Supervisor/Manager (or their designate):

• Review and communicate the current program to staff
• Develop and implement standards and procedures
• Implement a review of this policy as often as necessary to ensure policy is protecting all staff and children.
• Respond to recommendations from Public Health
• Provide ongoing training to Supervisors and Staff
• Communicate risk assessment results to the Board of Directors and the Health and Safety Representative

Supervisors:

• Understand their responsibilities under OHSA to take every precaution reasonable for the protection of persons within our workplace.
• Enforce the policies and procedures defined within this policy
• Train and educate persons with in our facility about the risk of infection and the controls to minimize possible infection of disease.

Staff:

• Understand your rights under OHSA
• Participate in training as directed by Public Health
• Wear the Personal Protective Equipment as directed by your supervisor and this policy/ procedure.
• Report any known violation of this policy or procedure
• Report to your supervisor if you feel or suspect that you may be infected or not feeling well

Health and Safety Representative:

• Be consulted in the development of programs and assessments, and review them for improvements
• Make recommendations where required
• Engage Staff in identifying hazards

Definitions/ Acronyms:

• COVID -19 – Is a disease caused by the 2019 Novel Coronavirus
• MOH -Medical Officer of Health
• PPE -Personal Protective Equipment
• Persons – includes workers, children & their families, support staff, contractors
• JHA -Job Hazard Analysis

The following safe work procedures will define how Heritage Green Child Care Inc. will manage the hazards of contacting COVID 19.

COVID 19

Coronaviruses are spread mainly from person to person through close contact, for example, in a household, workplace or daycare centre.  There are a number of COVID-19 vaccines that are currently approved for use in Canada including but not limited to Pfizer-BioNTech, Moderna, and AstraZeneca. Staff are encouraged to receive their COVID-19 vaccine.

 

The 2019 novel coronavirus is spread through respiratory droplets:

• • from person to person through coughing, sneezing, close contact; and
  • touching contaminated surfaces.

Symptoms

Symptoms range from mild – like the common cold and other common respiratory infections – to severe, and can include: fever, cough, and difficulty breathing, muscle aches, fatigue, headache, sore throat, and runny nose. Also, difficulty swallowing, new olfactory or taste disorder.

 

Complications from the novel coronavirus can include serious conditions, like pneumonia or kidney failure, and in some cases, death.

Symptoms for children could include;

o Sore throat, hoarse voice
o Diarrhea
o Look to see if exhibiting a runny nose

Atypical Symptoms/ signs of COVID-19 should be considered, particularly in children, older persons, and people living with a developmental disability.

Atypical symptoms can include:

o Unexplained fatigue/ malaise
o Delirium (acutely altered mental status and inattention)
o Unexplained or increased number of falls
o Acute functional decline
o Exacerbation of chronic conditions
o Chills, Headache
o Croup, Conjunctivitis
o Atypical signs can include:
o Unexplained tachycardia, including age specific tachycardia for children
o Decreased in blood pressure
o Unexplained hypoxia (even if mild i.e. O2 sat>90%)
o Lethargy, difficulty feeding in infants (if no other diagnosis)

 

COVID-19 Screening for Individuals Experiencing Post-Vaccine Symptoms

If a child, parent/guardian, staff, provider, placement student or visitor received a COVID-19 vaccination in the last 48 hours and are experiencing mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, and no other symptoms as indicated in the COVID-19 School and Child Care Screening Tool, they may continue to attend the child care/EarlyON program if they are feeling well enough to do so.

• These individuals are to wear a properly fitted mask for their entire time in the child care/EarlyON setting. Their mask may only be removed to consume food or drink and the individual must remain at least two metres away from others when their mask has been removed.
• If the mild headache, fatigue, muscle aches, and/or joint pain symptoms worsen, continue past 48 hours, or if the individual develops other symptoms, they should leave the child care/EarlyON setting, self-isolate and seek COVID-19 testing.
• The staff, provider or placement student must not attend child care/EarlyON if household members are experiencing any new COVID-19 symptoms (this direction does not pertain to those who received a COVID-19 vaccination in the last 48 hours are are experiencing milk headache, fatigue, muscle aches, and/or are waiting for COVID-19 test results after experiencing symptoms.

