6 Colo. Code Regs. § 1010-7.10

Current through Register Vol. 47, No. 24, December 25, 2024

Section 6 CCR 1010-7.10 - Disease Prevention

7.10.1Personal Health

A. Staff shall be in good health and be free from communicable disease while caring for children, preparing food or employed in any capacity where there is a likelihood of transmitting disease to others at the facility.

B. Children in care shall be immunized as required by 6 CCR 1009-2, Rules Pertaining to the Infant Immunization Program and the Immunization of Students Attending School. The official Certificate of Immunization, official Exemption form or written documentation of the student or child being In-Process shall be on file for each enrolled individual. Upon request of state or local health agencies, child care facilities are responsible for providing records with identifiers removed if the facility is subject to the Family Educational Rights and Privacy Act (FERPA).

1. A child who is not appropriately vaccinated for his/her age and not in-process, or not exempt, shall be denied attendance in accordance with the 6 CCR 1009-2.

C. Disease outbreaks shall immediately be reported to the Department. Reportable communicable disease shall be reported to the Department in the time frame stipulated by 6 CCR 1009-1, Rules and Regulations Pertaining to Epidemic and Communicable Disease Control.

1. Child care facilities shall manage and control disease transmission through consultation with their child care health consultant and the Department.

2. Additional guidance regarding infectious disease guidelines is provided in the CDPHE's Infectious Diseases in Child Care and School Settings, the American Academy of Pediatrics Managing Infectious Disease in Child Care and Schools, and Caring for Our Children National Health and Safety Performance Standards Guidelines for Early Care and Education Programs. Child care facilities may rely on this guidance.

3. A written policy shall be implemented for staff and children regarding symptoms of illness that require exclusion from the child care facility. Guidance documents listed in 7.10.1(C)(2) should be used.

4. Each child shall be observed for common signs of illness at arrival and throughout the day. A child who is ill upon arrival at the facility shall not be admitted pursuant to the exclusion or illness policy, pursuant to Section 7.10.1(C)(3).

5. A thermometer capable of measuring human temperatures shall be available. Glass and mercury thermometers are prohibited. The thermometer shall be protected with a single-use cover or sanitized pursuant to Section 7.10.5 after each use.

6. When a child is ill, he or she shall be separated from other children until the parent or guardian can pick up the child.

7. In resident camps and 24-hour child care facilities, when an ill child is unable to be picked up by a parent or guardian within a reasonable time or when a child lives at the facility, the child must be isolated pursuant to the exclusion or illness policy, Section 7.10.1(C)(3).

8. Child care staff shall wear gloves when in contact with blood, feces and other high hazard body fluids.

9. Logs shall be kept to record children's symptoms of illnesses occurring among children attending the child care facility. Logs shall be maintained at the facility for two months and provided to the Department upon request. The logs shall include, at minimum, the following information:

a. Child's name or other identifying information;

b. Child's assigned classroom or group;

c. Date and time of symptoms of illness;

d. Symptoms;

e. Actions taken; and,

f. Date and time child was returned to group setting.

7.10.2Demonstration of Knowledge

A. Upon request, the person or persons performing a specific task shall demonstrate to the regulatory authority knowledge of communicable disease prevention as it relates to the specific task. This will be determined by staff's ability to show knowledge of the following:

1. When, where, and how handwashing is required;

2. When to prohibit staff members from caring for children;

3. When to prohibit handling and preparation of food;

4. Proper diapering procedure;

5. Proper sanitization and disinfection of surfaces and toys; and,

6. When to exclude or isolate children with symptoms of communicable illness.

7.10.3Handwashing and Hygienic Practices

A. Staff members and children shall wash their hands using the following procedures:

1. Moisten hands with warm running water;

2. Apply soap;

3. Rub hands vigorously until a soapy lather appears;

4. Continue washing for at least 20 seconds outside of the water, rubbing areas between fingers, around nail beds, under fingernails, under jewelry and the backs of hands;

5. Rinse hands under warm running water until they are free of soap and dirt; and,

6. Dry hands with a disposable towel, a clean cloth towel laundered after use, or a mechanical drying device.

B. Staff members and children toddler-aged and older shall wash their hands at the following times:

1. Upon arrival for the day and after breaks;

2. When caregivers move from caring for one group/classroom of children to another;

3. Before and after:

a. Preparing food or beverages;

b. Eating, handling food, or feeding a child;

c. Giving medication, applying a medical ointment or cream or administering first aid; and,

d. Setup or use of a sensory table.

