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Cryptosporidium

Day Care Facilities

Crypto Prevention Measures for Day Care Facilities Control Measures for Outbreaks
Daycare Brochure (PDF)

Cryptosporidiosis is a gastrointestinal illness, caused by the parasite, Cryptosporidium. This disease is a common cause of diarrhea in children, especially in child care settings. The hallmark symptom of cryptosporidiosis is watery diarrhea, which might be accompanied by stomach ache, nausea and vomiting, fever, and a general sick feeling. Healthy people who contract cryptosporidiosis almost always get better without any treatment but treatment is available by prescription. An unusual feature of cryptosporidiosis is that some people seem to get better only to have the diarrhea come back in a few days. Symptoms can come and go for up to 30 days, but usually subside in 1 to 2 weeks. However, cryptosporidiosis can cause severe illness in persons with compromised immune systems, such as those with HIV infection or those taking drugs that suppress the immune system.

Because Cryptosporidium is in feces, anything that gets contaminated by feces can potentially spread the parasite. As a result, the parasite can be spread directly from person-to-person, through contact with contaminated objects (e.g., toys), or by swallowing contaminated food or water (drinking and recreational). Cryptosporidiosis outbreaks in child care settings are most common during late summer/early fall (August/September) but might occur at any time. The spread of cryptosporidiosis is highest among young children who are not toilet trained and their caregivers (those who change diapers).

Cryptosporidium is resistant to chlorine disinfection so it is tougher to kill than most disease-causing organisms. The usual disinfectants, including most commonly used bleach solutions, have little effect on the Cryptosporidium parasite. An application of either hydrogen peroxide or ammonia seems to work best. Hydrogen peroxide is probably the best choice in the child care setting, because ammonia has a strong odor and produces hazardous gas when mixed with bleach or other chlorinated solutions.

Good hygiene practices can help prevent cryptosporidiosis outbreaks.

http://www.cdc.gov/crypto/daycare.html

Crypto Prevention Measures for Day Care Facilities

Good hygiene practices can help prevent cryptosporidiosis outbreaks. Effective measures include:

Frequent hand washing and good hand washing technique for all children and adults.

Good hand washing means:

Wet your hands with clean running water and apply soap.
Rub hands together to a lather and scrub all surfaces.
Continue rubbing hands for 20 seconds (imagine singing “Happy Birthday” twice).
Rinse hands well with water.
Dry hands with paper towels or an air dryer. If possible, use a paper towel to turn off the faucet.

For children – observe hand washing or assist when needed. Wash children’s hands when they arrive at the child care facility, after they use the toilet, after having their diapers changed, and before eating snacks or meals.
For adults – Wash hands after using the toilet, after helping a child use the toilet, after diapering a child, and before preparing or serving food. (Note: Where staffing permits, people who change diapers should not prepare or serve food).
Note: Cryptosporidium is not killed by alcohol gels and hand sanitizers. Soap and clean running water are specifically recommended for preventing cryptosporidiosis.

Clear separation of diapering and food-handling areas and responsibilities.
Clear separation of diaper-changing areas and children’s play areas.
Clothes worn over diapers to reduce the opportunity for leakage.
Use of disposable gloves when changing diapers. Gloves should be changed after each diaper change.
Use of disposable paper over the diaper changing surfaces. The paper should be changed after each diaper change.
Daily disinfection of surfaces and objects, including but not limited to bathrooms, diaper-changing areas, food-preparation areas, tabletops, high chairs, and toys.

Control Measures for Outbreaks

If an outbreak of cryptosporidiosis occurs in the child-care setting:

Educate staff and parents

Inform all staff about the ongoing outbreak, the symptoms of cryptosporidiosis, how it is transmitted, and control measures to be followed.
Inform parents about the ongoing outbreak, the symptoms of cryptosporidiosis, how it is transmitted, outbreak control policies, and needed changes in hygiene and cleanliness.

Notify parents of children who have been in direct contact with a child or an adult caregiver with diarrhea. Parents should contact the child's healthcare provider if their child develops diarrhea.

Inform parents of children and staff about Cryptosporidium’s potential to cause severe disease in immunocompromised persons. Immunocompromised persons should consult their healthcare provider for further guidance.

Exclude any child with diarrhea from the child care setting until the diarrhea has stopped.

Children who are infected with Cryptosporidium but who do not have diarrhea may be allowed to return.
Recently returning children can be grouped together in one classroom to minimize exposure to uninfected children.
Move adults with diarrhea to jobs that minimize opportunities for spreading disease (administrative work instead of food preparation).

Terminate all water play or swimming activities (e.g., water tables, inflatable or rigid temporary swimming pools, public pool visits). This water can become contaminated and facilitate the spread of infections.

Practice good hygiene. Note: The measures outlined should be routine but are especially important during outbreaks.

Enforce frequent hand washing and good hand washing technique for all children and adults.

Note: Cryptosporidium is not killed by alcohol gels and hand sanitizers so these materials are of little use in controlling an outbreak.
Use disposable towels.
Good hand washing means:

Wet your hands with clean running water and apply soap.
Rub hands together to a lather and scrub all surfaces.
Continue rubbing hands for 20 seconds (imagine singing “Happy Birthday” twice).
Rinse hands well with water.
Dry hands with paper towels or an air dryer. If possible, use a paper towel to turn off the faucet.

For children:

Observe hand washing or assist when needed. Wash children’s hands when they arrive at the child care facility, after they use the toilet, after having their diapers changed, and before eating snacks or meals.

For adults:
Wash hands after using the toilet, after helping a child use the toilet, after diapering a child, and before preparing or serving food. (Note: Where staffing permits, people who change diapers should not prepare or serve food).

Improve diaper changing practice.

Separate diaper changing areas from children’s play and food preparation areas.
Use disposable gloves and change them after each diaper change.
Use disposable paper over the diaper changing surfaces and change it after each diaper change.
Ensure children wear clothing over their diapers to reduce the opportunity for leakage.
Wash hands: both yours and the child’s.

Disinfect surfaces and objects

No disinfectant is guaranteed to be completely effective against Cryptosporidium. However, hydrogen peroxide is usually effective.

Instead of a bleach solution, use a 3% (99% kill rate) or, if available, 6% (99.9% kill rate) concentration of hydrogen peroxide to soak contaminated surfaces for 20 minutes.
Ammonia can also be used (5% solution for 18 hours) but it has a strong odor and, if accidentally mixed with bleach or other chlorine-containing solutions, produces hazardous chlorine gas.

Disinfect bathrooms, diaper areas, and food preparation surfaces daily.
Disinfect toys, tabletops, and high chairs more frequently than usual (at least twice daily).

Dishwasher-safe toys can be disinfected in a commercial dishwasher that has a dry cycle or a final rinse that exceeds 113°F for 20 minutes or 122°F for 5 minutes or 162°F for 1 minute. Cloth toys may be washed and heat-dried on the highest clothes dryer heat setting for 30 minutes.

These are not routine measures, but may be necessary if an outbreak occurs; usually 2 or more cases in the same child care group.

Notify the state or local health department about an excessive level of diarrhea or any Cryptosporidium infections in a daycare. Cryptosporidium is a reportable disease.

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