 

Parent Drop Off and Pick Up Procedures

Entry into the child care centre is limited to staff, children, parents and essential visitors.

• All individuals, including children, parents and staff must complete the online screening prior to arrival
• Staff must show a “pass” prior to entry.

Child Care

Screening will be completed daily prior to arrival for both children and parents.

Parents/caregivers are to pull up to a designated pylon based on what room their child is in. Two pylons will be designated for each classroom. This allows for a maximum of 6 parents to be in the building at one time. Parents/guardians will sanitize their hands upon entry and wear a medical mask. A medical mask will be provided for them should they not have one. The parent/guardian will walk their child to their classroom door where there is a floor distancing marker. The parent/guardian will maintain distance from others at all times. The parent/guardian will sanitize their hands upon exiting the building, return to their car and pull away so the next parent/guardian can park and enter.

Children between the ages of 2 and 3.8 years are encouraged to wear a mask at the program. This, however, will remain at the parent’s discretion. Communication with all parents and caregivers will be sent out to families advising of this recommendation.

School Age Programs

In the before and after school programs, screening will be completed daily prior to arrival for both children and parents. Screening can be found at https://covid-19.ontario.ca/school-screening/. Parents/guardians will use a designated door to enter the school and will sanitize their hands upon entry and wear a medical mask. A medical mask will be provided for them should they not have one. The parent/guardian will walk their child to their classroom door. The parent/guardian will maintain distance from others at all times. The parent/guardian will sanitize their hands upon exiting the building.

The school age programs will work closely with the schools to maintain effective communication in regards to children who fail screening or are sent home during the school day.

All school age children are required to wear a non-medical or cloth mask while inside the school, including hallways and in the classrooms. Where physical distancing can’t be maintained, students are required to wear masks outdoors unless within their own cohort. If a child requires a “mask break”, they will be encouraged to move to a space that is a minimum of 6 feet away from all other children and staff before removing their mask.

Alcohol based hand rub containing at least 70% alcohol content will be provided at the entrance to the facility. Any adult entering beyond the door must perform hand hygiene upon entering. Cohort staff (public health and the government direction: a cohort is defined as a group of children and staff) will assist child with hand hygiene upon entering the classrooms.

Pick Up Procedures

Child Care

Parents will follow a similar procedure to drop off. They will pull up to one of the designated pylons based on what classroom their child is in. Again, two pylons will be designated to each classroom. This allows for a maximum of 6 parents in the building at one time. Parents/guardians will sanitize their hands upon entry and wear a medical mask. The centre will provide a medical mask should a parent/guardian require one. Parents/guardians will go to one of the distancing markers on the floor outside of their child’s classroom maintaining physical distance throughout the pick-up procedure. Once parents have picked up their child they will head towards the exit maintaining physical distance from others. Parents/guardians will sanitize their hands as they exit. They will return to their car and pull away for the next parent/guardian to park and enter.

School Age Programs

Parents will follow a similar procedure to drop off. Parents/guardians will sanitize their hands upon entry and wear a medical mask. The centre will provide a medical mask should a parent/guardian require one. Parents will go to the door of their child’s classroom. If there is another parent waiting, they will maintain a 6-foot distance. Once parents have picked up their child they will head towards the exit maintaining physical distance from others. Parents/guardians will sanitize their hands as they exit.

Health Screening Procedure for Essential Visitors

Upon arrival of an essential visitor to the child care or school age program, a staff member requests to see that the essential visitor has passed their online screening, or will actively screen the visitor. Once the essential visitor has passed the screening, a staff member will gather information including the visitor’s name, email, phone number and arrival/departure time. Phone numbers and contact information for the essential visitor will be kept on file at each site for one year. No volunteers will be allowed at this time. Ministry and Public Health officials must be screened prior to entry and must wear PPE, and follow all protocols.

An individual who fails the screening process will be advised to contact their health care provider and book a COVID-19 test by visiting www.hamiltoncovidtest.ca. If unable to access the online booking site, individuals can call Public Health’s COVID-19 line at (905) 974-9848 option 2 to book a testing appointment.

