Protocol for a Diaper Change or Open Heart Surgery?

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If I wrote another book (no plans!) I might call it “Obsessive-Compulsive Nation.” Because in our desire to keep everyone safe from every possible danger, we are like OCD sufferers, who, according to Psychology Today:
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…resort to repetitive behaviors called compulsions. The most common of these are checking and washing…. These behaviors generally are intended to ward off harm… Some people with OCD have regimented rituals: Performing things the same way each time may give the person with OCD some relief from anxiety, but it is only temporary.
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Here’s Exhibit A of how we are demanding OCD instead of common sense. This list was sent in by reader Gina Bernbuam, who worked at a day care center in Arizona where, she said, these rules for diaper changing are mandated by state law:
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1. Wash the table with soap and water and then disinfect with bleach spray (BEFORE diaper change)
2. Wash your hands with soap and water then put on gloves.
3. Pick up child and put on table.
4. Open diaper, wipe child (wet or poop), envelope diaper, wipe and gloves into glove. Throw away gloves.
5. Wash your hands and put on new gloves
6. Put fresh diaper on child
7. Envelope gloves into each other, throw away.
8. Wash your hands with soap and water; wash child’s hands with soap and water.
9. Wash table with soap and water, disinfect table with bleach spray.
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Repeat for EVERY child.
Gina added a bunch more OCD-esque rules which I will share in another post, if you’d like. Then she wrote the few rules that SHE is adamant about:
–Locked pool fences
–Bike helmets on big roads
–Seatbelt/carseats
–No drinking/texting/drugs and driving
–Ask the owner before approaching a dog
Her list seems sound, sane and smart. And no enveloping of things into gloves, which sounds almost impossible. – L

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Between handwashings daycare workers may wash their hands.

Between handwashings daycare workers may wash their hands.

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63 Responses to Protocol for a Diaper Change or Open Heart Surgery?

  1. Meg September 9, 2016 at 10:11 am #

    Let me get this straight.

    Wash your hands THREE times.

    Two pairs of gloves for one diaper change.

    Disinfect table twice.

    And what, exactly, is the child doing after you take off the diaper, clean up, wash hands, and change gloves in the middle of the diaper change? Laying there peacefully? Not likely. Anyone who has ever changed a diaper knows you do it FAST, as fast as possible.

    Not to mention all the waste (2 pairs of gloves her change) and harsh chemicals being used.

    Oh and wait when the parents start screaming because their kid’s clothes have bleach stains on them from laying a child down on a newly disinfected-with-bleach changing table.

  2. BL September 9, 2016 at 10:13 am #

    I think the diaper-changer ought to wear a bicycle helmet.

    And no texting while changing diapers! (for the changer or the baby)

  3. Brooks September 9, 2016 at 10:16 am #

    Alabama’s list is 13 points long.

    see page 25
    http://dhr.alabama.gov/documents/MinimumStandards_DayCare.pdf

  4. Brooks September 9, 2016 at 10:20 am #

    Dad version:
    1. Take big deep breath
    2. Throw kid on table/bed/kitchen table;workbench/car seat, etc.
    3. Unclip soiled diaper, and in three rapid swipes clean kid
    4. Throw on clean diaper with one hand, and close diaper with other
    5. Gently place baby in safe place.
    6. Race out to get a breath.
    7. Listen to wife yell about the dirty diaper left on the table. Claim no knowledge.

  5. Marianne September 9, 2016 at 10:23 am #

    This sounds like it was written by someone who’s never changed a diaper before.

  6. Sarah September 9, 2016 at 10:32 am #

    And how will they compensate the parents for their now brain injured child who fell off the very clean changing table while the daycare provider was changing her gloves?

  7. Myriam Francoeur September 9, 2016 at 10:40 am #

    Wow, that’s already over the top for poop, and they also require that for pee? Crazy! I get that they have to be more careful in the daycare setting than parents are at home, but it’s just impossible… If you washed your hands before putting on te glooves, why do you need to put on new ones once the child is clean? What are you trying to prevent there? I’m lost…

  8. Rachel September 9, 2016 at 10:40 am #

    This is why when I did daycare I only had three children. Then I didn’t have to follow alli these stupid laws.

