Guidance

Preventing and controlling infections

Updated 21 February 2024

This section provides general guidance for staff in settings on the prevention and control of infections. A proactive and preventive approach is advised, including the promotion of available immunisations.

Germs are spread during the infectious period. For some diseases such coronavirus (COVID-19) this can be before the person affected shows any signs or symptoms of a respiratory infection.

Infection prevention and control measures aim to interrupt the chain of transmission.

Hand hygiene

What you need to know

Hand hygiene is one of the most important ways of controlling the spread of infections, especially those that cause diarrhoea or vomiting and respiratory infections.

What you need to do

Ensure all individuals have access to liquid soap, warm water, and paper towels. Bar soap should not be used. Alcohol hand gel can be used if hands are not visibly dirty. Alcohol hand gel is not effective against organisms that cause gastroenteritis, such as norovirus.

Advise all individuals to clean their hands after using the toilet, before eating or handling food, after playtime and after touching animals.

All cuts and abrasions should be covered with a waterproof dressing.

Educate children and young people on why hand hygiene is so important. Free resources to support this have been developed by the UK Health Security Agency (UKHSA) with teachers for ages 3 to 16 and are available at e-bug.eu.

Respiratory and cough hygiene

What you need to know

Coughs and sneezes spread diseases. Covering the nose and mouth when sneezing and coughing can reduce the spread of infections.

What you need to do

Discourage spitting.

Encourage all individuals, particularly those with signs and symptoms of a respiratory infection to follow respiratory hygiene and cough etiquette, specifically, to:

• cover nose and mouth with a tissue when coughing and sneezing, dispose of used tissue in a waste bin, and clean hands
• cough or sneeze into the inner elbow (upper sleeve) if no tissues are available, rather than into the hand
• keep contaminated hands away from their eyes, mouth and nose
• clean hands after contact with respiratory secretions and contaminated objects and materials

Educate children and young people on why respiratory hygiene is so important. Free resources to support this have been developed by UKHSA with teachers for ages 3 to 16 and are available at e-bug.eu.

Cleaning

What you need to know

Keeping settings clean, including equipment, reduces the risk of transmission. Effective cleaning and disinfection are critical in any setting, particularly when food preparation is taking place.

Cleaning with detergent and water is normally all that is needed as it removes most germs that can cause diseases.

Essential elements of a comprehensive cleaning contract include daily, weekly and periodic cleaning schedules. Read more on buying cleaning services.

In the event of an outbreak of infection at your setting, your UKHSA health protection team (HPT) may recommend enhanced or more frequent cleaning, to help reduce transmission. Read guidance on managing outbreaks and incidents.

Advice may also be given to increase cleaning of areas with particular attention to hand touch surfaces that can be easily contaminated such as door handles, toilet flushes, taps and communal touch areas.

What you need to do

Clean surfaces that people touch a lot. Regularly clean and disinfect all areas or surfaces in contact with food, dirt, or bodily fluids.

In cleaning schedules, clearly describe the activities required, the frequency of cleaning and who will carry them out.

Develop plans for situations where additional cleaning will be required (for example in the event of an outbreak) and how the setting might carry this out.

Ensure cleaning staff are appropriately trained and have access to the appropriate personal protective equipment (PPE), such as household gloves and aprons.

Although there is no legislative requirement to use a colour-coding system, it is good practice. Use colour-coded equipment in different areas with separate equipment for kitchen, toilet, classroom, and office areas (for example, red for toilets and washrooms; yellow for hand wash basins and sinks; blue for general areas and green for kitchens).

Cleaning equipment used should be disposable or, if reusable, disinfected after each use.

Nominate a member of staff to monitor cleaning standards. Have a system in place for staff to report issues with cleaning standards and discuss any issues with cleaning staff, or contractors employed by the setting.

In areas where food is handled or prepared

The Food Standards Agency (FSA) strongly advises the use of either a dishwasher, a sterilising sink, or a steam cleaner to clean and disinfect equipment and utensils.