 

Attendance Records and Contact Tracing

Should contact tracing be required, weekly/monthly attendance sheets, daily staff screening chart which includes staff’s shifts for each day, as well as the visitor log, will be kept in a log book at each site for a period of one year. The supervisor of the child care site, and at each of the school age sites, will be responsible for overseeing the log book. Records must include name, contact information, and time of arrival/departure for each child, parents, staff and visitor who enters the program. These records will be kept up to date and available to facilitate contact tracing in the event of a confirmed COVID-19 case or outbreak.

Daily Health Screening Procedure

This tool provides basic information only and contains recommendations for children to support decision making by parents about whether their child should attend school/childcare and/or needs to be tested for COVID-19. This can be used to assess symptoms of any child who attends child care or school. It is not to be used as a clinical assessment tool or intended to take the place of medical advice, diagnosis or treatment.

 

Parents, caregivers and staff are to complete the online screening in advance of arrival for themselves, or on behalf of their child at ( https://covid-19.ontario.ca/school-screening/), Confirmation of a “pass” by seeing the green check mark from the online screening may be required upon arrival to the child care centre for all staff, children, and essential visitors.

 

When assessing for the symptoms, you should focus on evaluating if they are new, worsening, or different from your child’s baseline health status or usual state (check off “Yes”). Symptoms associated with known chronic health conditions or related to other known causes/conditions should not be considered unless new, different or worsening.

After developing symptoms, in general, children should no longer have a fever and their symptoms improving to be able to return to school/child care. Mild symptoms known to persist in young children (e.g. runny nose or mild cough that may persist following infections) may be ongoing at time of return to school/child care if other symptoms have resolved.

The City of Hamilton wants to ensure that all licensed child care centres/school age sites are providing a safe and healthy environment for children, families and providers. Licensed child care providers must be aware of and adhere to established exclusion criteria. Information on different conditions and exclusion periods is available in City of Hamilton’s Infection Control Guidelines for Child Care Centres (https://www.hamilton.ca/sites/default/files/media/browser/2018-12-07/infection-control-guidelines-child-care-centres.pdf).

In response to COVID-19, it is critical for licensed child care providers to properly exclude ill children and staff.

When to Exclude:

A child/staff should be excluded when displaying any signs or symptoms of illness or if the child is unable to participate in regular programming because of illness.
Please see above list of symptoms.

How to Exclude:

• If a child or child care staff becomes sick while in the program, they should be isolated and family members contacted for pick-up. If the sick person is a child, a child care staff should remain with the child until a parent/guardian arrives.
• If tolerated and above the age of 2, the child should wear a surgical/procedure mask.
• The child care centre/school age site should specify where the isolation room/area will be and who will be responsible for monitoring the child.
• As soon as the child is isolated from others, the staff member caring for the child should perform hand hygiene and put on a surgical/procedure mask and face shield/goggles.
• The child care staff should also avoid contact with the child’s respiratory secretions.
• Staff member must perform hand hygiene after any contact with the ill child.
• If a separate room is not available, the ill child should be kept at a minimum of 2 metres from others. This may be achieved by using physical barriers, floor markers, etc.
• The ill child should be provided with tissues and reminded of hand hygiene, respiratory etiquette, and proper disposal of tissues.
• Anyone who is providing care to the ill child should maintain a distance of at least 2 metres or wear appropriate PPE (surgical/procedure mask and eye protection, gloves and gown if there is risk of exposure to infectious droplets).
• All items used by the ill person should be cleaned and disinfected by the cleaning staff designated for that cohort. Any items that cannot be cleaned (paper, books, cardboard puzzles) should be removed and stored in a sealed container for a minimum of 3 days.

How to Report Illness:

Confirmed cases of COVID-19 in all child care centres and school age programs must be reported to the Ministry of Education as a serious occurrence. Closure of a room or centre by Public Health is also a serious occurrence under the “Unplanned Disruption of Service” category, and must be reported.