  9. lotllipoplover September 9, 2016 at 10:47 am #

    The bleaching alone would turn me off from anyone following state mandated *laws* to change a diaper.
    Young lungs being exposed to bleach fumes several times a day and babies treated like toxic waste contamination sites and prolonged rubber glove changing procedures as the young babe rolls to freedom, and head trauma.

    Most of my diaper changing was done on the floor, on a mat, with lightning speed. Get in, get out, wash your hands.

    These state mandated laws are a load of sh*t.

  10. Liesbet September 9, 2016 at 10:57 am #

    How they do it at the daycare here:
    – change diaper
    – wash hands.
    Unless there are several kids with dirty diapers, then they probably only wash their hands after the last one.
    No gloves. Duh!

  11. Anna September 9, 2016 at 11:01 am #

    “Young lungs being exposed to bleach fumes several times a day”

    I wonder about this too, and likewise with the gallons of hand sanitizer used these days. I asked my son’s preschool teacher not to use it on him (she agreed) but the entire room is enveloped in the smell of rubbing alcohol most of the time. Has anybody studied what the respiratory effects of that are? It certainly doesn’t feel or smell healthy to me.

  12. Workshop September 9, 2016 at 11:11 am #

    A couple decades ago, my father (a registered nurse) let me know that one of the rules he was being tasked with implementing was a hand-wash log that would be kept 7-10 years after the hand-washing occurred. (Unsurprisingly, this particular rule did not get very far along before it was eliminated.)

    So it’s not a new thing, and it’s not limited to daycares.

    Mainly, it’s a bureaucratic exercise in making sure things are done ‘just so.’ Logic has no place inside a bureaucratic machine. One must follow the steps outlined because reasons.

    Usually, I see these sorts of things as used to introduce someone who has never done an action before into how to perform that action. But bureaucracy takes over, and it becomes an official policy.

    And seriously, if you need to tell your employees how to change a baby’s diaper, perhaps they don’t have the experience with children that they claimed to have when you interviewed them.

  13. Jenny Islander September 9, 2016 at 11:36 am #

    If the point is to prevent the spread of disease, then why do the rules mandate reusing the same surface at all? Change those diapers on disposable chux pads. No bleach required!

  14. lotllipoplover September 9, 2016 at 11:43 am #

    @Anna-

    http://www.dailymail.co.uk/health/article-3023373/Super-clean-houses-20-likely-spread-flu-tonsillitis-pneumonia.html

    Our youngest daughter was in preschool when they rolled out the bleach and OCD handwashing. Some of her classmates had sores and cracked skin from the required washing and would cry! We pulled her out and switched to a more laid-back church preschool. Those former classmates who stayed at that school are now in her elementary school. All have allergies and several have severe asthma. I have no idea if it’s related. I DO think VOCs and indoor air pollution, especially with how much time kids now spend INDOORS, need to be fully understood before these OCD laws are actually enforced and causing more illness than preventing the spread of it.

  15. Kimberly September 9, 2016 at 11:47 am #

    So, you are supposed to not only STEP AWAY from the child being changed, but TAKE YOUR ATTENTION away from the child to wash your hands?

    Isn’t that a violation of the #1 rule of changing tables?

  16. marjorie September 9, 2016 at 11:51 am #

    THIS. IS. NUTBALLS.

  17. K September 9, 2016 at 12:08 pm #

    What kind of throwaway society is this. A single diaper change produces a prodigious amount of non-recyclable, non-biodegradable waste that will (at best) languish in a landfill for 2000 (!!!) years.

  18. Naomi September 9, 2016 at 12:15 pm #

    And we wonder why the cost of childcare has skyrocketed. . .

  19. Beth September 9, 2016 at 12:15 pm #

    In CA our licensing doesn’t mandate a specific procedure, but best practice that most places follow is to wash hands and disinfect the table afterward. I believe the law does say you can’t handle food and change diapers the same day. That’s it. Washing hands and changing gloves (gloves? Really?) in the middle of the change is the most ridiculous thing I’ve ever heard of. Whoever came up with that rule has clearly never changed a busy, reluctant toddler before…

  20. Sheri September 9, 2016 at 12:32 pm #

    What happens to the ceiling and room with that naked baby boy laying on the changing table?

