Name: Date: Room(s):

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1 Name: Date: Room(s): System for Diluting Bleach Is bleach stored out of the reach of children? Bleach Bleach strength (% Sodium Hypochlorite) used: 6.0% 6.15% Other Are bleach solutions prepared daily? Is antibacterial soap used for pre-cleaning? Are the children using antibacterial soap for hand-washing? Is used to dilute bleach? What is used? Gloves Eye protection Mask Apron Spray Bottles Size of spray bottles: Are the spray bottles old? Do the nozzles spray properly? Does the center need to replace the spray bottles currently in use? Are separate bottles designated for sanitizing and disinfecting? Are the bottles labels appropriately (i.e. with a label stating the contents)? 32 ounces 24 ounces t specified Other Sanitizing Disinfecting Dilutions Sanitizing: Disinfecting: Dilutions Tools for Diluting Bleach Are calibrated pumps used to dispense bleach? Are separate calibrated pumps used to dilute sanitizing and disinfecting level solutions? If calibrated pumps are not in use, what system is used to measure bleach? Teaspoon Cap of bleach bottle Tablespoon Eyeball method San Francisco Asthma Task Force: Reducing the Overuse of Bleach in Child Care (November 2010) Page 1 of 6

2 System for Using Bleach Is used when spraying bleach? What is used? Gloves Eye protection Mask Apron Sanitizing Were the children in another area when the sanitizing process was performed? Was sanitizing performed before and after meals? Before: After: Was the surface pre-cleaned? Was the solution sprayed away from the breathing zone? Did the surface remain wet with bleach solution for the correct dwell time of two minutes? How was dwell time measured? Digital timer Wall clock Watch Other What was used to wipe the surface? Rag/towel Paper towel Wipes Air dry Other Were the surfaces wiped dry when children came in contact with them? Disinfecting Were the children in another area when the disinfecting process was performed? Areas disinfected: Diaper changing table Potty training chairs Toilets Sinks Activity tables Toys Other Was the surface pre-cleaned? Was the solution sprayed away from the breathing zone? Did the surface remain wet with bleach solution for the correct dwell time of two minutes? How was dwell time measured? Digital timer Wall clock Watch Other Was the surface rinsed? What was used to wipe the surface? Rag/towel Paper towel Wipes Air dry Other Were the surfaces wiped dry when children came in contact with them? Frequency of Disinfecting How often was the diaper changing table disinfected? After every child Other: How often was the training chair disinfected? After every child Other: How often was the toilet disinfected? After every child Other: How often was the sink disinfected? Other surfaces: Mouthed toys with hard surfaces Activity tables Soft toys Cots After tooth-brushing After toileting Other: Disinfecting frequency: San Francisco Asthma Task Force: Reducing the Overuse of Bleach in Child Care (November 2010) Page 2 of 6

3 Maintaining Infection Control Was disposable paper used on the diaper changing table? Was the diaper changing table disinfected even though disposable paper was used? Was the toileting process monitored to detect bodily fluid spills that require disinfecting? Were mouthed toys separated and placed in a designated labeled container before disinfecting? Standardized Practices Were infection control practices standardized within a classroom? Were infection control practices standardized among classrooms? If applicable, are infection control practices standardized among the following: Parents Interns/students Volunteers? Key for California Child Care Licensing 1 requirements and the proper use of bleach per EPA registration 2 : California Child Care Licensing Requirements for Sanitizing and Disinfecting Requirements Surface How Often DISINFECT Hard Non Porous, Non Food Contact Surfaces SANITIZE Food Contact Surfaces Infant/Toddler Classrooms: Diaper Changing Areas * Potty Training Chairs * Napping Equipment **** Mouthed Objects (Including Toys) *** Infant/Toddler/ Classrooms with Mildly Ill Children: Sinks ** Floors *** Walls/Partitions **** All Classrooms: Snack/Meal Table * High Chairs * Dishes/Utensils, Cups * Infant/Toddler Classrooms: Disposable diaper containers *** * After each use ** After each use if soiled *** Daily **** Weekly * After each use *** Daily SANITIZE Non Food Contact Surfaces References: 1 CALIFORNIA-DSS-MANUAL-CCL, MANUAL LETTER NO. CCL-98-11, Effective 11/1/98 2 United States Environmental Protection Agency: Office of Pesticides Program. Ultra Clorox Brand Regular Bleach. EPA Registration No the Clorox Company, PO Box 493, Pleasanton, CA, November 25, 2009; pp See the San Francisco Asthma Task Force website for additional information. San Francisco Asthma Task Force: Reducing the Overuse of Bleach in Child Care (November 2010) Page 3 of 6

