Guidelines For Child Care Facilities during a Boil Water Advisory

NOTE: These guidelines have been designed for generic use in a boil water advisory. Please speak with the inspection department of your local Health Unit for instructions regarding the particular circumstances of a specific boil water event.

The guidelines below are provided to child care facilities further to the boil water advisory issued by the Medical officer of health.

During A Boil Water Advisory

Water For Drinking

• Use only boiled or bottled water. All water for drinking or for use as an ingredient in drink mixes must be commercially bottled or boiled for one minute then stored in clean, covered containers until served.
• Post signs advising not to drink the tap water at all sinks.

Food Preparation

• Discard all foods and beverages made with untreated or potentially contaminated water
• All water that is used to wash, rinse or soak foods (i.e. fruits and vegetables) must be commercially bottled or boiled for one minute. Children and staff should not consume raw foods rinsed with water that has not been disinfected.

Exclusion With Diarrhea

• Exclude all children or staff reporting diarrhea until symptoms have subsided for at least 24 hours.
• Report all illness linked to a community outbreak to the MOH
  

NOTE: If there is a known agent, or the MOH declared an outbreak in the community or facility, then more stringent guidelines may need to be followed based on relevant enteric disease guidelines.

Handwashing

• Enforce frequent thorough handwashing for all staff and children. Signs advising of the appropriate handwashing technique should be posted at all sinks. Supervision of children during handwashing should occur.
• If the boil water advisory has been issued as a precaution and there is no outbreak of human illness, there is no need for additional hand disinfection with bleach solution or alcohol using the measures described below.
• If the boil water advisory has been issued because of an outbreak of human illness or the presence of a known pathogen (e.g. E. coli or Shigella), hands should be washed with tap water and liquid soap and rinsed using the following solution:
• Place approximately 5 ml (1 tsp.) of liquid household bleach in 4.5 L (1 gallon) of water.
  
• Mix and let stand for at least 15 minutes before using.
  
• Transfer the mixture to smaller, clean containers for use. A one gallon hand pump works well.
  
• Do not wash hands directly in solution unless wash water is emptied after each use.
  
• Label the containers as follows: "Chlorine Bleach Solution. Apply to hands after washing. Do not drink".
  
• This solution must be provided in children's' washrooms as well as staff washrooms and at all hand basins.
  
• Alcohol-based hand disinfectants, containing more than 60% alcohol may be used after washing hands with soap or in situations where water is not available.

Teethbrushing

• Ensure availability of potable water for teethbrushing and ensure that supervision of this activity occurs.

Diapering

• Use disposable gloves, alcohol/gel rinses and disposable moistened towelettes when diapering children.
• Use disposable paper to cover diaper-changing areas
• Clean children's hands with the gel after diapering and ensure staff wash hands after each diaper change.
• If face cloths are used, ensure they are moistened with non-contaminated water then laundered after each use.
• Use overclothes or diapers capable of retaining liquid feces.
• Disinfect diaper areas after each child has been changed with a chlorine solution of 100 parts per million (or a solution of equivalent disinfection capability).
• Ensure clear separation of diapering and food-handling areas and responsibilities
• Ensure separation of diaper changing areas from children's play areas.

Dishwashing

• Disinfect dishes by washing in dishwashing machines that have a dry cycle or a final rinse that exceeds 45° C (113° F) for 20 minutes or 50° C (122° F) for five minutes or 72° C (162° F) for one minute, or
• Use single-use, disposable dishware and utensils

Water Play Stations

• Stop the use of water play tables during this time. Drain all water play tables or or play areas containing water.
• Discourage activities/crafts which utilize water and where there is a risk that children may consume a product (e.g. handpainting, baking, pasting with glue made from flour and water).

Washing Toys

• Wash cloth toys or dress up clothes in a washing machine and heat dry them in a clothes dryer for 30 minutes.
• Disinfect toys in a disinfectant solution ensuring adequate contact time. Dishwasher-safe toys may also be cleaned in a dishwasher providing that the machine uses a hot water wash at 60° C (or 140° F) with a hot water sanitizing rinse of 82° C (or 180° F) for ten seconds.

Laundry

• Launder dish cloths, bedding, bibs and facecloths in a standard washing machine provided that a sanitizing rinse or hot rinse cycle is used. Items should be dried in a standard dryer for a minimum of 30 minutes.

Communication to Parents

• Inform parents of the boil water advisory, symptoms of enteric illness, need for exclusion, reporting requirements, risk of severe illness in immunocompromised persons, and necessary control measures.

Upon Rescinding A Boil Water Advisory

Once the BWA has been lifted, all water-using fixtures or pieces of equipment should be re-started, flushed and sanitized in accordance with the manufacturer's specifications. This may vary from fixture to fixture. Water filters, softeners and treatment devices may need to be completely replaced. The facilities engineer and/or the fixture manufacture should be consulted for specific guidance when re-starting equipment.

Additional Measures To Be Effected:

• Run cold faucets for one minute before using the water.
• Run drinking fountains for one minute before using the water.
• Backwash pool filters and change media or water as warranted.
• Drain and refill hot water heaters set below 45° C (113 ° F)
• Drain and refill all water play stations

Adapted from Guidelines contained in the Protocol for the Investigation and Control of Cryptosporidium and Giardia Waterborne Outbreaks (Public Health Branch, August 1997) and Cryptosporidium and Water: A Public Health Handbook (1997).