Stepping Stones Therapy Inc.

COVID 19 Protocols and Procedures

We have adopted the guidelines put in place by BC Center of Disease Control for Daycare facilities.  We have revised the guidelines where needed to suit our center and our services.  The goal in creating this protocol is to keep staff, clients and their families as safe as possible during the COVID 19 pandemic.  Please refer to  http://covid-19.bccdc.ca/ for current, up to date information and best practice protocols.

 

Environmental Measures

 

Outdoor Spaces and Ventilation

 

  • Staff is to implement therapy goals outside as much as possible and where it makes sense for the child and their programs.

  • All therapy activities should be organized in a thoughtful way, taking into consideration personal space and safe transitions.

  • Reassure children and parents that playgrounds are a safe environment, and encourage appropriate hand hygiene practices before, during, after outdoor play. Staff should always carry hand sanitizer for themselves and their client to use.

  • The center is equipped with a ventilation system that has recently been reviewed to ensure it is running adequately to reduce the risk of airborne transmission.

 

Cleaning and Disinfection

 

Regular cleaning and disinfection are essential to preventing the transmission of COVID-19 from contaminated objects and surfaces. The center should be cleaned and disinfected in accordance with the BCCDC’s Cleaning and Disinfectants for Public Settings document (Appendix A).

 

  • General cleaning and disinfecting of the centre should occur after each session (min 3 times per day).

  • Frequently touched surfaces should be cleaned and disinfected after each session (min 3 times per day). These includes doorknobs, light switches, faucet handles, tabletops and counters, chairs, electronic devices, and toys.

  • Clean and disinfect any surface that is visibly dirty.

  • Use common, commercially available detergents and disinfectant products. Follow the instructions on the label. See Appendix A for more information.

  • Toys and other items that cannot be easily cleaned (e.g., avoid plush/stuffed toys) have been removed from the space. Staff should encourage parents not to allow their children to bring these types of toys/materials from home into the center.

  • Empty garbage containers daily, at minimum.

  • Wear disposable gloves when cleaning blood or body fluids (e.g., runny nose, vomit, stool, urine). Wash hands before wearing and after removing gloves.

  • Clean diapering station after each use.

  • There is no evidence that the COVID-19 virus is transmitted via textbooks, paper or other paper-based products. As such, there is no need to limit the distribution of books or paper based educational resources to children because of COVID-19.

 

Administrative Measures

 

Pick up/Drop off and Meetings Protocol

 

  • Parents must assess their children daily for symptoms before sending their children to therapy.  If the parent/guardian sees signs of illness (coughing, sneezing, runny nose) of a fever (100.4F/38C) they are to report this by calling 250-472-8304 (office) and should not bring their child in for their session that day.

  • Children will line up with their parent/guardian in the taped boxes outside of the center to wait for their worker to come and collect the child and their belongings.

  • Each child will be brought in one at a time and their worker will test their temperature prior to bringing them in.  If the child’s temperature is 100.4 F/38 C or higher, or they are showing signs of illness (coughing, sneezing, runny nose) they will be sent home.

  • Daily check at drop-off will be conducted by asking parents and caregivers to confirm that their child does not have symptoms of common cold, influenza, COVID-19, or other respiratory disease.

  • Stagger the use of the cubby area so that only one child is coming in and out at a time.

  • Parents should remain outside of the center.  However, if a parent must enter the setting for some reason, they should maintain physical distance from staff and other children present and practice diligent hand hygiene and maintain physical distance when they are in the center.

  • Pick up will be done outside.  After the session the child will be brought outside and will wait in the marked square with their worker until their parent/guardian collects the child and their belongings.

  • Parents are to maintain 2 m physical distancing from all staff at all times.

  • All parent/guardian meetings with clinicians will take place online.

 

 

 

 

 

 

 

Staff/Clients Become Ill at Work Protocol

 

IF CHILD DEVELOPS SYMPTOMS AT HOME:

 

If a child is assessed by their family physician or nurse practitioner and a doctor’s note is provided and it is determined that they do NOT have COVID-19, they may return to sessions once symptoms resolve.

 

OR

 

If a child has not been assessed by their family physician or nurse practitioner, parents or caregivers must keep their child at home for a minimum of 10 days from the onset of symptoms AND until symptoms resolve, whichever is longer.