Operate and maintain equipment according to the manufacturer’s instructions and include regular dishwasher interior cleaning cycles.

Follow food hygiene standards from the Food Standards Agency.

Educate children and young people on their role in improving food hygiene.

Free resources to support this have been developed by UKHSA with teachers for ages 3 to 16 and are available at e-bug.eu

Toileting and sanitation

What you need to know

Good hygiene practices depend on adequate facilities and clear processes. Hand hygiene is extremely important to emphasise to individuals who are supporting children and young people with toileting.

Individuals who use continence aids (like continence pads, catheters) should be encouraged to be as independent as possible. The principles of basic hygiene should be applied by both individuals and staff involved in the management of these aids.

What you need to do

For all individuals and staff

Have hand wash basins available, with warm running water along with a mild liquid soap, preferably wall-mounted with disposable cartridges.

Place disposable paper towels next to basins in wall-mounted dispensers, together with a nearby foot-operated wastepaper bin.

Make sure toilet paper is available in each cubicle (it is not acceptable for toilet paper to be given out on request). If settings experience problems with over-use, they could consider installing paper dispensers to manage this.

Suitable sanitary disposal facilities should be provided where there are children and young people aged 9 or over (junior and senior age groups).

Where nappy changing is taking place

Create a designated changing area for children and young people using nappies.

This should:

• where possible, be away from play facilities and any area where food or drink is prepared or consumed
• have appropriate hand washing facilities available

Staff involved in managing nappies should:

• wash and dry their hands after every nappy change, before handling another child or leaving the nappy changing room
• wrap soiled nappies in a plastic bag before disposal in the general waste unless collected separately as offensive waste – see safe management of waste.
• where appropriate, clean children’s skin with a disposable wipe (flannels should not be used)
• label nappy creams and lotions with the child’s name and do not share with others
• wipe changing mats with soapy water or a mild detergent wipe after each use and at the end of each day
• check mats weekly for tears and discard if the cover is damaged

Where potties are used

Designate a sink for cleaning potties (not a hand wash basin). This should be located in the area where potties are used.

Wear disposable gloves to flush contents down the toilet.

Wash the potty in hot soapy water and dry.

Store potties upside down. Do not stack potties inside each other.

Wash hands using soap and warm water and dry after removing disposable gloves.

For individuals with continence aids

Change continence pads in a designated area.

Wear appropriate personal protective equipment (PPE). such as disposable gloves and a disposable plastic apron, and change after every child or young person.

Ensure hand washing facilities are readily available.

Personal protective equipment

What you need to know

PPE can protect individuals and staff from contamination with blood or bodily fluids, which may contain germs that spread disease.

PPE should be used in line with risk assessments in all settings, proportionate to the risk identified.

Risk assessments look at both the risk of occurrence and the impact, and may need to be dynamic, based on the emerging situation. This ensures that all people, including those with complex or additional health needs, are supported to continue their care and education in the setting, where it is safe to do so.

What you need to do

Conduct risk assessments that are dynamic and long-term.

If there is a risk of splashing or contamination with blood or bodily fluids during an activity, wear disposable gloves and plastic aprons. Gloves and aprons should be single-use disposable, non-powdered vinyl/nitrile or latex-free and CE marked.

Wear a fluid-repellent surgical facemask and eye protection if there is a risk of splashing with blood or body fluids to the face. If reusable, decontaminate prior to next use.

For aerosol generating procedures (AGPs)

An AGP is a medical procedure that can result in the release of airborne particles (aerosols) from the respiratory tract. See full AGP list.

Wear eye and face protection, apron and gloves to protect against the splashing or spraying of blood and bodily fluids from AGPs. If you or a member of your staff is performing an AGP on an individual who is suspected of being infectious with a respiratory agent (for example respiratory syncytial virus (RSV) or COVID-19), use additional airborne PPE, including a fit tested FFP3 respirator.

Safe management of the environment

Ventilation

What you need to know

Ventilation is the process of introducing fresh air into indoor spaces while removing stale air. Letting fresh air into indoor spaces can help dilute air that contains viral particles and reduce the spread of COVID-19 and other respiratory infections.