4. After:

a. Using the toilet or assisting a child with toileting;

b. Diapering each child;

c. Handling body fluids;

d. Handling animals or cleaning up animal waste;

e. Coming in from outdoors;

f. Cleaning or handling garbage; and,

g. At any other time that hands become soiled.

C. Infants shall have their hands washed with:

1. Soap and running water; or,

2. A clean cloth that contains soap and is laundered after each use; or,

3. The use of soap and warm water solution dispensed from a clean spray bottle, followed by a rinse before drying with a clean cloth or disposable towel:

a. Before and after meals and snacks;

b. After:

(1) Having their diaper changed;

(2) Coming in from outdoors; and,

(3) Whenever their hands become soiled.

D. The use of hand sanitizers or wipes in lieu of handwashing is not approved for use within the facility. Hand sanitizers or wipes may be used for staff and children three years of age and older and only at times and in areas where handwashing facilities are not available, such as while out of doors in remote locations. Hand sanitizers and wipes shall be stored out of reach of children.

E. Staff shall supervise children's handwashing to assure adequacy of the procedure.

F. All staff members shall practice good personal hygiene in order to reduce the potential for disease transmission.

G. All staff members shall wear clean outer garments. Staff members involved in both child care and food preparation shall wear a clean smock whenever they are involved with kitchen food preparation.

H. Personal articles, such as combs, toothbrushes, razors, pacifiers, washcloths, water bottles, etc., shall be individually identified and shall be stored in a sanitary manner so as not to contaminate or come into contact with the personal hygiene articles of another child. Personal articles shall not be shared between children.

I. Towels used for recreational water activities shall be individually identified, stored in a sanitary manner, laundered at least weekly, and not to be shared or intermingled among children.

7.10.4Medications and First Aid

A. Medication shall be inaccessible to children and shall be stored in the original container in a controlled area separated from food, cleaning compounds and other toxic substances. If refrigeration is required, the medication shall be stored:

1. In a separate refrigerator maintained for that purpose only; or,

2. In an impervious secondary container in a designated area of a food storage refrigerator, separated from food and inaccessible to children.

B. Medications acquired by the facility or abandoned by parents or guardians shall be disposed of in accordance with 6 CCR 1007-2, Part 1, Regulations Pertaining to Solid Waste Sites and Facilities and 6 CCR 1007-3, Parts 260-268, and Parts 99 and 100.

C. Medical oxygen shall not be used by children or staff in areas with open flames. Signage shall be posted in the child care facility that oxygen is in use.

D. Basic first aid medical supplies, including gauze pads, rolled gauze, adhesive tape, cold pack, plastic bags, disposable gloves, band-aids, mechanism for cleaning hands in a remote location, and scissors, shall be provided and kept in clean storage, conveniently located and available to staff for emergency use and inaccessible to children.

1. The poison control center may be called for guidance about any exposure to toxic substances or any potential poisoning emergency.

2. First aid supplies and equipment with an expiration date shall be discarded and replaced once that date has passed.

7.10.5Sanitizers

A. Acceptance of sanitizers shall be determined by the following requirements:

1. The chemical shall have a U.S. Environmental Protection Agency registration number and designation as a food contact surface sanitizer, be registered with the Colorado Department of Agriculture, and used in accordance with labeled instructions and 40 CFR 180.940, including:

a. Concentration;

b. Contact time;

c. Method;

d. Surfaces; and,

e. Does not require a final rinse step.

2. Household bleach used shall be free of compounds to enhance the scent or other compounds that may adversely affect its use as a sanitizer.

B. Sanitizers are to be used on surfaces that commonly come into contact with food, hands, the mouth, eyes, nose, and exposed skin of children and staff. These surfaces include, but are not limited to, kitchen surfaces, infant food preparation areas, pacifiers, drinking fountains, table tops, keyboards, toys, sleeping mats, cribs, high chairs, head phones, tumbling mats and furniture.