The licensee must contact Hamilton Public Health Services to report:

• Clusters of suspected cases (e.g. two or more children or staff with COVID-
  19 symptoms within a 48-hour period).
• Cases of COVID-19 among staff or child attendees that are laboratory confirmed or probable (i.e. symptoms occurring among a staff or child who has been exposed to a person with confirmed COVID-19, or, travelled to an affected area in the 14 days prior to symptom onset.)
• Public Health will provide specific advice on what control measures should be implemented to prevent the potential spread and how to monitor for other possible infected staff members and children. Notification should be provided by calling the COVID-19 hotline, 905-974-9848 option 6
• Children or staff who have been in contact with a suspected COVID-19 case should be monitored for symptoms and grouped together until laboratory tests, if any, have been completed or until directed by the local public health unit.
• You must stay home if you have COVID-19 symptoms or are waiting for test results after experiencing symptoms.
• Everyone in your household (unless they are fully vaccinated) must also stay home until you get a negative COVID-19 test result, or you are cleared by Public Health, or you are diagnosed with another illness. Get a COVID-19 test (not a rapid antigen test) if you have symptoms of COVID-19 or are a contact of a known COVID-19 case.
• Persons who test positive may not return to the child care setting until they are cleared by the local public health unit. Note that individuals do not need to provide a medical note or proof of negative result to return to the program. For home-based programs: if a person who resides in the home tests positive for COVID-19, the local public health unit should be notified and their advice on next steps should be followed (including closing the program and notifying all families if necessary).

 

End of Exclusion

• Ill children/staff, if not tested, must be excluded for a minimum of 10 days from onset of symptoms; unless they have received an alternative diagnosis provided by a health care provider. If a child/staff have an alternative diagnosis, they will need to isolate at home without symptoms for 24 hours. A child or staff with symptoms, and is not tested for COVID-19 must self-isolate for a minimum of 10 days. Child/staff can return to school/child care when they do not have a fever (without the use of fever-reducing meds) and when symptoms have been improving for 24 hours, after the 10 day period).
• Children/staff who test negative for COVID-19 must be excluded until 24 hours after symptom resolution.
• Children/staff who test positive for COVID-19 must be excluded from child care centre/school age program for 14 days after the onset of symptoms and clearance has been received

Triggering an outbreak assessment

Once at least one child or staff has presented with new symptoms compatible with COVID-19, the child care centre/school age site should immediately trigger an outbreak assessment and take the following steps:

Exclusion
Individuals who are tested:

• Children/staff who test negative for COVID-19 must be excluded until 24 hours after symptom resolution
• Children/staff who test positive for COVID-19 must be excluded from child care centre/school age site for 10 days after the onset of symptoms and clearance has been received from the local public health unit.

Individuals who are not tested:

• Ill children/staff, if not tested, must be excluded for 14 days from onset of their symptoms

Outbreak Management

An outbreak may be declared by the local public health until when:

• Within a 14-day period, there are two or more laboratory-confirmed COVID-19 cases in children, staff/providers or other visitors with an epidemiological link (e.g., cases in the same room, cases that are part of the same before/after school care cohort) where at least one case could have reasonable acquired their infection in the child care setting.

If the local public health unit declares an outbreak, they will determine what happens next. This could include closing particular child care rooms or cohorts or an entire child care setting. The public health unit will help determine which groups of children and/staff need to be sent home or if a partial or full closure of the child care setting is required.

Communication Plan and Required Steps in an Outbreak

If a positive COVID-19 case, or an outbreak is declared at the child care centre/school age site, the following measures must be taken:

1. Consult with and follow directions from Public Health.
2. Notify all family, staff, essential visitors, school boards of the facility’s outbreak status by an email and/or phone call to each family.
3. Enhance cleaning and disinfecting procedures
4. Enhanced screening procedures (i.e. increased frequency of health checks)
5. More frequent hand hygiene with children and staff.
6. Review staff training on proper PPE use.

Management of cases in multiple cohorts

If there are additional positive cases in other cohorts, the facility will close. In consultation with Public Health, all staff and children in the child care centre/school age site may be referred for testing.

Declaring an Outbreak Over

In consultation with Public Health, the outbreak can be declared over if no new cases have occurred in 14 days from the last day of attendance of the most recent COVID-19 positive staff/child.

Every effort will be taken to encourage physical distancing between children by spreading children out into different areas, staggering lunch and snack times and play times outside.

 

We will avoid taking the children to community play grounds.  Outdoor play at our own play area outside is encouraged in small groups. All equipment will be disinfected as needed.

 

We will stagger meal and snack times to allow for safe physical distancing.