As part of the COVID-19 pandemic response, the Department for Education provided state-funded education and childcare settings with access to CO₂ monitors to help them assess how well ventilated their spaces were.

Settings can continue to use these monitors as a helpful tool to manage ventilation, sitting alongside the other protective measures in place to manage transmission, such as vaccinations and increased hygiene.

CO₂ monitors are portable, enabling settings to move them around to assess ventilation across their full estate, starting with areas they suspect may be poorly ventilated.

Where an area of poor ventilation has been identified, there are several simple measures that can be taken to resolve this. Further information is available: Ventilation to reduce the spread of respiratory infections, including COVID-19.

What you need to do

All settings should keep occupied spaces well ventilated to help reduce the number of respiratory germs. Open windows and doors as much as possible to let fresh air in (unless it is unsafe to do so, for example, do not keep fire doors open).

Try and open higher-level windows to reduce draughts, where it is safe to do.

If you have CO₂ monitors, use them to balance the need for increased ventilation with maintaining a comfortable temperature.

During the colder months, you may consider opening windows more when the room is unoccupied in between lessons.

If the above does not help to reduce CO₂ levels, settings should explore what remedial works may be required to improve ventilation.

Keeping animals on site

What you need to know

Some settings will choose to include pets and other animals to enhance the learning environment or provide respite or support for people. However, contact with animals can pose a risk of infection including gastro-intestinal infection, fungal infections and parasites.

Some people may be at greater risk of developing a severe infection. However, sensible measures can be taken to reduce the risk of infection.

What you need to do

Only consider pets that are mature and toilet trained.

A knowledgeable staff member needs to be responsible for animals and abide by the Animal Welfare Act 2006, which places a duty on animal owners to ensure their animal’s welfare needs are met.

The responsible person should ensure that the animal has recommended treatments and immunisations, is regularly groomed (including claws trimmed) and checked for signs of infection.

Where an individual has a support animal, responsibility for implementing infection prevention measures, and supporting the individual to do so, should be allocated to a staff member.

Develop a written agreement within the setting detailing:

• the types of animals allowed in the setting
• how to manage them and permitted behaviour whilst on the premises
• any insurance liability of owners and handlers

Ensure animals are always supervised when in contact with children and young people and that all persons wash their hands immediately after handling animals, or touching their bedding or equipment.

Maintain a clean environment, making sure that:

• bedding is laundered regularly
• feeding areas are kept clean and food stored away from human food
• food not consumed within 20 minutes is taken away or covered

There are some additional considerations for cats, such as:

• cat litter trays should be cleaned daily wearing disposable gloves
• litter trays should not be placed near food preparation, storage or eating areas
• pregnant staff should not clean litter trays due to a risk of toxoplasmosis

Reptiles are not suitable as pets in children and young people settings as all species can carry salmonella which can cause serious illness.

Safe management of linen and soft furnishings

What you need to know

Where soft furnishings are used, they should ideally have a wipeable surface.

What you need to do

If there is a need for laundry facilities, designate an area on site that:

• is separate from any food preparation areas
• has appropriate hand washing facilities
• has a washing machine with a sluice or pre-wash cycle

Avoid rinsing clothing by hand as there is a risk of inhaling fine contaminated aerosol droplets. Instead, rinse soiled articles of clothing in a washing machine pre-wash cycle, prior to washing.

If the setting uses linen then:

• ensure that linen is washed at least weekly and when visibly dirty
• bedding should be allocated to a named person
• launder face flannels after each use
• remove dirty and used linen from areas that are accessible to children and young people
• carefully dispose of any soiling (faeces) found on clothing or linen into the toilet, for example from reusable nappies – note: do not rinse soiled clothing, including reusable nappies
• wash all linen at the hottest temperatures specified on the fabric
• keep fresh linen in a clean, dry area separate from used linen

If staff have uniforms or use cotton tabards, they should change them every day and wash them using normal washing detergent at the hottest temperature specified on the garment.