  21. Gina September 9, 2016 at 12:33 pm #

    FIRST: BERNBAUM
    Yes….ridiculous rules. And we also cannot handle food the same day we change diapers. Nor can we use a handwashing sink for anything food-related, nor vice versa.
    What are they trying to prevent? It would seem that they are trying to prevent HEALTHY IMMUNE SYSTEMS.

    Just FYI: With my own kids, I’ve been known to wipe a runny nose with the end of a diaper that I was changing at the moment…(the dry part at the front, but still…LOL)..and I changed them wherever I could lay them down: the ground, a bench, a car seat, a kitchen table…

    Everyone lived to adulthood with no health issues. Imagine that!

  22. Katie September 9, 2016 at 12:36 pm #

    Exposing kids to all that bleach is far more dangerous than a few germs. But then again this makes the oligarchy money. This is also why I stay home and I hope more parents do the same in the future.

  23. Havva September 9, 2016 at 12:36 pm #

    Even with open heart surgery they don’t wash hands in the middle of the procedure. The patient’s blood isn’t going to infect the patient with anything the patient doesn’t already have. The same goes for a baby’s waste.

    I believe, the daycare center this came from is going well beyond the requirements of Arizona law. I think Gina Bernbuam, would have a good case to get the procedure changed to something more sane. Here is what in the Child Care Facilities Licensing section of the Arizona Department Of Health Services:

    http://www.azdhs.gov/documents/licensing/childcare-facilities/rules/bccl-child-care-facility-rules.pdf (See page 35)
    —-
    R9-5-503.Standards for Diaper Changing

    D. A licensee shall ensure that a written diaper changing procedure is posted and implemented in each diaper
    changing area.
    E. A licensee shall ensure that the written diaper changing procedure in subsection (D) states that an enrolled child’s diaper is changed as soon as it is soiled, and that a staff member, when diapering:
    1. Uses a separate wash cloth and towel only once for each enrolled child;
    2. Washes and dries the enrolled child using the enrolled child’s individual personal products labeled with
    the enrolled child’s name;
    3. Uses single-use non-porous gloves;
    4. Washes the staff member’s own hands with soap and running water between 86° F and 110° F before and
    after each diaper change;
    5. Washes each enrolled child’s hands with soap and running water between 86° F and 110° F after each
    diaper change;
    6. Cleans, sanitizes, and dries the diaper changing surface following each diaper change; and
    7. Uses single-use paper towels from a dispenser to dry the diaper changing surface or the hands of the
    enrolled child or staff member.
    —-
    Note, the staff member doesn’t have to personally worry about the temperature of the water. Section A, in the set up of a diaper changing area requires a sink that delivers water in that temperature range.

    Between Arizona law, and common sense, I’d say steps 2, 3, 6, 8 and 9 are required. And 4 needs replaced to specify wiping the kid down and throwing away gloves and diaper.

    While more intense in infection control than require by Arizona law, I would note that the American Academy of Pediatrics in their infectious disease curriculum even has a box in their detailed diaper change procedure that says “This is the end of the soiled portion of the diaper change. Gloves should be off and all soiled articles should be in the hands-free can.” http://www.healthychildcare.org/pdf/infdiseases/m2_diaperchanging.pdf

    I’m ready to play ball on the next over the top procedure from that daycare.

  24. SteveD September 9, 2016 at 1:27 pm #

    How about THIS obscure danger:

    ————————————–

    “How hidden hairs can STRANGLE babies’ toes… leading to amputation”

    http://www.dailymail.co.uk/news/article-2160120/How-hidden-hairs-STRANGLE-babies-toes–leading-amputation.html

  25. SteveD September 9, 2016 at 1:44 pm #

    History of raising babies — things you might not know.

    https://theotherbabybook.wordpress.com/2012/08/13/a-peek-into-the-past-touching-our-babies/

  26. Gina September 9, 2016 at 1:58 pm #

    Havva; I no longer work in a Child Care center. I do private nannying for one family I know who thinks like I do. 🙂

  27. fred schueler September 9, 2016 at 2:16 pm #

    …now as a robust and diverse interstinal microbiome is coming to be the criterion of healthy development, the requirments will switch ensuring an exchange of fecal material among the kids and the (soon to be mandatory) day care pets.