 

IF CHILD DEVELOPS SYMPTOMS WHILE AT CENTER:

 

Staff must take the following steps:

 

  1. Identify a staff member to supervise the child.

  2. Identified staff member should immediately separate the symptomatic child from others in a supervised area until they can go home. This area will be the teen room.

  3. Contact the child’s parent or caregiver to pick them up right away.

  4. Where possible, maintain a distance of 2 metres from the ill child. If this is not possible, the staff member may use a mask, or use a tissue to cover their nose and mouth.

  5. Provide the child with tissues, and support as necessary so they can practice respiratory hygiene.

  6. Avoid touching the child’s body fluids. If you do, wash your hands.

  7. Once the child is picked up, wash your hands.

  8. Clean and disinfect the space where the child was separated and any areas used by the child (e.g., bathroom, common areas).

  9. If concerned, contact 8-1-1 or the local public health unit to seek further advice. Parents or caregivers must pick up their child promptly once notified that their child is ill.

  10. If a child is assessed by their family physician or nurse practitioner and it is determined that they do NOT have COVID-19, they may return to sessions once symptoms resolve.

 

IF STAFF DEVELOPS SYMPTOMS AT HOME:

 

If a staff member is assessed by their family physician or nurse practitioner and a doctor’s note is provided and it is determined that they do NOT have COVID-19, they may return to sessions once symptoms resolve.

 

OR

 

If a staff member has not been assessed by their family physician or nurse practitioner, staff must be excluded from work, stay home and self-isolate for a minimum of 10 days from the onset of symptoms AND until all symptoms resolve, whichever is longer.

 

IF STAFF DEVELOPS SYMPTOMS WHILE AT WORK:

 

Staff should go home right away where possible. If unable to leave immediately, the symptomatic staff person should:

 

  1. Separate themselves into an area away from others. This area will be the teen room.

  2. Maintain a distance of 2 metres from others.

  3. Use a tissue or mask to cover their nose and mouth while they wait for a replacement or to be picked up.

  4. Remaining staff must clean and disinfect the space where staff was separated and any areas used by them (e.g., office, bathroom, common areas).

  5. If concerned, contact 8-1-1 or the local public health unit to seek further advice.

  6. If a staff member is assessed by their family physician or nurse practitioner and it is determined that they do NOT have COVID-19, they may return to sessions once symptoms resolve.

 

Physical Distancing and Minimizing Physical Contact

 

Staff should minimize the frequency of direct physical contact with children and encourage children to minimize physical contact with each other.

Staff should use prompt levels thoughtfully and ensure that they are actively reducing their prompts when possible based on therapy guidelines.

Staff should maintain physical distancing from one another.

It is reasonable to establish different expectations based on age and/or developmental readiness. For example:

  • Younger children should be supported to have minimized direct contact with one another, while older children should be supported to maintain physical distance whenever possible.

  • Children from the same household (e.g., siblings) do not need to maintain physical distance from each other.

The following physical distancing strategies should be implemented where possible in the center setting:

 

  • Avoid close greetings (e.g., hugs, handshakes). Regularly remind children to keep “Hands to yourself”.

  • Strive to minimize the number of different staff that interact with the same children throughout the day.

  • Organize children into smaller groups and/or spread children out to minimize direct physical contact.

  • Use different room configurations (e.g., separating tables).

  • Set up small group environments to reduce the number of children in a group, for example, set up 2 or 3 areas for colouring or doing crafts.

  • Provide children with their own labelled set of art/sensory supplies paid by the  parents.

  • Incorporate more individual activities or activities that encourage more space between children and staff.

  • Remove toys that encourage group play in close proximity or increase the likelihood of physical contact.

  • Keep toys that encourage individual play.

  • Help younger children learn about physical distancing and less physical contact by creating games that include basic principles such as “two arm lengths apart”.

  • Consider using books, individual games, video and online programs as a part of learning so children can sit independently and distanced from each other.

  • The teen room is the separate, supervised area available for children who have symptoms of illness so they can rest until they can be picked up.  Ensure this area is cleaned and disinfected after the child has left.

  • Stagger snack or mealtime to allow spacing between children during meals.

  • Minimize the number of additional adults entering the centre, unless that person is providing care and/or supporting inclusion of a child in care (e.g. supportive child care assistants, BCBA’s, speech language pathologist, etc.)

  • Implement a new traffic flow to help guide children and staff in a circular rotation to access the toy room.

