La. Admin. Code tit. 51 § XXI-301

Current through Register Vol. 50, No. 11, November 20, 2024

Section XXI-301 - General Standards [formerly paragraph 21:010]

A. Written policies and procedures regarding infection control practices and disease prevention shall be developed by each center which include the following.

1. [Formerly paragraph 21:010-1] Staff and children shall wash their hands at least at the following times: upon entering the center, before preparing or serving meals, after toileting or changing diapers, before and after eating meals or snacks, and anytime hands become soiled with body fluids (urine, stool, saliva, blood, nasal discharge).

2. [Formerly paragraph 21:010-2] Procedures shall ensure that staff teach use of running water, soap, and single use of disposable towels. Hands shall be washed and scrubbed for at least 10 seconds with soap and running water. Warm running water in sinks is required.

3. [Formerly paragraph 21:010-3] Weekly monitoring by the center director shall ensure that handwashing and cleaning procedures are followed as specified in the center's plan.

4. [Formerly paragraph 21:010-4] Noses shall be blown or wiped with disposable, one-use tissues that are discarded in a plastic-lined and covered garbage container.

5. [Formerly paragraph 21:010-5] Draining or oozing cuts or sores shall be covered.

6. [Formerly paragraph 21:010-6] Child care personnel shall adopt routine procedures for handling blood and blood-containing fluids and wound exudates of all children in the center.

a. For spills of vomitus, urine, and feces, floors, walls, bathrooms, table tops, toys, kitchen counter tops, and diaper-changing tables shall be cleaned and disinfected.

b. For spills of blood or blood-containing body fluids and injury and tissue discharges, the area shall be cleaned and disinfected. Gloves shall be used in these situations unless the amount of blood or body fluid is so small that it can easily be contained by the material used for cleaning.

c. Persons involved in cleaning contaminated surfaces avoid exposure of open skin sores or mucous membranes to blood or blood-containing body fluids and injury or tissue discharges by using gloves to protect hands when cleaning contaminated surfaces.

d. Mops shall be cleaned, rinsed in sanitizing solution and then wrung as dry as possible and hung to dry.

e. Blood-contaminated material and diapers shall be disposed of in a plastic bag with a secure tie.

7. [Formerly paragraph 21:010-7] The day care center director shall exclude from care any child with the following illnesses or symptoms based on potential contagiousness of the disease. Periods may be extended beyond this depending upon individual conditions.

Illness/Symptom	Exclude Until
Meningococcal disease (Neisseria meningitis)	Well and proof of non-carriage1
Hib disease (Haemophilus influenza)	Well and proof of non-carriage1
Diarrhea (two or more loose stool, or over and above what is normal for that child)	Diarrhea resolved or is controlled (contained in diaper or toilet)
Fever of unknown origin (100°F oral or 101 rectal or higher) and some behavioral signs of illness	Fever resolved or cleared by child's physician/health department
Chicken pox	Skin lesions (blisters) all scabbed over
Hepatitis A	One week after illness started and fever resolved
AIDS (or HIV infection)	Until child's health, neurologic development, behavior, and immune status is deemed appropriate (on a case-by-case basis) by qualified persons, including the child's physician2 chosen by the child's parent, guardian and the center director
Undiagnosed generalized rash	Well or cleared by child's physician as non-contagious
Any child with a sudden onset of vomiting, irritability or excessive sleepiness	Evaluated and cleared by child's physician

a.¹Proof of non-carriage: Either by completion of appropriate drug regimen of Rifampin (two-day course for Meningococcal disease or four-day course for Hib disease) or by a negative throat culture obtained after completion of treatment for meningitis.

b.²These persons should include the child's physician and other qualified individuals such as the center director, a representative from the Office of Public Health, and a child development specialist, and should be able to evaluate whether the child will receive optimal care in the specific program being considered and whether an HIV-infected child poses a potential threat to others.

c. With most other illnesses, children have either already exposed others before becoming obviously ill (e.g., colds) or are not contagious one day after beginning treatment (e.g., strep throat, conjunctivitis, impetigo, ringworm, parasites, head lice, and scabies). The waiting periods required after the onset of treatment vary with the disease. Check with your local health department for information on specific diseases. Children who are chronic carriers of viral illnesses such as cytomegalovirus (CMV) and Herpes simplex can and should be admitted to day care centers.

d. The parent or designated person shall be notified as soon as possible if a child develops symptoms of illness or suffers an accident while in care.

8. [Formerly paragraph 21:010-8] Guidelines shall be developed regarding biting behavior, treatment of bites, and notification to parents of the children (if injury requires first aid or medical attention).

9. [Formerly paragraph 21:010-9] Each child care employee shall receive a total of three hours of training per year on infectious diseases, health and safety, and/or food service preparation. Whenever possible, this training should be provided during regular working hours.

B. [Formerly paragraph 21:011] Indoor environmental surfaces associated with children's activities and objects handled by children shall be cleaned when soiled and at least on the following basis.