  28. LauraL September 9, 2016 at 2:44 pm #

    at some point in the excessive handwashing, the baby is going to roll off that table.

  29. Annie September 9, 2016 at 2:48 pm #

    I can only imagine how chapped the hands of daycare workers are in the state of Arizona. And I hope they have nitrile/non-latex gloves. Heaven forbid a child or a worker have a latex allergy.

  30. NY Mom September 9, 2016 at 2:50 pm #

    Those in societies with certain parasitic microbes have no asthma, allergies or certain other devastating diseases of the gut.

    I grew up free range eating my share of dirt, and have been healthier than my friends whose mothers were nurses.

  31. lotllipoplover September 9, 2016 at 3:15 pm #

    @NY Mom-

    I’ve had moms give me dirty eyeballs for letting my kids eat fruit off the vine and pick and eat tomatoes in the garden (and berries, carrots, etc.) but the dirt isn’t the problem, it’s all of the chemicals.

    Day care is turning into an antiseptic institution instead of a warm, caring environment to touch (with skin to skin contact) and raise healthy children. Treating every kid with 2 sets of latex gloves like they are dirty, filthy hazmats and leaving a trail of trash to fill up the landfills of our future generation only adds to the nonsense.

  32. Flossy73 September 9, 2016 at 3:24 pm #

    What we have to remember is that ALL government agencies start with the assumption that Americans are incompetent idiots. The vast majority of safety and health rules and recommendations are purposely written to be over-the-top and excessive with the idea that most Americans will only comprehend of follow the information about half way. For example, the rest of the world knows most pregnant women can have the occasional alcoholic beverage but our government and our doctors think we can’t handle moderation so they say “zero alcohol.”
    As Free Range Kids has pointed out, we take these types of excessive advice as gospel and then moralize anyone who doesn’t follow it to perfection as being unfit parents.
    *Men are generally immune to this because it’s funny when that lovable oaf, “Silly Daddy” just can’t “do it right” because “Gosh, that’s obviously WOMAN’S work.”

  33. Rachael September 9, 2016 at 3:46 pm #

    Enveloping gloves isn’t that hard, and makes sense. So does washing your hands before and after. Even wiping down the table and sanitizing it. But the rest… Come on! What happened to ‘keep one hand on the child at all times?’ Isn’t that safety protocol too? I’m hoping they have a five point harness to restrain the child on the table during all this obsessive washing. Cuz I know my boys haven’t laid on a changing table peacefully since they were about two weeks old. Those lap belts are a joke, they can totally wiggle out of those.
    I’m also wondering what they think happens to the table between diapers….

  34. BL September 9, 2016 at 4:16 pm #

    If this is a matter of law, let’s see it in the presidential debates:

    The Donald will say to change diapers or “you’re fired”.

    Hillary will say it takes a village to change a diaper.

  35. Jen September 9, 2016 at 4:29 pm #

    Baby changing protocol:

    Gather changing supplies..diaper, wipes, powder

    1. place baby on his back on the floor in front of you
    2. begin to unfasten diaper…grab wiggly scrambling baby by right foot and drag back to changing area
    3. grab wipe and holding baby by feet (like trussing a turkey) try to wipe soiled bum
    4. grab wiggly scrambling baby by foot, pull back within reach–grab another wipe and now proceed to wipe bum and any other area soiled during escape attempt.
    5. Poof powder out into a cloud hoping to distract baby long enough to finish diapering procedure
    6. Poof again, baby is laughing but still on his back.
    7. Lift baby again and put diaper under general vicinity of bum (moving target). If needed, pin baby down with one knee on chest while using two hands to secure diaper around one leg.
    8. curse as baby escapes and runs down the hall with diaper around one leg
    9. chase baby attempting to fix tape around other leg so that diaper stays put.
    10. Pass out from exhaustion but victorious — while baby uses newly found dexterity to remove diaper

  36. Liz September 9, 2016 at 4:57 pm #

    You’d think that the NICU would have stronger protocols than this state-mandated list. They don’t. There are no gloves and sterility, no wipes just wet towels. And they do it QUICKLY, because while you’re doing your handwashing and glove put-on the kid could crap, since they’re laying there diaperless.
    I think the protocol the hospital has is better than the state’s.