  • Where appropriate, eye level signage and floor decals will be posted to encourage physical distancing while moving throughout the building.

  • Use of walkie talkies to alert fellow staff to direction of travel through narrow hallways where physical distancing would otherwise be unattainable.

  • To comply with the guidelines for physical distancing, signage is posted outside of rooms that have maximum occupancy limits.

 

Personal Measures

 

Daily Checks for Respiratory Illness and Staying Home When Sick

 

  • All parents, caregivers, children and staff who have symptoms of COVID-19 OR travelled outside Canada in the last 14 days OR were identified by Public Health as a close contact of a confirmed case must stay home and self-isolate.

  • Parents and caregivers must assess their child daily for symptoms of common cold, influenza, COVID-19, or other infectious respiratory disease before sending them for therapy sessions.

  • A child may not receive therapy if another person in their home has symptoms of COVID-19 even if the child remains asymptomatic.

  • Children who are ill, including children of essential service providers, will not be permitted to attend therapy sessions.

  • Staff must assess themselves daily for symptoms of common cold, influenza, or COVID-19 prior to working and stay home if they are ill.

  • If a parent, caregiver or staff member is unsure if they or a child should self-isolate, they should use the BC COVID-19 Self-Assessment Tool, contact 8-1-1 or the local public health unit. They can also be advised to contact a family physician or nurse practitioner to be assessed for COVID-19 and other respiratory diseases.

 

Hand Washing Hygiene

 

Rigorous hand washing with plain soap and water is the single most effective way to reduce the spread of illness. Children and staff can pick up germs easily from anything they touch, and can spread those germs to objects, surfaces, food and people. Everyone should practice diligent hand hygiene. Parents and staff can teach and reinforce these practices amongst children.

 

How to perform hand hygiene:

 

  • Wash hands with plain soap and water for at least 20 seconds (sing the “ABC’s” or “Twinkle Twinkle Little Star”).

  • Antibacterial soap is not needed for COVID-19.

  • If sinks are not available (e.g., children and staff are outside), supervised use of alcohol-based hand sanitizer containing at least 60% alcohol should be used.

  • If hands are visibly soiled, alcohol-based hand sanitizers may not be effective at eliminating respiratory viruses. Soap and water are preferred when hands are visibly dirty.

 

Strategies to ensure diligent hand hygiene:

 

  • Hand hygiene stations are set up at the entrance, so that children can clean their hands when they enter.

  • The children and staff will use hand sanitizer immediately upon entry and then go and wash hands with soap and water.

  • Keep hand sanitizer out of children’s reach and supervise its use.

  • Incorporate additional hand hygiene opportunities into the daily schedule.

  • Ensure the centre is well-stocked with hand washing supplies at all times including plain soap, clean towels, paper towels, waste bins, and where appropriate, hand sanitizer with a minimum of 60% alcohol.

  • Staff should report to management when any hand washing or cleaning supplies are running low.

  • More supplies should be ordered immediately once report is made.

  • Children regularly forget about proper hand washing. Staff and children should practice often, and staff should model washing hands properly in a fun and relaxed way.

  • Staff should assist young children with hand hygiene as needed.

 

 

Respiratory Etiquette

 

Children and staff should:

 

  • Cough or sneeze into their elbow sleeve or a tissue. Throw away used tissues and immediately perform hand hygiene (“Cover your coughs”).

  • Not touch their eyes, nose or mouth with unwashed hands (“Hands below your shoulders”).

  • Parents and staff can teach and reinforce these practices amongst children.

  • It is not recommended that children wear cloth or homemade masks.

 

Other Considerations

Children and staff should not share food, drinks, soothers, bottles, sippy cups, toothbrushes, facecloths, chewelry and other personal items.

  • Label personal items with the child’s name to discourage accidental sharing.

  • Children should not be allowed to prepare or serve food.

  • Ask parents and caregivers not to bring personal comfort items (e.g., stuffies).

  • Ask parents to supply an extra outfit or two in their bags with an empty plastic bag.  If a child soils their clothing with bodily fluids the clothing should be removed, placed in the plastic bag, and new clothing put on the child. 

  • Parents should ensure regular and vigilant cleaning of all food /drink containers, food bags, extra clothing, bags and ipads brought into the center.

 

 

Personal Protective Equipment

 

Personal protective equipment, such as masks and gloves are not needed in the center, beyond those used by staff as part of regular precautions for the hazards normally encountered in their regular course of work.