1. Table tops and objects handled by children such as washable toys shall be cleaned at least once weekly. Items that children may place in their mouths shall be washed and sanitized at least daily. Soft, non-washable toys shall be limited to personal use items brought from home that are not shared between children.

2. All walls and ceilings shall be of a color that readily shows soil. Walls, ceilings, and other surfaces shall be maintained in good repair and in a clean condition; not able to visibly contaminate cold rinse water.

3. Floors, except those carpeted, shall be vacuumed or swept, and mopped with a disinfecting solution at least daily and when soiled. Soiled mop water shall be disposed of immediately after use. Stored mops shall be hung.

4. Carpeted floors and large throw rugs which cannot be washed, shall be vacuumed at least daily and shampooed at least every three months and when soiled.

5. Toilet rooms and fixtures shall be cleaned and disinfected at least daily and shall be in good repair. Toilet rooms shall have walls, floors and ceilings of a smooth, easily cleanable finish, and shall be painted a light color. These rooms must be ventilated by means of a ventilation system in compliance with Part XIV.

6. Potty chairs and diaper changing surfaces shall be cleaned and disinfected after each use.

7. Any object or surface contaminated by bodily fluids (e.g., urine, feces, blood, wound or tissue exudate) shall be cleaned immediately and disinfected with a fresh solution of household bleach diluted 1/4 cup in 1 gallon of water made fresh every 24 hours.

8. Soap and separate paper towels will be provided at handwashing sinks.

C. [Formerly paragraph 21:012] Coat hooks spaced at least 12 inches apart, or individual cubicles or lockers, child's height shall be provided for storage of clothing and personal possessions of the children.

D. [Formerly paragraph 21:013] All areas accessible to children shall be free of toxic or hazardous materials and conditions.

1. [Formerly paragraph 21:013-1] Cleaning materials, detergents, aerosol cans, pesticides, health and beauty aids, poisons, and other toxic materials shall be stored in their original labeled containers and shall be used only in a manner that will not contaminate play surfaces, food, food preparation areas, or constitute a hazard to the children. When not in actual use, such materials shall be kept in a locked place inaccessible to children and stored separately from medications and food. Matches and lighters shall be inaccessible to children.

2. [Formerly paragraph 21:013-2] All medications will be kept in a locked cabinet.

3. [Formerly paragraph 21:013-3] Poisonous or potentially harmful plants on the premises shall be inaccessible to children.

4. [Formerly paragraph 21:013-4] No pets shall be maintained on the premises except aquarium fish if they are kept out of the reach of children, or animals to aid the disabled.

5. [Formerly paragraph 21:013-5] Electrical outlets accessible to the children shall be covered with child resistant covers or be of the child-proof type.

6. [Formerly paragraph 21:013-6] All stair cases must be provided with suitable barriers to prevent access by children. All porches and decks where children are allowed to play must be provided with suitable barriers to prevent falls.

7. [Formerly paragraph 21:013-7] Smoking shall not be permitted in indoor areas of the child care facility.

8. [Formerly paragraph 21:013-8] Premises shall be maintained free of insect, rodent or other pest infestations or haborages. Application of any pesticide shall not be done when children are present. No restricted use pesticides shall be stored or used on the premises unless by properly licensed persons.

9. [Formerly paragraph 21:013-9] Open containers such as mop buckets shall not be left unattended.

E. [Formerly paragraph 21:014] Openings to the outside shall be protected against the entrance of flies or other flying insects by outward opening, self-closing doors, closed windows, screening or other effective and approved means.

F. [Formerly paragraph 21:015] Each foundation, floor, wall, ceiling, roof, window, exterior door, and basement shall be free from openings which may permit the entry of rodents.

G. [Formerly paragraph 21:016] Each center shall be provided with a designated area for the care of a child who needs to be separated from the group due to injury, illness or the need for additional rest. This area shall be located so the child may be supervised. Toilet and lavatory facilities shall be readily accessible. If the child under care is suspected of having a communicable disease, all equipment used by the child shall be cleaned and sanitized after use. This area may be used for other purposes when not needed for the separation and care of a child or if the uses do not conflict.

H. [Formerly paragraph 21:017] All formula bottles for those children still on bottles must be properly designated with the particular child's name attached to the bottle. These formulas are to be brought in bottles with caps and tops and shall immediately be placed under refrigeration by the operator. When bottles are emptied, they must be promptly cleaned and any bottles to be reused must be properly sterilized.

I. [Formerly paragraph 21:018] In child care centers, infants shall be cared for in an area separated by a suitable barrier from older children. Activities which bring infants and older children in contact with each other shall be limited.

La. Admin. Code tit. 51, § XXI-301

Promulgated by the Department of Health and Hospitals, Office of Public Health, LR 28:1401 (June 2002).

AUTHORITY NOTE: Promulgated in accordance with the provisions of R.S. 40:4(A)(10) and R.S. 40:5.