  37. SanityAnyone? September 9, 2016 at 5:00 pm #

    That’s like a 28 minute procedure.

    1. Wash and bleach table. Wait ten minutes for bleach to sterilize area. If you put baby down before it decomposes into salt, oxygen, water and adsorbable organic halides then the surface is not sterile and cute onesie is subject to holes and white spots, baby open to burns on skin. If you wait the full ten minutes, leaky screaming baby realizes that you, who may or may not be a veritable stranger, are the only thing between him and a clean tushie.

    2. Complete litany, purging and confessions. Apologize profusely to baby. (8 minutes)

    3. Repeat step one with clean baby in arms (somehow), another ten minute procedure. Do not leave your station or place baby on unsterilized surface. If you leave, the next caretaker might attempt to lay the next baby in bleach or start cleaning process before the last cleaning process is complete.

  38. SKL September 9, 2016 at 5:16 pm #

    LOL they forgot the part about what you do if the kid pees all over while you’re playing around with your hands.

  39. Backroads September 9, 2016 at 5:24 pm #

    Bah. I’ve texted while changing my own child.

  40. SKL September 9, 2016 at 5:26 pm #

    This is how I did it (my kids were 9mos & 12mos when I got custody though):

    1. hold kid over toilet.
    2. undo diaper.
    3. quick wipe if the diaper is poopy.
    4. drop the poo in the toilet if applicable.
    5. put the diaper on the back of the toilet and sit kid on potty.
    6. wrap up the diaper, bag in repurposed plastic grocery bag, put in garage so it doesn’t stink up the house.
    7. put fresh diaper on kid.
    8. wash hands.

    But when I hired a nanny 3 mos later, she refused to do that procedure, so I bought wee pull-ups and then it was:

    1. pull down pull-up and sit kid on potty.
    2. switch out pull-up if it’s nasty. Dispose as above. (We were mostly done with poo in diapers by then.)
    3. wipe butt if poo is involved.
    4. pull up pull-up when done.

    When my kids went to daycare, they had been long out of diapers, so I never had to worry about that particular fuss.

    I could imagine a lot of daycare workers getting skin problems from the required procedure. And I could imagine babies being left in their mess too long, as you would need to wait for backup before paying that much attention to hand washing etc.

  41. Renee Anne September 9, 2016 at 6:21 pm #

    Whichever silly person came up with those rules has obviously never had a baby boy pee or poop on them during diaper changes.

  42. Nicole R. September 9, 2016 at 6:29 pm #

    @Jen – I love your more realistic protocol! The writing was funny, and it was way closer to the truth!

  43. Nicole R. September 9, 2016 at 6:30 pm #

    I’m glad my son wasn’t in day care as a baby, but if he had been, and this policy had been implemented, I would have had to find another. The risk of falling off the changing table is way higher than the risk of germs!

  44. Jennifer September 9, 2016 at 6:35 pm #

    now Repeat every 2 hours in a class of 22 2-year-olds (Florida ration is 1:11 once at 9am then before lunch then after nap then at 5 whether they need it or not. I can guarantee you it is not being down that way at least I’ve never seen it done like that unless inspectors were there. As it is I’m surprised I don’t have to sanitize the toilet with bleach in between each child. And now thinking back on my day today I don’t think I had even one group hand washing even though I should be doing it about 8 times a day when we arrive, before snack, after snack, after playground, before lunch, after lunch, before snack, after snack, and again after the playground. and not to mention after bathroom times. But I’m the opposite of OCD so hand washing after slips my mind while I’m herding my 3.5 and 4s around. I’m glad I haven’t had a baby class in almost 8 years.

  45. MichelleB September 9, 2016 at 8:05 pm #

    SteveD — That obscure danger (minus the amputation) happened to one of my children. Unlike all of the common dangers that he managed to avoid. It’s not bad to know that hair tourniquets are a thing, or for moms with long hair to check the toes of sleepers to make sure they’re empty. It would be bad to be paranoid about it.

