Bleach-free Best Practices for Infection Control in Child Care Settings

Infection control using diluted bleach has been an important protection required in child care settings over many decades. A four-state medical surveillance project has shown an association between bleach exposure and work-related asthma. Child care workers must spray bleach dilutions on food contact and diaper-changing tables from 25-96 times per day, with significant potential for breathing and skin exposure and inadequate ventilation. Our project has received national and state recognition for identifying best practices for required infection control that are safer for both children and caregivers. These practices reduce or eliminate exposure to bleach, by (a) substitution with bleach-free EPA-registered antimicrobials, or by (b) methods that reduce bleach use and exposure. This project evolved within a child care and health/asthma-based stakeholder coalition looking for alternatives to bleach. We piloted safer bleach methods and substitute bleach-free sanitizers and disinfectants for operator acceptability; created low literacy trilingual training curriculum and postings; and provided onsite coaching of staff implementation and completion of evaluative data. Subsequently we reported findings to stakeholders and created plans to disseminate recommendations citywide and to advocate for policy and practice changes with coalition partners. We have also advocated to this end by presenting to statewide agencies including California Child Care Licensing and the Emergency Medical Services Authority; and at conferences such as the California Association for the Education of Young Children, REACH US-California and Beyond, and the California Head Start Health Institute.