 

When setting cots up for nap time, they will be set up in such a way to keep the children 2m apart or set up so that they are head to toe. Cots should be disinfected after each use. (Childcare only)

 

If we need to have conversations with parents, we will try and have these using live streaming programs like Zoom to have that discussion rather than a face to face meeting.  Preplanned in-person meetings and preplanned group events will be cancelled or rescheduled to a later time.

Our center will provide tissues and dispose of used tissues in plastic-lined receptacles.

 

Staff will be required to regularly wash their hands for at least 20 seconds with soap and warm water at:

• At the start of their shifts
• Before preparing or serving food, cleaning up after meals and snack times
• After touching shared items and after using the washroom,
• Before and after changing a child’s diaper,
• Helping others with toileting and after handling garbage,
• Before leaving your workspace.

Deciding to use PPE is based on your risk assessment of the situation.

PPE should not be worn when it is not needed but ensure everyone knows how to use and maintain the PPE that you are required to wear.

Social distancing at 2 metres and proper hand hygiene will be the most important way to protect yourself from the COVID-19 virus

Improper use of PPE can create a false sense of confidence, increase chances of infection and waste supply

Proper use of PPE is an effective part of infection prevention and control, however it is not a stand-alone method

Proper hand hygiene must be exercised before donning and after doffing PPE including gloves, face masks and eye protection.

The following PPE is available at all ECC sites and may be used is there is an identified risk of exposure to the COVID-19 virus:

Gloves, Masks and Eye Protection

Gloves may be worn when hands come into contact with a child exhibiting respiratory symptoms or objects that may be contaminated. Gloves are disposable and single use, and must be disposed of after the task is completed. Gloves protect you against contact with infectious materials. However, once contaminated, gloves can become a means for spreading infectious materials to yourself, other patients or environmental surfaces. Therefore, the way YOU use gloves can influence the risk of disease transmission. These are the most important do’s and don’ts of glove use.

 

Work from clean to dirty. This is a basic principle of infection control. In this instance it refers to touching clean body sites or surfaces before you touch dirty or heavily contaminated areas.

 

Limit opportunities for “touch contamination” – protect yourself, others and environmental surfaces. How many times have you seen someone adjust their glasses, rub their nose or touch their face with gloves that have been in contact with another person or surface? This is one example of “touch contamination” that can potentially expose oneself to infectious agents. Think about environmental surfaces too and avoid unnecessarily touching them with contaminated gloves. Surfaces such as light switches, door and cabinet knobs can become contaminated if touched by soiled gloves

 

Change gloves as needed. If gloves become torn or heavily soiled and additional tasks must be performed, then change the gloves before starting the next task. Always change gloves after use, and discard them in the nearest appropriate receptacle. Gloves should never be washed and used again. Washing gloves does not necessarily make them safe for reuse; it may not be possible to eliminate all microorganisms and washing can make the gloves weak.

 

A face mask must be worn by an individual with respiratory symptoms. If the individual is unable or unwilling to wear a face mask, the person providing care must wear a face mask if a physical distance of 2 metres cannot be maintained.

 

A combination of PPE types is available to protect all or parts of the face from contact with potentially infectious material. The selection of facial PPE is determined by the isolation precautions required or the nature of contact.

 

Masks should fully cover the nose and mouth and prevent fluid penetration.

 

Masks should fit snuggly over the nose and mouth. For this reason, masks that have a flexible nose piece and can be secured to the head with string ties or elastic are preferable.

 

Goggles/Face Shields provide barrier protection for the eyes; personal prescription lenses do not provide optimal eye protection and should not be used as a substitute for goggles. Goggles should fit snuggly over and around the eyes or personal prescription lenses. Goggles with antifog features will help maintain clarity of vision.

 

Eye protection and Face shields are reusable and must be washed and disinfected between each use.

 

There are four key points to remember about PPE use.

 

First, don it before you have any contact with another person, generally before entering the room. Once you have PPE on, use it carefully to prevent spreading contamination. When you have completed your tasks, remove the PPE carefully and discard it in the receptacles provided. Then immediately perform hand hygiene.

 

The gown should be donned first (if wearing one) The mask should be put on next and properly adjusted to fit. The goggles or face shield should be donned next and the gloves are donned last. Keep in mind, the combination of PPE used, and therefore the sequence for donning, will be determined by the precautions that need to be taken.