  46. Elin Hagberg September 10, 2016 at 3:32 am #

    I worked taking care of elderly people, some of which were no longer able to use a bathroom some or all of the time. Even then we did not change gloves in the middle of the whole affair. I put on gloves, took the diaper off, washed the skin, put a new one on and then after throwing out the diaper and wipes, took the gloves off and used hand sanitizer. We were taught to not wash hands unless they were visibly dirty or if the person we cared for had diarrhea (some stomach viruses are not killed by hand sanitizers and can only be removed that way) since soap and water is much harder on your hands than hand sanitizer and washing too much is a risk too because you will get sores on your hands. Before entering any clients home we used hand sanitizer and when necessary when we were there working but normally we did not walk around putting on hand sanitizer every 5 mins.

  47. Katie G September 10, 2016 at 6:30 am #

    Unbelievable! And to think I cringe at the wastefulness of using throwaway diapers (two!) overnight…when we use cloth diapers all day.

  48. Sarah September 10, 2016 at 8:47 am #

    When I changed my son’s diapers I always had to hold a cloth over him when I took his dirty diaper off or pee would go everywhere!

  49. baby-paramedic September 10, 2016 at 10:39 am #

    I don’t understand how I am meant to wash my hands and put on gloves, while also holding the child onto the dressing table to keep them safe.

    (As for enveloping things into gloves, it really is quite easy and becomes a habit quickly. I envelope most things into my gloves without thinking. I still don’t get how I am meant to keep the child from falling with all this glove changing going on though).

  50. C. S. P. Schofield September 10, 2016 at 10:47 am #

    This happens because bureaucrats produce rules. In much the same way that babies produce poop. And, sadly, our society is only slowly realizing that bureaucrats are like cockroaches; you have to keep the population down somehow or the area becomes uninhabitable.

  51. Avin September 10, 2016 at 11:24 am #

    WOW! @Brooks , I think your Dad version seems closest to mine, except I wash my hands after. Oh and you left out the part about wresting a squirmy toddler while simultaneously willing them with you mind not to fall off the table.

    Completely unrelated side note: Lenore, it would be super awesome if your comments sections could somehow scroll from newest to oldest, with the newest ones being at the top. In long discussions like this one, I sometimes find it hard to comment on the most recent and relevant points of a discussion when you have to scroll down to the very end to reach the newest comments. Thanks a bunch and I apologize for the digression.

  52. K September 10, 2016 at 1:41 pm #

    SteveD – I actually don’t think hair tourniquets are all that uncommon. I had one happen to me, but as an adult. I woke up in the middle of the night with a lot of pain in one pinky toe. Being a grown up, I just got up, turned on the light, and cut it with some nail scissors. The fear mongering is unnecessary, but I think it’s fairly reasonable for parents to be aware they exist. I never panicked over the possibility, but I did check my son for them on the occasional night when he woke up crying more than usual with no obvious cause.

  53. pentamom September 10, 2016 at 2:35 pm #

    baby-paramedic, enveloping in a glove just means turning the glove inside out over the other thing as you remove it from your hand, right? I do this instinctively to minimize the touching of the yucky outside of the glove as I throw it away.

  54. Reziac September 10, 2016 at 3:43 pm #

    [My background is biochemistry and microbiology.]

    The reason this is protocol in an Arizona day care center is because a lot of immigrant children arrive with pinworms and other parasites and pathogens that are not typically seen in the U.S.

    While pinworms are not terribly serious (according to antibody surveys, 30% of U.S. kids have had pinworms at some point), they can cause a painful gassy diarrhea in kids that don’t have existing antibodies to pinworms, and because U.S. doctors are not used to seeing pinworms, it may be misdiagnosed as just an “upset tummy”. And a variety of E.coli that you’re not used to can also cause serious illness, which could be fatal in a young child. E.coli is readily passed via fecal matter.

    So I don’t disagree given where and what they’re working with, and the risk of spreading disease to children who did not grow up with it and therefore have no immunity.

    However, it’s probably a little silly to do the whole shebang more than once per child. Change ’em, THEN sterilize hands and work surface, change gloves, NEXT!

    But, liability insurance. Also, putting extra steps into the protocol ensures that when (not if) daycare workers skip a few steps, the critical step — a single complete cleanup for each child — is likely to still get done.