4 Key for Diluting Bleach Bleach storage Recommended bleach strength Prepare bleach solutions When diluting bleach, wear in order to reduce exposure Spray bottle size for proper dilution Separate bottles are needed for sanitizing and disinfecting Label bottles appropriately Bleach Spray Bottles Dilutions Bleach Dilution Tools Proper bleach dilutions using 6.0% Sodium Hypochlorite The center may reconsider the use of antibacterial soaps containing triclosan due to the potential health risks associated with the ingredient. Tools should be used to measure bleach when preparing solutions Always out of the reach of children 6.0% Sodium Hypochlorite Daily Recommended : Gloves and protective eyewear 32 ounces Sanitizing and disinfecting require different dilutions Label bottles as and Water Or Sanitizing/Disinfecting Bleach Solution in order to avoid accidents Sanitizing: ~ 1 Teaspoon of Bleach per Quart (32 ounces) of Water Disinfecting: 1 Tablespoon of Bleach per Quart (32 ounces) of Water Disinfecting bodily fluid spills*: ~6 Tablespoons bleach per quart (32oz) of water * Per Cal-OSHA, bodily fluid spills greater than 10mL require disinfection using a 1:10 dilution. When dealing with outbreak situation, please refer to the medical personnel serving the center. Studies show there are no additional benefits using antibacterial soap containing triclosan. This ingredient is currently under review by the FDA as an additive. Animal studies suggest triclosan may enable the spread of antibiotic-resistant bacteria, and may mimic hormones resulting in possible health risks such as: reproductive harm developmental effects on the nervous and endocrine systems. In order to prepare the proper dilutions for sanitizing and disinfecting and to reduce exposure to the health risks associated with bleach (asthma development and exacerbation) Key for Using Bleach When spraying bleach, wear in order to reduce exposure In order to reduce exposure to children Pre-cleaning is a necessary step in the sanitizing or disinfecting process Sanitizing and Disinfecting Maintaining Proper Infection Control Correct dwell time for bleach Rinse after disinfecting Wipe the surface dry Frequency of processes When disposable paper is used on diaper changing tables Monitoring toileting and tooth brushing and disinfecting of toilets and sinks regularly are highly recommended. Mouthed toys should be separated Recommended : Gloves Ensure that children are in another area before disinfecting and sanitizing Pre-cleaning removes debris that form a shield around bacteria and viruses. If the pre-clean step is omitted or not performed properly (i.e. sprayed at the same time as the sanitizer or disinfectant), the sanitizer or disinfectant will not be as effective as intended. Two minutes for sanitizing and disinfecting Surfaces require a rinse step after disinfecting since this solution contains more bleach. After dwell time has elapsed or after rinse step in order to avoid exposure to children See table for California Child Care Licensing Requirements Diaper changing tables require disinfecting regardless of the use of disposable paper. Soiled surfaces require disinfecting. When toileting and tooth brushing are not monitored, children may come into contact with potentially infectious bodily fluids. Mouthed objects require disinfecting. Separating these objects into designated bins before disinfection occurs is a means of ensuring that the children do not come in contact with potentially infectious bodily fluids. San Francisco Asthma Task Force: Reducing the Overuse of Bleach in Child Care (November 2010) Page 4 of 6

