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May 14, 2013
ERS Moment: Diapering & Toileting
“Moving from good to great is not a difference of miles, its millimeters.” – Anonymous
Below you will find the appropriate diapering and toileting procedures per ERS, thanks to the Pennsylvania Early Learning Keys. This is a step-by-step guide as to the correct procedure, keeping in mind some of our NYS OCFS requirements. During the sanitizing portion to be sure solution either sits on diapering surface for at least 10 seconds, or both sanitizers are used appropriately to ensure proper sanitization. It is also required that children wash their hands, both after a diaper change and toileting. If the child is a young infant (15 months or younger) a clean wipe will be considered sufficient enough to count as handwashing.
Changing Diapers, Pull-ups and Soiled Underwear
The following guidelines are for use in child care centers, group homes and family day care homes where diapering and toilet training occurs. The ERS Authors, Caring for our Children 3rd Edition Standards, DPW Certification Regulations and ECELS guidance were used in the creation of this document.
Soiled/Wet Diapers*
1. Adult washes their hands. (Only if prior to changing the diaper, pull up or underwear it is “checked” by reaching into it to see if a change is needed)
2. Gather all supplies for the diaper change and place on or near the changing surface above the child’s head. (Enough wipes for the process removed from container, clean diaper, a plastic for soiled clothing, and clean clothes if needed) If used: disposable gloves, dab of diaper cream on disposable towel, changing table paper (enough to reach from child’s shoulders to their feet)
3. Place the child on the changing table and remove clothing to access diaper keeping the clothing out of the contaminated area. Never leave the child unattended on a changing table or countertop. If clothing is soiled place in a plastic bag to send home.
4. Unfasten diaper leaving it under the child.
5. Use wipes to clean child’s bottom from front to back and place inside the soiled diaper or directly into a lined, hands-free covered trash can. Use each wipe for only one swipe.
6. Fold the soiled surface of the diaper inward over the used wipes and place the bundle in the trash can. If gloves were used discard them at this time into the same trash can.
7. Use a wipe to remove soil from your hands and throw it in the trash can. Use another wipe to remove soil from the child’s hands and throw it in the trash can.
8. If paper liner was used, check for soil under the child and fold paper up from the child’s feet to cover the area and create a clean surface under the child’s bottom.
9. Put the clean diaper and diaper cream if needed and redress the child.
10. Wash the child’s hands and return them to the group without touching other surfaces. Store bagged, soiled clothing for parents in an area inaccessible to children.
11. Dispose of paper liner in trash can if used. Clean visible soil from changing table and disinfect the surface with bleach/water solution or an EPA approved product according to directions.
12. Adult washes hands. Record the change in the child’s log.
Soiled/Wet Pull-ups and Underwear*
1. Adult washes their hands. (Only if prior to changing the diaper, pull up or underwear it is “checked” by reaching into it to see if a change is needed)
2. Gather supplies for the change process and place on or near the changing surface outside the contaminated area. (Enough wipes for the process removed from container, clean pull up or underwear, clean clothes and aplastic bag for soiled clothing if needed) If used: Paper liner (large enough to stand on and fold over if needed), disposable gloves.
3. Consider whether to change the child lying down or standing up. (If child will be changed lying down follow the procedure for diapers)
4. If using paper liner, have child stand on paper.
5. To avoid contamination of clean shoes, socks and clothing and set aside. (if the child’s shirt is clean it is helpful to have them hold their shirt up above their wast during the change.)
6. Remove soiled clothing and place in a plastic bag to end home. If a pull-up was used, remove by pulling the sides apart and discard it in a lined, hands-free covered trash can. If underwear was used remove from the child doing your best to avoid contamination of surfaces and place with clothes in the bag.
7. If paper lined was used check for soil around the child and fold paper over if needed so there is a clean surface to stand on.
8. Clean the child’s skin around their pull-up/underwear area, wiping from front to back using each wipe for only one swipe. Place each used wipes in the trash can. If gloves were used discard them at this time in the trash can.
9. Use a wipe to remove soil form your hands and throw it in the trash can. Use another wipe to remove soil from the child’s hands and throw it in the trash can.
10. Assist the child, as needed, in putting on a clean pull-up or underwear and getting redressed, including socks and shoes. Supervise the washing of the child’s hands and their return to the group without touching other surfaces.
11. Store bagged, soiled clothing for parents in an area inaccessible to children. Dispose of paper liner in trash can if used. Clean visible soil from changing area and disinfect the surface with bleach/water or an EPA approved product according to directions.
12. Adult washes hands. Record the change in the child’s log.
Handwashing Procedure:
1. Moisten hands with water and use liquid soup
2. Rub hands together away from water for 20 seconds
3. Rinse hands free of soap under running water
4. Leaving water running, dry hands with a clean paper towel or an air blower
5. Turn off faucet using paper towel
6. THrow the used paper towel into a hands-free trash can
*Note: All changes must be completed on a surface that can be disinfected after use. Because changing a child from the floor level or on a chair puts the adult in an awkward position and increases the risk of contamination it is recommended that a changing table be used when possible. (CFOC, 3rd Edition).