  55. Tsu Dho Nimh September 10, 2016 at 6:28 pm #

    Leonore …

    The rules for a daycare center have to be a lot tighter than any home rules. Because one kid with rotavirus or norovirus can wipe out the entire school. Hepatitis A also spreads through feces.

    Let me put on my hospital microbiologist hat and explain why it is mandated this way for infection control.

    1. Wash the table with soap and water and then disinfect with bleach spray (BEFORE diaper change)

    **This is because you don’t know what the user before you did. Bleach spray, BTW (just household bleach and water) is a great virus and bacteria killer. Cheap, too

    2. Wash your hands with soap and water then put on gloves.

    **Protect the caregiver from the feces

    3. Pick up child and put on table.

    4. Open diaper, wipe child (wet or poop), envelope diaper, wipe and gloves into glove. Throw away gloves.
    5. Wash your hands and put on new gloves

    **This ensures that you haven’t contaminated yourself with feces, and makes sure you will not be contaminating the clean diaper, or the trash receptacle with bits of feces.

    6. Put fresh diaper on child
    7. Envelope gloves into each other, throw away.
    8. Wash your hands with soap and water; wash child’s hands with soap and water.

    Because after all, you’ve been playing in poop, and you don’t know what the child’s hands might have touched during the change.

    9. Wash table with soap and water, disinfect table with bleach spray.

    So if some child decides to lick the table, it will be clean.

    ******************
    And if you do it this way every time, it becomes a habit.

  56. Emily September 11, 2016 at 11:11 am #

    So, in order to wash hands in the middle of all that, one would have to leave a naked (probably wiggly and screaming) baby ALONE on a changing table, which we’ve also learned never to do.

    I thought the rule was never take your hands off a baby on a changing table.

    But maybe things have changed since I had one in diapers. Maybe now we risk falls to assure that our bare skin never touches another persons child!

  57. baby-paramedic September 11, 2016 at 11:51 am #

    pentamom – yep, that’s right

  58. hineata September 11, 2016 at 3:56 pm #

    This is hilarious! My 17 year old does way less disinfecting than that setting herself up for her infusion, and that is supposed to be a sterile procedure for someone who is in a bit more danger from germs than the rest of us. Talk about overkill! I don’t remember doing anything much with all the kids I looked after when mine were preschoolers either, just wiping the mat down with a wet one and grabbing the next kid. ☺

  59. Juluho September 11, 2016 at 6:47 pm #

    Reizac- I don’t know where you live but Pinworms are really common in the South. From what I understand they live in the soil. Children get them as frequently as lice. It’s also an easy fix that doesn’t require a doctor’s visit.

    I’d love to know how the child is kept safe during this 20 minute OCD meltdown? Even with the belt straps that changing tables come with, it would be pretty easy for a rambunctious child to fall into the floor. Which is a real danger. If they even use straps? I didn’t read anything about bleaching the straps.

  60. Bridget September 12, 2016 at 9:35 am #

    How are you supposed to do step five safely? How often is there a sink right next to the changing table?

  61. that mum September 12, 2016 at 12:19 pm #

    I worked in early childhood for over 10 years. We always had a way to clean them but unless the kid could not stand on their own (or is was a poop explosion) I learned to change them standing up,. Way easier. Pull down pants take off diaper, sit em on the potty—wipe, replace diaper, wash everyone’s hands. No surfaces.

  62. pentamom September 12, 2016 at 3:48 pm #

    Tsu Do Nimh — the problem remains that there is no feasible way to wash your hands between removing the diaper and putting on a fresh one. Infection control or no, you only have two hands.

  63. Ravin September 12, 2016 at 7:31 pm #

    It sounds a little cray-cray, but kids are little germ shedding pathogen parties, and when you put 6-20 of them in close quarters all day, finding ways to disrupt the fecal-to-oral transmission path between kids is not a bad thing. The goal is to make sure that when you line kids up to change diapers, you don’t transfer those germs from one child to the next. And it certainly taught my son to wash his hands after going to the bathroom, since we reinforced that part of the drill at home.

    This is a very different situation from parents changing diapers in their own home.

    They had a pretty solid routine at my son’s child care facility, and they also had no problem with cloth diapers, unlike the regs in some states that mandate landfill-piling disposables.