5 Other products used in the center Bleach satisfies California Child Care Licensing requirements for sanitizing and disinfecting; therefore, no other products are needed. Although this checklist is specifically designed for bleach, centers/providers may have other products in use by their workers. Although using multiple products is not recommended when the primary product is bleach, staff should be aware of which products are at their workplace. Are sanitizers and disinfectants stored out of the reach of children? In addition to bleach, how many other products are used in Sanitizers Disinfectants the center? Total Are other products used by classroom staff in addition to bleach? If yes, why? Is there a list of specified products for use in the center? Are there products in the center that are not on the list? Are parents and staff members aware of the products specified for use in the center? Are multiple products used for the same function (i.e. is more than one product used for disinfecting)? Products Are different products used in different classrooms? Do the sanitizer/disinfectants or other products used by the Quaternary ammonium compounds center contain any of the following ingredients? Including alkyl dimethyl benzyl ammonium chloride and didecyl dimethyl benzyl ammonium chlorides: Benzalkonium chloride Benzyl-C10-16-alkyldimethyl, chlorides Dodecyl-dimethyl-benzyl ammonium chloride Lauryl dimethyl benzyl ammonium chloride Benzyl-C12-18-alkyldimethyl, chlorides Benzyl-C12-16-alkyldimethyl, chlorides Benzyl-C16-18-alkyldimethyl, chlorides Ethylene glycol butyl ether (2-butoxyethanol) Thymol Triclosan Do the other products have the following? Aerosol spray Fragrance Is antibacterial soap used for pre-cleaning? Are the children using antibacterial soap for hand-washing? San Francisco Asthma Task Force: Reducing the Overuse of Bleach in Child Care (November 2010) Page 5 of 6

6 Potential health risks associated with products commonly found in child care. Active Ingredient Examples of Products with these Ingredients in Child care Settings Potential Health Risks Quaternary ammonium compounds Lysol Disinfectant Spray Includes alkyl dimethyl benzyl ammonium Clorox Disinfecting Wipes, chloride and didecyl dimethyl benzyl Bleach Free ammonium chlorides Lysol Brand Dual Action (Ingredients to look for: Disinfecting Wipes Benzalkonium chloride Benzyl C10 16 alkyldimethyl, chlorides Fantastik Antibacterial All Dodecyl dimethyl benzyl ammonium chloride Purpose Cleaner These compounds are listed as Lauryl dimethyl benzyl ammonium chloride Formula 409 Kitchen asthmagens in the database Benzyl C12 18 alkyldimethyl, chlorides Antibacterial All Purpose Cleaner maintained by the Association of Benzyl C12 16 alkyldimethyl, chlorides Benzyl C12 16 alkyldimethyl, chlorides Cling Free Fabric Softener, Static Occupational and Environmental Clinics Benzyl C16 18 alkyldimethyl, chlorides) Stopping Sheets (AOEC). Thymol Ethylene glycol butyl ether (2 butoxyethanol) Triclosan Seventh Generation Disinfecting Multi Surface Cleaner Benefect Botanical Disinfectant Sol U Guard Botanical (Melaleuca) Simple Green All Purpose Cleaner Windex Glass Cleaner Powerized Formula (institutional) Ultra Dawn Dishwashing Liquid and Antibacterial Hand Dial Antibacterial Liquid Hand Softsoap 2 in 1 Antibacterial Hand Plus Moisturizing Lotion Softsoap Aquarium Antibacterial Liquid Hand This ingredient is a possible carcinogen, and animals studies have associated 2 butoxyethanol with: liver damage/cancer red blood cell damage causing anemia impaired fertility reproductive and developmental toxicity Studies show there are no additional benefits using antibacterial soap containing triclosan. This ingredient is currently under review by the FDA as an additive. Animal studies suggest triclosan may enable the spread of antibioticresistant bacteria, and may mimic hormones resulting in possible health risks such as: reproductive harm developmental effects on the nervous and endocrine systems San Francisco Asthma Task Force: Reducing the Overuse of Bleach in Child Care (November 2010) Page 6 of 6