Germ Illustration

Control Measures in the Event of a Gastroenteritis (Enteric) Outbreak

Child care centres are becoming a frequent site of outbreaks of gastroenteritis. These settings present specific risks of spread of this illness among children because of large groups of children sharing the same rooms, toys/activities, eating spaces and bathroom facilities.

How to Identify A Gastrointestinal Case in Your Child Care Centre

A case is defined as a child or staff member who has been in the centre within the last 48 hours and is experiencing:

  • two or more episodes of unformed or watery stool within a 24 hour period;

OR

  • two or more episodes of vomiting within 24 hours;

OR

  • one episode of unformed or watery stool and one episode of vomiting within 24 hours period;

OR

  • at least one symptom compatible with enteric infection-nausea, vomiting, diarrhea, abdominal pain or tenderness AND lab confirmation of a known gastrointestinal pathogen.

Enteric Outbreak Definition

Three or more cases in the centre (as defined above) within a 48 hour period.

When an enteric outbreak has been identified, health unit staff will review with the centre the Daycare Enteric Outbreak Control Measures Form (PDF).

Outbreak Control Measures

  1. Post Signs
  • Post signs indicating your centre is in an outbreak.
  1. Reduce Interactions
  • Do not accept new children in your child care centre.
  • Exclude ill children and staff from child care until 48 hours after symptoms have stopped. This recommendation may change during an outbreak on direction from the Medical Officer of Health.
  • Suspend interactions between groups that have experienced illness and groups that have not experienced illness. Staff should be dedicated to assigned rooms and not move between rooms. Breaks should be covered off by a supervisor if possible. Staff responsible for diapering should not be preparing or handling food.
  • Assess the risk of social outings, including field trips, to determine if there is a need to cancel outings for the duration of the outbreak period.
  • Stop sensory play activities such as water tables, sand tables etc.
  1. Increase Cleaning
  • Ensure surfaces contaminated by feces or vomit are immediately cleaned and disinfected using a high level disinfectant. Gloves, mask and water resistant gown will reduce the risk of infection to the staff cleaning and disinfecting.
  • Increase cleaning and disinfection of common touch surfaces such as door handles, handrails, sink/toilet handles etc.
  • Clean and disinfect toys in outbreak affected areas at least on a daily basis and more frequently than the routine cleaning schedule. All plush toys, if not dedicated per child, should be removed during the duration of the outbreak. Toys handled by a child who has become ill while in care should be immediately removed from circulation until they have been washed and disinfected. “Mouthed” toys should always be dedicated per child and continue to be one-time use items, being cleaned and disinfected after each use.
  • Contaminated clothing should be put into a plastic bag and sent home with parents for hot water washing. Play clothing/costumes, re-usable mop heads, and all linens including cot liners should be washed on a hot cycle (>71°C for 25 minutes) with a detergent and hot air dried.
  • Soft furnishings or carpets should be thoroughly cleaned with detergent and hot water.
  • Hard surfaces (including common high touch surfaces and toys) should be thoroughly cleaned with detergent, hot water and a single use cloth then wiped down or immersed with a high level disinfectant and allowed to air dry. It is critical to ensure the appropriate contact time is used for the disinfectant.
  1. Hand Washing
  • Review hand hygiene with staff. Increased hand washing is strongly recommended during an outbreak for children and staff. Operators must ensure there is access to warm running water, single use soap and paper towels in dispensers. Do not share towels.
  • Wash children’s hands upon arrival at child care centre, in addition to usual hand washing practices.
  • Children using cloth diapers should be switched to disposable diapers for the duration of the outbreak.
  • Alcohol-based hand rubs (ABHRs), may be used when hands are not visibly soiled. ABHRs should have a minimum 60% alcohol concentration, kept out of reach of children and only used with children under direct supervision.
  1. Communicate with Parents/Guardians
    It is essential that parents and guardians are kept informed of the status of the outbreak. Notices should be posted indicating to visitors, delivery services, families etc. that the centre is experiencing an outbreak.It is important that parents/guardians understand the policy surrounding exclusion and understand why ill children are not to be present in the child care centre.

Stool Collection

In some instances, the health unit may ask that stool specimens be submitted for diagnosis. The health unit will provide these stool kits to the parents. For more information, please contact the health unit at 1.888.221.2133.

Declaring an Enteric Outbreak Over

An outbreak of gastroenteritis is declared over in consultation with the Huron County Health Unit.

Generally, the outbreak is declared over four days after the last episode of illness at the centre. These criteria may change depending on the identification of a specific agent causing the outbreak and upon consultation with the Medical Officer of Health.

Last modified: February 19, 2020