1. Sanitizers are not to be used in place of soaps, detergents or other cleaning compounds that are intended and utilized to remove soil from surfaces, unless specifically formulated as a cleaner sanitizer.

2. Sanitizing solutions shall be available to caregivers and staff during all hours of operation.

3. The frequency of sanitizer use for food contact surfaces shall be in accordance with the requirements of Section 7.11.

4. Toys used by preschool and older children shall be washed, rinsed, and sanitized at least once a week and whenever visibly soiled.

5. Toys used by infants and toddlers shall be washed, rinsed, and sanitized at least daily.

6. Toys that are placed in children's mouths or are otherwise contaminated by body fluids shall be washed, rinsed, and sanitized prior to use by another child.

C. Sanitizers shall be mixed and used according to the label instructions, including concentration and contact time.

1. If used as a sanitizer, household bleach shall be prepared and used at concentrations between 50 - 200 ppm chlorine.

2. For sanitizers requiring mixing, test kits shall be provided and used to verify the required concentration. Solutions must be tested upon mixing and daily.

3. Sanitizers obtained as ready-to-use (i.e., not requiring mixing) solutions and used in accordance with the manufacturer's labeled instructions, do not require the use of test strips.

D. Bulk and working containers of sanitizers shall be stored inaccessible to children. Working containers of sanitizers shall be easily accessible for use by caregivers.

1. Working containers of sanitizers shall be labeled as to their content and their intended use (i.e., sanitizer/toys and tables).

E. Nothing in this Section shall prohibit the use of a dish washing machine, pursuant to Section 7.11.1 , clothes washing machine, or clothes dryer, pursuant to Section 7.8.6 , for sanitization of toys or other classroom materials.

1. Handwashing sinks used in conjunction with toileting or diapering activities shall not be used for washing, rinsing, and sanitizing toys and equipment.

7.10.6Disinfectants

A. Acceptance of disinfectants shall be determined by the following requirements:

1. The chemical shall have a U.S. Environmental Protection Agency registration number and designation as a hospital grade disinfectant effective against Salmonella choleraesuis (enteric), Staphylococcus aureus, and Pseudomonas aeruginosa, and be registered with the Colorado Department of Agriculture. The chemical shall be used in accordance with the labeled instructions, including:

a. Concentration;

b. Contact time;

c. Method; and,

d. Surfaces.

B. Disinfectants are to be used on surfaces that are commonly contaminated with high hazard body fluids, such as but not limited to toilet seat inserts, diaper changing areas and tables, diaper pails and surfaces that have been in contact with high hazard body fluids.

1. Disinfectants are not to be used in place of soaps, detergents or other cleaning compounds that are intended and utilized to remove soil from surfaces, unless specifically formulated as a cleaner disinfectant.

2. Toys, food, or body contact surfaces that become contaminated with high hazard body fluids shall be disinfected and then washed, rinsed, and sanitized before returned to use.

3. Carpeting, rugs, and upholstery that have been contaminated by high hazard body fluids shall be cleaned by removing all visible debris with absorbent materials and treated through the use of a chemical or steam.

4. In facilities where children are in diapers or require bladder or bowel hygiene assistance, disinfecting solution shall be available during all hours of operation. In all other facilities disinfecting solutions shall be available as needed.

C. The frequency of disinfectant use shall be in accordance with the requirements of Section 7.12.4 or immediately upon clean up of or contact with high hazard body fluids.

D. Disinfectants, including household bleach, must be mixed and used according to the manufacturer's labeled instructions, including concentration and contact time.

1. Household bleach used shall be free of compounds to enhance the scent or other compounds that may adversely affect its use as a disinfectant.

2. When disinfecting solutions are mixed at the facility and used for more than one day, daily testing is required.

3. Disinfectants obtained as ready-to-use (i.e., not requiring mixing) solutions and used in accordance with the manufacturer's labeled instructions, do not require the use of test strips.

E. Bulk and working containers of disinfectants shall be stored inaccessible to children. Working containers of disinfectants necessary for diaper changing and bladder and bowel hygiene shall be easily accessible for use by caregivers.

1. Working containers of disinfectants shall be labeled as to their content and their intended use (i.e., disinfectant/restrooms).

6 CCR 1010-7.10

38 CR 24, December 25, 2015, effective 1/14/2016