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Hygiene concept for the protection of children and employees in child day care facilities and child day care workers in Hesse during the SARS-CoV-2 pandemic

As of: 29 June 2021

Table of contents

Preliminary remark .................................................................................................................. 2
General information on protective measures and the organisation of child day care .. 3
General protective measures ................................................................................................. 3
General hygiene rules ............................................................................................................. 6
Entrance area ........................................................................................................................... 7
Meals .......................................................................................................................................... 7
Educational and organisational everyday routines ..................................................................... 8
Conferences and meetings .......................................................................................................... 8
Documentation for tracing possible chains of infection ............................................................. 8
Room hygiene ............................................................................................................................ 9
Ventilation .................................................................................................................................. 9
Use of technical aids ................................................................................................................ 10
General cleaning ....................................................................................................................... 11
Hygiene and cleaning in the sanitary area ................................................................................ 11
Duties of the employer and persons at greater risk of severe COVID-19 disease progression 12
Obligation to report .................................................................................................................. 14
General ..................................................................................................................................... 14

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Preliminary remark
The global spread of COVID-19, a disease caused by the novel virus SARS-CoV-2, was declared a pandemic by the World Health Organisation (WHO) on 11 March 2020.
With the sharp rise in the number of infections in Germany, child day care facilities (crèches, day care centres, kindergartens, nurseries, after-school care) were closed nationwide in March 20201 including in Hesse. After temporary openings, further restrictions became necessary due to the incidences rising again.
Regular operations resumed on 25 June 2021. Since then, the admission of children cared for under contract or in accordance with the statutes has been based on SGB VIII (German social code). In principle, the framework conditions according to § 25a ff HKJGB (Hessian child promotion act) apply here; the changeover is to take place by 5 July 2021. However, it is still a regular operation which, for reasons of infection control, can only take place under the observance of various hygiene and accompanying measures. Therefore, the hygiene plans of the day care facilities must be continuously adapted to the conditions of the SARS-CoV-2 pathogen.
The incidence of infection in Hesse has declined strongly and continuously in recent weeks.
Weighing up all the health, economic and social factors, the protective measures ordered so far in the area of childcare can therefore be significantly reduced.
Hygiene rules and protective measures in child day care centres and child care facilities significantly reduce the probability of transmission and minimise the risk of infection. According to § 36 of the IfSG (German infection protection act), since 2001 community child care facilities have been obliged to define internal procedures for compliance with infection hygiene in hygiene plans.
1 1 In the following text, “child day care” is used as a generic term for crèches, child day care centres, kindergartens and after-school care centres.

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The present hygiene concept in relation to the COVID-19 pandemic serves as a reference for adjustments in the hygiene plans of child day care facilities and as recommendations for child day care.
Based on the escalation level concept of the state of Hesse for the independent cities and districts, specific orders can be imposed at the municipal level in the event of increasing infection numbers, depending on the escalation level, also on hygiene measures in child day care.
General information on protective measures and the organisation of child day care
The coronavirus virus SARS-CoV-2 is transmissible from person to person. The main modes of transmission are droplet infection and airborne transmission via aerosols, which are much smaller than normal droplets.
Droplet infection mainly occurs directly via the mucous membranes of the respiratory tract. In addition, indirect transmission is also possible via the hands, which are then brought into contact with the mucous membranes of the mouth or nose as well as the conjunctiva of the eyes. Maintaining a minimum distance of 1.5 metres can help reduce droplet transmission.
The airborne aerosols can remain in the air significantly longer than normal droplets, which sink to the ground due to their weight. Aerosols, on the other hand, can spread in enclosed spaces and cover greater distances in the process.
Since it is not to be expected that the minimum distance of 1.5 metres between each other is maintained for children under six years of age, and since educational care can also include close-to-body interaction, special protection and hygiene rules must be observed when caring for children.
General protective measures

