Reporting & Managing Increased Illness

Public Health helps child care centres manage instances of increased illness in their centres by providing best practice recommendations and resources on infection control measures to minimize the spread of illness.

Reporting increased illness

When your child care centre has an increase in the number of children absent due to illness, above what you would expect, start a line list and phone Public Health at 1-800-265-7293 ext. 4752.

Case definition for illness: 2 or more episodes of diarrhea/watery stool or vomiting within a 24-hour period OR 1 episode of diarrhea/watery stool and 1 episode of vomiting with a 24-hour period

Public Health will review your reported illnesses, and advise you on maintaining surveillance, exclusion of ill children, increased cleaning and disinfection, and communication with staff and parents. We will email resources to you to help you manage the increased illnesses at your child care centre to prevent further spread of illness in the centre. 

Exclusion of ill children

Ill children that meet the case definition should be excluded from the child care centre until at least 48 hours symptom-free. Once 5 days from the start of the last case has passed, the exclusion period can return to 24 hours symptom-free. There should be a supervised, dedicated space for ill children to wait for their parent/guardian to pick them up.


Keep staff and parents updated about the increased illness in the child care centre, eitehr verbally, electronically, or by posting a notice.

Parents can have their ill child assessed by their family physician. The physician will determine whether a stool sample should be collected.

visitors such as parents, housekeeping staff or support workers (e.g., speech language pathologist) should be advised by the child care centre of the increased illness in the child care centre. Encourage visitors to visit only one room or child and to perform hand hygiene before entering and after leaving.

Hand hygiene and personal protective equipment (PPE)

During periods of increased illness, hand hygiene should be increased, especially after toileting or diapering, after playing outside, and before and after eating or drinking.

Make sure each handwashing sink is supplied with liquid soap, paper towels and warm running water. Alcohol-based hand rub (70% alcohol content) may be used when hands are not visibly dirty. Children must be supervised by staff when using alcohol based hand rub. If your child care centre does not have any illness, the hand sanitizer may have a 60-70% alcohol content.

Staff cleaning up body fluids such as vomit and diarrhea should wear single use non-latex gloves and a mask. PPE should be placed throughout the child care centre so that it is readily accessible.

Cleaning and disinfection

Increase cleaning and disinfection in the centre using a product that is effective against norovirus (e.g., Virox 5, Percept, Accet TB, 1:10 bleach and water solution).

Cleaning and disinfecting surfaces and toys

Routinely touched surfaces, washrooms, common areas and toys must be cleaned and disinfected at least once a day while there is an increase in illness in the centre. These items must be cleaned before they are disinfected unless a one-step product is used.

Do not spray the cleaning and disinfection product on surfaces or toys. Either apply using a wipe/cloth or immerse the item following manufacturer’s instructions.

Always review the manufacturer’s label for the cleaning and disinfection product and follow its instructions, paying particular attention to:

  • Whether pre-cleaning is required before cleaning and disinfection
  • Whether PPE is required when using the product
  • How to apply the product
  • Contact time for disinfection (time the product must stay wet on a surface/toy)
  • Whether rinsing is required
  • Expiration date
  • Storage requirement

Any toys that cannot be cleaned and disinfected (e.g., cardboard, unsealed wood or wicker) should be removed from the classroom during the period of increased illness and for at least 2 weeks after.

Water table and sensory use should be discontinued until illness levels decrease to normal levels. Discard the water and clean and disinfect the water table.

Body fluid spill clean up

Staff should wear PPE while cleaning up vomit or feces. Clean up gross material first, then clean and disinfect the contaminated area as soon as possible. Make sure all surfaces are first cleaned with soap and water and then disinfected according to the product label and manufacturer’s instructions. This pre-cleaning step is important as visible soil must be physically cleaned in order for the disinfection product to be effective. Place all garbage directly into an impermeable bag.

After the contaminated area has been cleaned, remove and discard gloves, then wash hands using liquid soap, warm running water, and dry with paper towels.

Soiled clothing should be placed in a disposable plastic bag for parent pick-up. Staff should handle soiled clothing as little as possible.

launder any contaminated linens in a separate load. Do not mix contaminated linenes with regular linens.