Nursery Management

How to Prevent and Control Infection in Early Years Settings

  • How to Prevent and Control Infection in Early Years Settings

In order to maintain a safe and hygienic environment in your nursery, you have to assess the level of risk you face, as Laura West explains…

Infection control and prevention is critical in childcare settings as there are essential activities that could put both children and staff at risk of passing on or contracting an infection.

The highest risk of these is dealing with clinical waste, also known in the early years world as changing nappies. Infections can be easily contracted and transmitted, but are equally easy to avoid if everyone plays their part and puts into practice proper preventative actions.

Infections explained

First, let’s understand what an infection actually is. Infections are caused by bacteria, fungi or viruses entering the body. They can be minor and stay in one area, like an abscess or boil, or spread through the body, like flu or a blood infection.

General infections are easily dealt with, but sometimes they can cause more serious health problems. Infections like flu or norovirus can be spread from person to person, but not all infections are transmittable.

There are many infections that people can pick up, at work, around the home and in public places. They can be spread by blood, bodily fluids, waste, skin contact or infectious aerosols such as sneezing, dust and water droplets.

The chain of infection

The spread of infection is also known as the ‘chain of infection’, and by breaking a link we can halt the process. There are six links to consider:

  • Organism – the bacteria, virus or fungi
  • Reservoir – a reservoir can be environmental, such as the workplace setting, the water supply or in a living organism such as a rodent or bird. Humans are the only reservoir for many human pathogens
  • Portal of exit – how the organism leaves the reservoir. It could leave in faeces, blood, mucus, in contaminated water or in the bloody meal of an insect
  • Mode of transmission – how the organism is transmitted from one host to the next
  • Portal of entry – how the organism enters the body
  • Vulnerable host – commonly the most vulnerable are the very young, the elderly and people with a suppressed immune system

Infections generally enter the body via one of four routes:

Inhalation – meaning, we breathe it in.

Ingestion – entry through the mouth. This often occurs accidentally through hand-to-mouth transfer, when a person has a substance on their hand and then does something like bite their nails, smokes or eats lunch.

Injection – caused by sharp objects that penetrate the skin and allow harmful substances into the body. Particular hazards include discarded needles and syringes.

Absorption – this usually takes place through cuts or other breaks in the skin, although there are other substances that can penetrate and be absorbed by unbroken skin.

Infection can occur in a number of different ways within a childcare setting, the main way being putting contaminated hands, fingers or pens into the mouth, nose or eyes, or inhaling infectious aerosols or droplets from the air (eg breathing in after someone has sneezed).

Other ways include contamination via broken skin (a wound) or coming into direct contact with a microorganism or something contaminated by microorganisms.

More-serious ways of contamination could involve splashes of bodily fluids such as blood or excrement coming into contact with the eyes, nose, mouth or open wound, or a skin-penetrating injury – eg being contaminated via a discarded needle or animal/insect bite.

In order to control and prevent a potential infection you have to assess the level of risk. Once a source of infection has been identified you must consider how likely it is that infection will occur.

In order to do this, think about how often the task is carried out, how many employees are exposed, and how much infectious material is handled. If you consider that there is a risk, decide whether existing control measures are sufficient or if more are required.

Occupational hygiene

Within industries where people work with people (adults and children) or animals, the basic control principles of occupational hygiene should be applied in all situations. Occupational hygiene principles that all staff should be following include the following:

  • Washing hands and arms thoroughly if needs be before eating, drinking, smoking, using the telephone, taking medication, applying makeup or inserting contact lenses
  • Covering all existing and new cuts and grazes with waterproof dressings and if needed wearing gloves before starting work
  • Taking meal breaks away from the main work area
  • Wearing appropriate protective clothing to stop personal contamination, eg plastic aprons, gloves, disposable shoes, waterproof clothing
  • Avoiding hand-to-mouth or hand-to-eye contact. Don’t put pens and pencils in your mouth and dispose of contaminated water safely

As well as occupation hygiene, good environmental hygiene and design are also essential. These principles include the following:

  • Use equipment that is easy to clean and decontaminate
  • Clean all work surfaces and work areas regularly
  • Ensure, where possible, that the workplace and its services such as water systems and air conditioning systems are designed to be safe to use, easily cleaned and well maintained
  • Treat water systems to either kill or limit micro-organisms’ ability to grow
  • Control pests, such as rats or insects within the premises

Effective cleaning

Cleaning products is the next area of control and prevention to consider. Disinfectants can be used to reduce bacteria to a safe level; this is achieved by using the disinfectant along with very hot water (82ºC or higher) for best effectiveness.

But remember, they must be diluted to the correct levels and left in place for the specified ‘contact time’ before rinsing. Disinfectants won’t break down grease and dirt.

Detergents will break down grease and dirt but will not kill bacteria, However, sanitisers are a combined detergent and disinfectant that will kill bacteria if left for the correct ‘contact time’.

Washing your hands regularly, effectively and thoroughly is the best way to keep the level of hand-based bacteria to a low or zero level.

As well as controlling the day-to-day risks it’s important to consider potential action that may be required in an emergency situation. If an employee is exposed to blood or potentially infectious materials, you will need to wash the exposed area thoroughly with soap and running water.

If blood or bodily fluids are splashed in the eyes or mucous membrane, flush the eye area with running water for at least 15 minutes.

Report the exposure to your supervisor, document the incident and investigate how this happened using health and safety procedures. It is also advisable to seek medical advice. It is a good idea to have a ‘clean up’ or ‘spill kit’ available.

Don’t forget…

Washing your hands is one of the most important ways of controlling the spread of infection…

  • Use a designated hand-washing sink
  • When washing your hands thoroughly, don’t forget the backs of your hands and in between your fingers
  • Use liquid soap (antibacterial is best) and hot water
  • When drying your hands, never use shared towels – always use disposable paper towels or an air-dryer
  • Hand-washing needs to be done for a duration of 40–60 seconds

You need to wash your hands before and after:

  • Going to the toilet
  • Eating and drinking
  • Taking medication
  • Smoking
  • Putting makeup on
  • Inserting contact lenses
  • Handling raw food, eg meat, eggs, etc
  • Handling allergenic foods
  • Removing any rubbish, etc
  • Handling cleaning chemicals
  • Blowing your nose or touching your face or hair
  • After any work activity where you may have become contaminated

Laura West is the childcare health and safety specialist at MCW Nursery Support Service Ltd, a family-run business specialising in health and safety, auditing and training for the childcare industry. Visit