If clothing is contaminated with blood or bodily fluids:

• wear gloves and aprons when handling soiled linen or clothing
• remove clothing as soon as possible and place in a named and sealed plastic bag or container
• send clothing home with the child or young person with advice for the parent or carer on how to launder the contaminated clothing
• wash any contaminated clothing separately in a washing machine, using a pre-wash cycle, on the hottest temperature that the clothes will tolerate
• wash hands thoroughly after removing the gloves and aprons

Safe management of blood and bodily fluids

What you need to know

Blood and bodily fluids can contain germs that cause infection. It is not always evident whether a person has an infection, and so precautions should always be taken.

What you need to do

Cleaning blood and bodily fluid spills

Clean any spillages of blood, faeces, saliva, vomit, nasal discharges immediately, wearing PPE.

Use gloves and an apron if you anticipate splashing and risk assess the need for facial and eye protection.

Clean using a product which combines detergent and disinfectant that is effective against both bacteria and viruses. Manufacturer’s guidance should always be followed. Cleaning with detergent followed by the use of a disinfectant is also acceptable. It should be noted that some agents, such as NaDCC (Sodium Dichloroisocyanurate or Troclosene Sodium, a form of chlorine used for disinfection), cannot be used on urine.

Use disposable paper towels or cloths to clean up blood and bodily fluid spills. These should be disposed of immediately and safely after use.

A spillage kit should be available for bodily fluids like blood, vomit and urine.

Managing cuts, bites, nose bleeds and bodily fluid spills

Take standard precautions when dealing with any cuts or abrasions that involve a break in the skin or bodily fluid spills.

Be aware of the setting’s health and safety policies and manage incidents such as cuts, bites, bleeds and spills accordingly.

These policies should include having nominated first aiders who are appropriately trained.

Use Standard Infection Prevention and Control (SIPC) precautions to reduce the risk of unknown (and known) disease transmission.

These include:

• wearing gloves when in contact with blood, bodily fluids, non-intact skin, eyes, mouth, or nose (washing grazes, dressing wounds, cleaning up blood after an incident) and wearing a disposable plastic apron
• carefully cleaning the wound under running water if possible or using a disposable container with water and wipes; carefully dab dry
• covering all exposed cuts and grazes with waterproof plasters
• keeping the dressing clean by changing it as often as is necessary
• managing all spillages of blood or body fluids

Safe management of waste (including sharps)

What you need to do

Under the waste management duty of care, settings must ensure that all waste produced is dealt with by a licensed waste management company.

Place any used PPE in a refuse bag and dispose of as normal domestic waste. PPE should not be put in a recycling bin or dropped as litter.

Settings that generate clinical waste should continue to follow usual waste policies.

Nappy waste can sometimes be produced in large quantities in places such as nurseries. Although considered non-hazardous it can sometimes be offensive and cause handling problems. Contact your local authority if you are a setting that produces significant amounts of used nappies (more than 7kg per collection period) to discuss appropriate disposal arrangements.

Managing prevention of exposure to infection (including needlestick or sharps injuries, and bites)

What you need to know

An exposure is an injury from a used needle or a bite which breaks the skin, and/or exposure of blood and body fluids onto:

• broken skin
• the eyes, nose or mouth

Human mouths are inhabited by a wide variety of organisms, some of which can be transmitted by bites. Human bites resulting in puncture or breaking of the skin are potential sources of exposure to blood borne infections, therefore, it is essential that they are managed promptly.

What you need to do

If someone pricks or scratches themselves with a used hypodermic needle or has a bite which breaks the skin:

• dispose of the needle safely in a sharps container to avoid the same thing happening to someone else – please contact your local authority or school nurse for help with safe disposal of discarded needles
• wash the wound thoroughly with soap and warm running water
• cover the wound with a waterproof dressing
• seek immediate medical attention or advice from your local accident and emergency department or occupational health provider
• record it in the accident book and complete the accident form