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Persons (children, parents, employees, external persons) are not allowed to enter the facility/child day care centre,
• if they or members of their household show symptoms of COVID-19, in particular fever, dry cough (not caused by chronic illness) or loss of sense of taste or smell,
• as long as they or members of the same household are subject to an individually ordered isolation (quarantine order of the public health authority according to § 30 Infection Protection Act) or a general isolation due to an infection with SARS-CoV-2 detected by a PCR test. This does not apply to persons working in the institutions if the isolation was not for themselves but for a member of the same household.
The ban on entry does not apply to vaccinated or recovered persons as defined in § 2 No. 2 and 3 or No. 4 and 5 of the COVID-19 SchAusnahmV (German protection measures exemption ordinance) if
• they themselves do not show symptoms of COVID-19 and are not subject to isolation,
• the isolation of the household member did not occur due to a coronavirus SARS-CoV-2 variant of concern as defined by the Robert Koch Institute that is not yet widespread in Germany.
Within the meaning of § 2 No. 2-5 SchAusnahmV,
• a vaccinated person is an asymptomatic person who is in possession of a vaccination certificate issued to him/her,
• vaccination certificate as proof of the existence of full protective vaccination against the coronavirus SARS-CoV-2 in German, English, French, Italian or Spanish in paper or digital form, if the underlying protective vaccination was carried out with one or more vaccines named by the Paul Ehrlich Institute on the Internet at the address www.pei.de/impfstoffe/covid-19 , and

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a) either consists of a number of vaccine doses as published by the Paul Ehrlich Institute on the Internet at the address www.pei.de/impfstoffe/covid-19, and at least 14 days have elapsed since the last required individual vaccination, or
b) in a recovered person consists of one administered dose of vaccine,
• a recovered person is an asymptomatic person who is in possession of a recovered certificate issued to him/her,
• proof of a previous infection with the SARS-CoV-2 coronavirus in German, English, French, Italian or Spanish in paper or digital form, if the underlying test was carried out by means of laboratory diagnostics using nucleic acid detection (PCR, PoC-PCR or other methods of nucleic acid amplification technology) and at least 28 days and a maximum of six months have elapsed.
• In the event of acute signs of illness in a child, if available and depending on age, a caregiver should apply a mouth-nose covering and the affected child should immediately be taken to a separate room and cared for separately. The person caring for the sick child should also wear a mouth-nose mask or, if necessary, an FFP2 mask. Parents should then pick up their child as soon as possible.
• In the case of children who, according to information from the Robert Koch Institute, belong to groups of people who, based on current knowledge, have a higher risk of developing a serious illness (https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/risk-groups.html), parents should clarify suitable protective measures with their paediatrician and their implementation with their child day care provider.
• In case of acute illness of employees, they should leave the child day care centre immediately. In case of acute illness of the child day care worker or a person of the same household, contact should be made with the parents immediately and arrangements made to pick up the children.

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General hygiene rules
• The minimum distance when adults meet is 1.5 metres. For children, only if possible, e.g. when taking meals.
• The regulations of the CoSchuV (German coronavirus protection ordinance) apply to all visitors to the child day care centre / nursery school, i.e. from the moment they enter the facility, adults and children over 6 years of age should wear a medical mouth/nose covering, unless
o they are in areas within the facility that are not accessible to the public, provided that a distance of 1.5 metres from other persons can be safely maintained,
o a medical mouth-nose covering cannot be worn due to a health impairment or disability,
o insofar as the removal of the medical mask is necessary for educational and therapeutic reasons.
• Do not touch the face and especially the mucous membranes with your hands, i.e. do not touch the mouth, eyes and nose.
• Thorough hand hygiene of visitors, children, employees and child day care workers (e.g. after entering the child day care centre, before and after eating, after going to the toilet and before putting on and taking off a protective mask), e.g. by washing hands with soap for 20-30 seconds (see also https://www.infektions- schutz.de/washing-hands).
• Sufficient washing facilities should be available, with means for cleaning and caring for the skin.
• Cough and sneeze etiquette: Coughing and sneezing into the crook of the arm are among the most important preventive measures. When coughing or sneezing, keep as much distance as possible from other people, preferably turn away.

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• No touching, hugging or shaking hands with adults, with children, avoid as far as possible and communicable.
• Saliva contact with the children should be avoided. If this has taken place, the hands and face should be washed afterwards.
• If possible, adults should not touch publicly accessible objects such as door handles or lift buttons with their full hands or fingers, but instead should use their knuckles or elbows, for example.
In addition to the general instructions for hygiene and health protection, the following recommendations must be observed in particular:
Entrance area
• Disinfectant should be provided outside the entrance door, out of reach of the children, so that visitors entering the facility or the child day care centre can disinfect their hands. Liquid disinfectant or disinfectant wipes should be used, not a spray.
• The spray particles could be inhaled by children in the vicinity and pose a risk to them.
• Information posters on hygiene measures should be put up at the entrance door and other clearly visible places as well as in the sanitary area (hand washing rules).
Meals
When catering in child day care facilities, strict hygiene should be observed when processing and serving food (washing hands before preparing food, no sharing of eating utensils and cutlery). Especially when preparing non-heated food, care should be taken to maintain appropriate hygiene, as heating can kill pathogens.