 

  • Wear disposable gloves when cleaning blood or body fluids (e.g., runny nose, vomit, stool, urine) and when diapering. Remember to wash your hands before wearing, and after removing gloves.

  • Cloth or non-medical homemade masks are not recommended unless all other measures cannot be met (social distancing, barriers between staff and client). Wearing one is a personal choice, but Stepping Stones management is recommending every BI wear one when social distancing is not an option. Each staff member will be issued homemade cloth masks.  It will be the BI’s responsibility to have a clean mask that is brought to every session.  Replacement masks will be available at a cost.

  • Personal masks should be kept in a Ziploc bag with other personal items for use at work (pen, clickers, ect).  Each BI will be issued a drawstring bag to be carried throughout sessions.  Replacement bags will be available at a cost.

  • More information about COVID-related mask use is available in Appendix B.

  • In young children in particular, masks can be irritating and may lead to increased touching of the face and eyes. There is no evidence to support the use of medical grade, cloth, or homemade masks in childcare setting at this time. Wearing one is a personal choice.

  • It is important to treat people wearing masks with respect.

 

 

Appendix A

Appendix B

Masks

Facemasks should be used by people who are sick and health care workers.

Wear a mask if you are sick

Masks should be used by sick people to prevent transmission to other people. Masks are an appropriate part of infection prevention and control if you have symptoms of COVID-19 or are caring for a person with symptoms. The mask acts as a barrier and helps stop the tiny droplets from spreading when you cough or sneeze. Wearing a mask does not make it okay to go out but it can help prevent the spread of germs at home.

Using a mask is not enough and should be combined with other preventative measures such as frequent hand washing and physical distancing. Learn more about the precautions you should take if you are sick.

 

Wearing masks if you are healthy

  • Medical masks and N95 respirators should be reserved for healthcare workers.

  • Wearing a cloth mask is a matter of personal choice. Some people can spread the virus when they have very mild symptoms or may be unaware they are infected. In this case, wearing a mask can help in containing your own droplets and protect others but it will not protect you from COVID-19. Masks may give a person a false sense of security and are likely to increase the number of times a person will touch their own face (e.g., to adjust the mask). Any mask, no matter how efficient at filtration or how good the seal, will have minimal effect if it is not used together with other preventive measures, such as frequent hand washing and physical distancing.

  • It is important to treat people wearing masks with respect.

 

 

Considering the use of homemade masks

The use of a homemade mask should only be considered by members of the public who are symptomatic or caring for someone who is symptomatic as an interim measure if commercial masks are not available.

 

If you are making a mask, here is some information to improve the effectiveness of homemade masks:

  • Some materials are better than others. Use clean and stretchy 100% cotton t-shirts or pillowcases.

  • Ensure the mask fits tightly around the nose and mouth; material that allows droplets to pass through will not work.

  • The mask should be comfortable, or you won’t want to wear it consistently.

  • If the mask makes it a lot harder to breathe, then the seal will not be as good, and the mask will be less effective.

  • Clean or change the mask often:

    • To clean a homemade cloth mask, wash it using the directions on the original material (for example, if the mask was made from t-shirt material, follow the washing instructions on the t-shirt tag) but in general, warmer water is better.  Dry the mask completely (in the dryer using a warm/hot setting if possible). 

    • `Do not shake dirty masks to minimize spreading germs and particles through the air. If dirty cloth masks have been in contact with someone who is sick they can still be washed with other people’s laundry.

    • Any damage, fabric break down, or change in fit will reduce the already limited protection of cloth masks.

    • In general, surgical masks are disposable and should not be cleaned and reused. Putting surgical masks in the washing machine may damage the protective layers in the masks, reducing their effectiveness.

 

Disposing of used masks

Masks need to be changed frequently. To dispose of masks after use:

  • Wash your hands with soap and water before taking off your mask.

  • Dispose of used masks in a wastebasket lined with the plastic bag, if mask is disposable.

  • If mask is washable, put it directly into the washing machine.

  • After taking off your mask, wash your hands again with soap and water before touching your face or doing anything else.

  • When emptying wastebaskets, take care to not touch used masks or tissues with your hands. All waste can go into regular garbage bins.

  • Clean your hands with soap and water after emptying the wastebasket.

Copied and Revised from Supporting Child Care Communities - The BC Centre for Disease Control

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