 

To don a gown, first select the appropriate type for the task and the right size for you. The opening of the gown should be in the back; secure the gown at the neck and waist. If the gown is too small to fully cover your torso, use two gowns. Put on the first gown with the opening in front and the second gown over the first with the opening in the back.

 

Some masks are fastened with ties, others with elastic. If the mask has ties, place the mask over your mouth, nose and chin. Fit the flexible nose piece to the form of your nose bridge; tie the upper set at the back of your head and the lower set at the base of your neck. If a mask has elastic head bands, separate the two bands, hold the mask in one hand and the bands in the other. Place and hold the mask over your nose, mouth, and chin, then stretch the bands over your head and secure them comfortably as shown; one band on the upper back of your head, the other below the ears at the base of the neck. Adjust the mask to fit. Remember, you don’t want to be touching it during use so take the few seconds needed to make sure it is secure on your head and fits snuggly around your face so there are no gaps.

 

If eye protection is needed, either goggles or a face shield should be worn. Position either device over the face and/or eyes and secure to head using the attached ear pieces or head band. Adjust to fit comfortably. Goggles should feel snug but not tight.

 

The last item of PPE to be donned is a pair of gloves. Be sure to select the type of glove needed for the task in the size that best fits you. Insert each hand into the appropriate glove and adjust as needed for comfort and dexterity. If you are wearing a gown, tuck the gown cuffs securely under each glove. This provides a continuous barrier protection for your skin.

 

In addition to wearing PPE, you should also use safe work practices. Avoid contaminating yourself by keeping your hands away from your face and not touching or adjusting PPE. Also, remove your gloves if they become torn and perform hand hygiene before putting on a new pair of gloves. You should also avoid spreading contamination by limiting surfaces and items touched with contaminated gloves.

 

To remove PPE safely, you must first be able to identify what sites are considered “clean” and what are “contaminated.” In general, the outside front and sleeves of the isolation gown and outside front of the goggles, mask, and face shield are considered “contaminated,” regardless of whether there is visible soil. Also, the outside of the gloves are contaminated. The areas that are considered “clean” are the parts that will be touched when removing PPE. These include inside the gloves; inside and back of the gown, including the ties; and the ties, elastic, or ear pieces of the mask, goggles and face shield.

 

The sequence for removing PPE is intended to limit opportunities for self contamination. The gloves are considered the most contaminated pieces of PPE and are therefore removed first. The face shield or goggles are next because they are more cumbersome and would interfere with removal of other PPE. The gown is third in the sequence, followed by the mask.

 

Removing gloves: Using one gloved hand, grasp the outside of the opposite glove near the wrist. Pull and peel the glove away from the hand. The glove should now be turned inside-out, with the contaminated side now on the inside. Hold the removed glove in the opposite gloved hand.

 

Slide one or two fingers of the ungloved hand under the wrist of the remaining glove. Peel glove off from the inside, creating a bag for both gloves. Discard in waste container

 

Removing face shield: Using ungloved hands, grasp the “clean” ear or head pieces and lift away from face. If goggle or face shield are reusable, place them in a designated receptacle for subsequent reprocessing. Otherwise, discard them in the waste receptacle.

 

The front of the mask is considered contaminated and should not be touched. Remove by handling only the ties or elastic bands starting with the bottom then top tie or band. Lift the mask away from the face and discard it into the designated waste receptacle.

 

Removing gown: Unfasten the gown ties with the ungloved hands. Slip hands underneath the gown at the neck and shoulder, peel away from the shoulders. Slip the fingers of one hand under the cuff of the opposite arm. Pull the hand into the sleeve, grasping the gown from inside. Reach across and push the sleeve off the opposite arm. Fold the gown towards the inside and fold or roll into a bundle. (Only the “clean” part of the gown should be visible.) Discard into waste or linen container, as appropriate.

 

After removing PPE: Hand hygiene is the cornerstone of preventing infection transmission. You should perform hand hygiene immediately after removing PPE. If your hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE. Wash your hands thoroughly with soap and warm water or, if hands are not visibly contaminated, use an alcohol-based hand rub.

Version 10 – last updated November 22nd, 2021