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Educational and organisational everyday routines
• The hygiene rules should be worked out and implemented with the children in a developmentally appropriate manner. In particular, hand washing should be done thoroughly with the children (in a playful way). An appropriate hygiene routine is part of the educational mandate of the staff and the child day care workers.
• For reasons of infection control, sports activities should preferably be carried out outdoors; adequate ventilation should be ensured indoors. It can be assumed that intensive breathing increases the enrichment of the air with viruses.
• Singing or conversational speech exercises can lead to droplets being transported over a greater distance than 1.5 m. This circumstance should be taken into account in everyday educational routines. Children’s clothes should be changed as needed, e.g. if they are soaked through with saliva.
• Depending on the infection situation on site, there may be further restrictions on the daily educational routine.
Conferences and meetings
The regulations of the German coronavirus protection ordinance (CoSchuV) apply to meetings and parent meetings that take place in closed rooms (can be viewed at https://www.hessen.de/fuer-buerger/coronavirus-hessen/verordnungen-und-allgemeinverfuegungen). See also the notes under the item General regulations.
Documentation for tracing possible chains of infection


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In order to enable contact tracing, documentation on the persons (children, employees, third parties) present in the day care centre or child day care centre on a daily basis, such as group books, duty rosters, pick-up schedules, etc., must be kept.
Room hygiene
Special recommendations apply in times of the COVID-19 pandemic for group rooms and ancillary rooms, rooms for sleeping in, gymnasium or exercise rooms, recreation rooms such as staff rooms and break rooms, offices as well as cloakrooms and corridor areas, and for rooms used in the context of child day care.
Ventilation
Regular and proper ventilation is particularly important, as this exchanges the indoor air and can thus reduce the aerosol concentration in particular. The following recommendations are in line with the German Federal Environment Agency’s recommendations on proper ventilation.
The following applies in particular: Windows should be opened as wide as possible to ventilate frequently for short periods. A permanent tilt position is not sufficient. In winter, due to the temperature difference between inside and outside, a faster exchange of air is possible than in summer, when the outside temperatures are high. When the outside temperature is cold, one to three minutes of ventilation is quite sufficient. It is strongly advised not to ventilate continuously (including tilting the windows permanently) during the cold season (risk of mould, risk of children catching a cold). Cross-ventilation is even better than short, intense ventilation. This means that opposite windows are opened wide at the same time. The temperature in the room only drops by a few degrees during both short, intensive ventilation and cross ventilation. It quickly rises again after the windows have been closed.

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Attention: Open windows can also pose a fall hazard for the children. This means the requirements for adequate supervision also increase.
Use of technical aids
The carbon dioxide concentration (CO2 concentration) in the room is a good indication of the quality of the room air. CO2 devices (or CO2 traffic light systems) help with regular ventilation because they indicate when ventilation should take place. Somewhat more expensive devices display the digital course of the CO2 content in the room air. They are best placed at breathing height and centrally in the room (not at the window, not directly on the wall).
If air conditioning and ventilation systems are used, they should be operated with as high a proportion of fresh air as possible. Suitable filters are necessary when using the recirculation mode of central systems (if technically possible HEPA filters, class H13 or H14 according to DIN EN 1822- 1:2019-10). The frequency of filter changes and existing specifications for maintenance must be taken into account. Ventilation and air conditioning systems that only circulate room air are not suitable. Fans should not be used in common areas.
Mobile air purification units are not designed to remove stale indoor air or to bring in fresh air from outside; they therefore do not make a significant contribution to removing the resulting carbon dioxide (CO2), excess humidity and other substances from the interior. According to the recommendations of the German Federal Environment Agency, the use of mobile air cleaners, even with integrated HEPA filters, is therefore not sufficient to effectively and permanently remove suspended particles (e.g. viruses) from indoor air. The use of such devices can therefore not replace ventilation measures and should at best be used as a supporting measure. In accordance with the operating instructions, the equipment must be maintained and cleaned so that it does not pose a hazard. Regular filter changes are a prerequisite for proper operation. The use of such equipment

