)

(6) Potties that are utilized in a center-based program must be emptied into the toilet and cleaned and disinfected after each use in a utility sink used for this purpose.

  

Related Information: See 45 CFR 1304.53(a)(10)(xv) for guidance on the provision of toilet training equipment; 45 CFR 1304.22(e)(1) and (2) for information on hygiene; 45 CFR 1304.22(e)(3) on wearing gloves; and 45 CFR 1304.53(a)(10)(viii) for information on cleaning and disinfecting the premises.

Guidance: The spread of germs is prevented through the use of potties with smooth surfaces, with no cracks or crevices, and by cleaning and disinfecting potties in the following manner:

Empty contents into the toilet;
Rinse potties with running water in a utility sink never used for food preparation purposes, and empty the rinse water into a toilet;
Wash all parts of the potty with soap and water; empty soapy water into toilet;
Rinse again; empty into the toilet;
Spray with bleach solution;
Air dry;
Wash and disinfect sink; and
Wash hands.
Performance Standard

1304.22(e)(7)

(7) Grantee and delegate agencies operating programs for infants and toddlers must space cribs and cots at least three feet apart to avoid spreading contagious illness and to allow for easy access to each child.

  

Rationale: Spacing cribs and cots properly is an effective means of avoiding the spread of contagious illness, and it ensures that each child can be checked on and attended to quickly, in case of emergencies.

Related Information: See 45 CFR 1304.53(a)(5) for guidance on cribs and usable space requirements.

Guidance: Children can be placed in alternating head-to-foot positions, at least three feet apart, in order to prevent the face-to-face spread of germs.

For purposes of hygiene, all bed linen is assigned to children for their exclusive use while enrolled in the program, and no child sleeps on an uncovered surface. Seasonably appropriate covering also is provided. Washing all linens on a regular basis, as well as immediately following an illness, and after "accidents," helps prevent the spread of germs. If linens are air dried, there is a possibility that germs may not be killed. The heat from machine drying or ironing linens will kill germs. Cribs and cots are also regularly disinfected.
Performance Standard

1304.22(f)(1)

(f) First aid kits.

(1) Readily available, well-supplied first aid kits appropriate for the ages served and the program size must be maintained at each facility and available on outings away from the site. Each kit must be accessible to staff members at all times, but must be kept out of the reach of children.

  

Rationale: Many injuries may be treated by staff, who are trained in first aid and are provided appropriate first aid supplies. This rationale serves 45 CFR 1304.22(f)(1)-(2).

Guidance: Each first aid kit, including those used in group socializations, outings, or when transporting children on a day-to-day basis, are tailored for the ages and program size served. The American Red Cross has compiled an approved list of supplies to include in a first aid kit. The Health Services Advisory Committee also may recommend materials to include.

Home visitors discuss with families the importance and use of first aid kits and determine what first aid supplies the family has available or may need in the home. Home visitors help to identify potential community resources to secure needed items.
 

Performance Standard

1304.22(f)(2)

(2) First aid kits must be restocked after use, and an inventory must be conducted at regular intervals.

 Guidance: To ensure that kits are restocked regularly, agencies:
Assign a staff member to inventory and to restock supplies;
Establish an inventory checklist;
Conduct and document a monthly inventory of all supplies; and
Check expiration dates on all supplies.

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