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should be assessed in advance by an occupational safety specialist.
General cleaning
Thorough and regular cleaning, especially of frequently used surfaces and objects, is an essential prerequisite for a good hygiene status in child day care centres.
In general, the infectivity of SARS-CoV-2 viruses on inanimate surfaces decreases rapidly depending on the material and environmental conditions such as temperature and humidity. Nevertheless, according to current knowledge, transmission through smear infection is possible. Therefore, cleaning of surfaces is important in child day care facilities. This also applies to surfaces that are said to have antimicrobial properties; here, too, secretions and soiling should be removed mechanically.
Door handles and objects that the children and employees touch should be cleaned regularly with water and soap solution, cuddly toys should be washed at least every three days (at least at 60 degrees Celsius with laundry detergent and completely dried). Disinfectants should only be used to a very limited extent (e.g. in the entrance area for adults) and should generally be avoided around children.
Routine surface disinfection in child day care facilities is not recommended by the Robert Koch Institute in the current COVID-19 pandemic.
Hygiene and cleaning in the sanitary area
Sufficient liquid soap dispensers and disposable towels should be provided and regularly replenished in all toilet rooms. The appropriate disposal containers for disposable towels and hygiene items, such as nappies and wet wipes, should be adequately stocked.

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Toilet seats, taps, washbasins and floors should be cleaned daily. Cleaning staff should wear the appropriate protective equipment such as protective gowns, rubber work gloves and, if necessary, mouth-nose covering. In case of contamination with faeces, blood or vomit, prophylactic cleaning with disinfectant disposable wipes can be carried out after removal of the contamination.
Changing pads as well as potties and toilet seats should be cleaned with water and soap solution by employees immediately after use. Disposable gloves must be worn. Disposable gloves should be worn when changing nappies, and hands and changing pads should be washed afterwards. Personal protective equipment (see Protective measures at the workplace) may also be required for an acutely ill child.
Duties of the employer and persons at greater risk of severe COVID-19 disease progression
Employers must, in principle, offer a coronavirus test at least once a week to all employees who do not work exclusively in their homes. Employees who are exposed to a particular risk of infection in their jobs are entitled to testing at least twice a week; this group also includes employees in child day care centres. You can find more detailed information here https://www.bmas.de/DE/Coronavirus/Fragen-und-Antworten/Fragen-und-Antworten- ASVO/faq-coronavirus-asvo.html
According to § 5 of the Arbeitsschutzgesetz (German occupational health and safety act), employers have the obligation to assess the risks to the safety and health of their employees at the workplace (risk assessment) and to derive infection control measures from this. The German Federal Ministry of Labour and Social Affairs has published the SARS CoV-2 occupational health and safety standard and a SARS CoV-2 occupational health and safety rule to assist with this. These apply to all child day care centres. Which measures are necessary in

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each case depends on the operational circumstances and is determined and specified in the risk assessment.
The Robert Koch Institute points out that due to the various influences and their possible combinations, a general determination for classification into a risk group is not possible. Rather, this requires an individual risk factor assessment, in the sense of an (occupational) medical appraisal. The same applies to people who live in the same home with a person at risk or those who provide them with care and to people with disabilities.
Employees have the right to an occupational health check-up on the occasion of the COVID-19 pandemic, which should also determine the extent to which they should be released from direct care activities due to previous illnesses and individual dispositions and the special risk of falling ill with COVID-19, or which requirements should be made for another workplace or for specific protective measures. Employers are obliged to inform their employees of this right. The risk assessment should be carried out by the attending physician and the assignment to the group of risk patients should be supported by an appropriate certificate. This also applies to employed child day care workers. Insofar as child day care workers are self-employed, they must make this assessment independently and should contact the Jugendamt (German youth welfare agency) if necessary.
The decision on protective measures to be taken for a pregnant woman is a case-by-case decision that must be made by the employer with the involvement of the company doctor and in knowledge of the specific workplace and defined with regard to the COVID-19 pandemic.
In any case, especially if you belong to a risk group, protective measures at the workplace, such as wearing personal protective equipment (PPE), must be observed:
• Use disposable protective gloves for the removal of bodily excreta, when helping with toileting or changing nappies.


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• Use protective gowns, e.g. for activities in the sanitary area.
• For special occasions, it may also be appropriate to temporarily take special protective measures.
The aforementioned personal protective equipment as well as the mouth-nose covering shall be provided by the employer to all workers. Instruction of staff in the proper use and disposal of materials is required.
Obligation to report
Suspicion of COVID-19 and the occurrence of COVID-19 cases in a child day care facility must be reported to the public health department and the local youth welfare office. The reporting obligation is based on the IfSG (German infection protection act). According to § 8 para. 1 no. 7 in conjunction with § 6 para. 1 sentence 1 no. 1, the management of the facilities are obliged to report the suspicion of a disease or the presence of COVID-19 to the competent health authority. § 9 IfSG regulates that the report must be made without delay and which data the report contains.
General
The hygiene plan of the child day care facility is to be submitted to the local health authority upon request.

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